Facing Cuts, Gov’t Pressured to Take Lead in Fight Against AIDS

Two of the major donors who have supported Cambodia’s highly successful fight against HIV/AIDS are set to make significant cuts to their funding, putting pressure on the government to increase its own spending, officials and experts said.

Both the Global Fund, which has contributed more than $252 million to the fight against HIV/AIDS since 2003, and USAID, which has given more than $140 million since 2006, are planning to scale down their spending, according to Ly Penh Sun, deputy director of the National Center for HIV/AIDS, Dermatology and STD (NCHADS).

After reviewing funding of its campaign against malaria, tuberculosis and HIV/AIDS in Cambodia, the Global Fund deemed HIV/ AIDS “significantly over-allocated” earlier this year, leading to severe spending cuts.

Dr. Penh Sun said NCHADS has been spending between $40 and $50 million on drugs, services and other expenses in the fight against HIV/AIDS every year. “Now, we will have about $40 million for 2 1/2 years [from the Global Fund],” he said, leaving NCHADS “significantly short” of its needs.

In a November 14 letter signed by Ieng Mouly, chairman of the Global Fund’s Country Coordinating Committee, the organization informed NCHADS that it would have to stretch out $3.6 million in previously planned spending from now until the end of 2017.

“The focus will be on the patient; we have to ensure that we have the medicine, that they can live their life,” Mr. Mouly said this week. “We prioritized the treatment and care [and] slowed down other activities like training, conferences, coordination and meetings.”

Adding to Global Fund’s hard-hitting cuts, NCHADS’ Dr. Penh Sun said, other donors were also set to reduce spending on HIV/AIDS.

“I don’t think that we will easily get other funding because all donors are cutting,” he said. “The USAID is another big source and it will cut 50 percent starting next year.

However, John Simmons, spokesman for the U.S. Embassy, which oversees USAID’s work in the country, said spending through the President’s Emergency Plan for AIDS Relief (PEPFAR)—the only channel of HIV/AIDS funding to USAID and the Center for Disease Control —would not decrease in 2015.

“The amount of total U.S. government funding available through PEPFAR in 2015 for HIV/AIDS programs implemented by USAID and CDC in Cambodia will remain the same as in 2014,” he said in an email.

With the imminent drop in funding, the government and donors now face the task of implementing a new strategy to fight a virus that reached epidemic levels in the late 1990s, when HIV and AIDS infected 1.7 percent of Cambodians between the ages of 15 and 49, but has dropped to below 0.7 percent today.

UNAIDS country representative Marie-Odile Emond said that despite the fall in the prevalence of the virus, “all the people that were infected early, they need treatment for life.”

“Now, we need the government to increase contributions to fund services, especially treatment,” Ms. Emond said. As Cambodia moves closer to being a middle-income country, “external assistance will decline, and the government should take over as the tax revenue increases…it’s a normal and healthy evolution.”

And though its initial commitments have been modest compared to donor spending, Ms. Emond said, the government will for the first time fund about 10 percent of antiretroviral (ARV) drugs distributed in the country next year, at a cost of about $1 million, with its total spending on the drugs set to reach $1.5 million in 2017.

“That’s a strong signal that the government is taking the HIV response very seriously,” she said.

Masami Fujita, the World Heath Organization’s HIV/AIDS team leader in Cambodia, said that because the cost of ARV drugs has fallen steeply in recent years, along with the rate of new infections, previous strategies to fight HIV/AIDS in the country are now “outdated.”

In the early 2000s, a “community-based care” model was put in place because, in addition to offering treatment, community workers were necessary to provide support and encouragement for infected people to seek care, and stop them spreading the virus further, Dr. Fujita said.

This model was “extremely expensive…[and] established when most people living with HIV were sick,” he said. “ARV coverage increased from zero percent to 80 percent in the last 10 years.”

“So that model 10 years ago was reviewed and we have to adjust and only focus on very poor people… people with HIV that are having problems.”

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