Reworking of PEPFAR in South Africa must be handled carefully to ensure continuation of care

"Government assurances that the scaling back of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) program in South Africa (SA) will be carefully managed to protect patients are welcome, but ... [t]he reality is that the Department of Health is struggling to cope with severe medical staff shortages, financial resources that never seem to stretch far enough, inadequate infrastructure and maintenance programs, and administrative bottlenecks," a Business Day editorial states. Though the reworking of PEPFAR funding will take place over five years "and does not entail the complete loss" of funding, "the shortfall will have to come from somewhere," the editorial says, adding, "It will be tragic if, just as we are starting to see light at the end of the long, dark tunnel of the HIV/AIDS epidemic in SA, the gains of the past few years were to be reversed due to the loss of critical foreign funding and the government's lack of capacity to plug the gap."

While "in most cases there should be ample time to ensure an orderly transition," "the state of some provincial health departments is such that an eternity would not be sufficient to ensure that no patient's prophylactic treatment is compromised," the editorial states, calling for "determined intervention by the national health department." The editorial continues, "Of course, as the name implies, PEPFAR was always intended to be an emergency program, and it was inevitable that it would be scaled back once the South African government got its act together and the HIV/AIDS explosion was under control." South Africa "is not the only beneficiary country that is seeing its funding cut," and it "seem[s] likely ... that the decision has been prompted in part by U.S. domestic politics," according to the editorial, which concludes, "The federal budget deficit is going to have to be tackled at some point, ... and foreign aid programs are low-hanging fruit" (8/30).