Dear Editor,
There is a report that the government’s spending to fight HIV increased by 150% in 2016, compared to 2015. This is an impressive increase and, if the report is true, then the government deserves commendation. I have no reason to think that the Ministry of Public Health might have misinformed us. But I do have questions about that reported spending. The global commitment to fund the fight against HIV is waning and we need governments that show greater fidelity to the promise to fund the fight until we can truly declare victory. It is in this context that I am seeking clarification from our government to determine if funding for HIV and AIDS has really increased by 150%.
Has there been an increase of 150% in total spending for the fight against HIV and AIDS in Guyana in 2016 compared to 2015, as reported by the Ministry of Public Health? Was the Ministry merely reporting HIV spending in 2016 and 2015, as catered for in the national budget only and not total spending for HIV? Note that HIV spending by the Ministry of Public Health in Guyana is equal to funds allocated by government in the national budget, Global Fund, PEPFAR and other agencies. The Ministry needs to be honest and provide a total picture of spending. Could it be that spending by Global Fund, PEPFAR and other agencies has declined and that the increased government spending is necessary to continue the total public health response?
In fact, Global Fund and PEPFAR have been indicating for some time now that certain expenditures that they supported in the past would have to be taken up by the government. For example, significant expenditure to continue procurement of medicines and supplies for the treatment and care of persons living with HIV have to be phased in as this international funding for medicines and supplies is phased out. Thus, we must address total funding, since as funding from Global Fund and PEPFAR falls, government spending has to reciprocally increase to maintain overall spending.
Thirty-five years after HIV and AIDS first came to global attention and thirty-one years after Guyana’s first diagnosed HIV case, HIV still represents devastating public health challenges here and around the world. The impacts on the health sector and on people’s lives are as grave today, as they were twenty years ago. Spending on HIV cannot be diminished, but there is evidence of funding fatigue and waning interest in funding at national and global levels.
Global mobilization of funds to fight HIV dramatically increased after 2003, moving from less than US$1B to almost US$7B annually. While global mobilization is still in place, some believe that continued funding at high levels is not as pressing as before. But the increased funding after 2003 to fight HIV and AIDS resulted in major dents, with a reduction in new HIV cases being reported globally, more people being treated with powerful medicines and a significant reduction in AIDS deaths and mother-to-child transmission of HIV. These global successes have also been seen in many poor countries, including Guyana. In fact, Guyana stands out as a best-practice country, recording dramatic successes in the fight against HIV. In countries like Guyana, mother-to-child transmission has approached zero, AIDS deaths have dramatically decreased and there is universal treatment and care for HIV.
Spending by the Ministry of Health on HIV in Guyana is a complex arrangement in which government’s allocation in the national budget represents only one component. Whereas, before 2003, government’s budgetary allocation for HIV represented virtually 100% of money expended on the fight against HIV and AIDS, after 2003, government spending became only a small component. This does not mean that government’s actual expenditure decreased after 2003. In fact, Government allocation consistently increased. But after 2003, there was a dramatic, unprecedented increase in external flows of financing to fight HIV, leading to a dramatic increase overall.
The US PEPFAR (Presidential Emergency for AIDS Response) program, popularly known as the Bush Program, began spending significant amounts of money in 2003 around the world to fight HIV. Initially, the program was conceived to fight HIV in Africa. But President Jagdeo pushed me to lobby the US extensively and the result was that Guyana and Haiti became included in a cohort of 15 countries. The PEPFAR program was managed through various US government agencies, such as USAID and the US CDC and by various American NGOs.
At that same time, the Global Fund, established by the UN, headquartered in Geneva, began operation. Guyana was fortunate to be among the first countries to successfully apply for grants from the Global Fund. In fact, from 2003 to present, we have continuously maintained funding from the Global Fund. In recent years, funding from the Global Fund and from PEPFAR has been declining and both these and other funding agencies have cautioned Guyana that government will have to increase allocations to replace the funds that were coming from these organizations.
Decline of funding from these international organizations is not the fault of government. The significant funding from these organizations going back to 2003 always came with the condition that as these international organizations wean themselves away from funding the national programme, the Guyana Government will take up the expenditure.
Yours faithfully,
Dr. Leslie Ramsammy
