Kampala - The Ugandan government's draft 2013/2014 budget allocates US$38.5 million to enrol a further 100,000 people living with HIV on life-prolonging antiretroviral (ARV) drugs. But activists say the money, while welcome in a country still largely dependent on donor funds for its HIV programmes, is not sufficient to meet treatment needs.
"With the current allocation and funding, we still have a long way to go," said Raymond Byaruhanga, the executive director of the AIDS Information Centre (AIC). "We need the government's commitment to increase the number of people on ARVs and decrease the number of those getting HIV if we are to achieve universal access."
The country enrolled an estimated 65,493 new HIV patients on ARVs in 2012, bringing to 356,056 the number of those on ARV therapy (ART), according to Uganda AIDS Commission statistics. However, this figure represents less than 70 percent of those in need of treatment. The government has set a target of reaching 80 percent of HIV-positive people with ARVs by 2015.
"The government efforts to contribute more funding for adding more patients on ART is commendable. However, we still need additional resources for scaling up on evidence [-based] interventions in order to be in position to halve the new infections," Monica Dea, senior programme advisor for the US Centres for Disease Control in Uganda, told IRIN.
Playing catch up
Uganda has seen its HIV prevalence rise from 6.4 to 7.3 percent over the past five years. Experts say the rising prevalence means the government must work doubly hard to ensure even more people are placed on treatment, especially given recent research showing ARVs have a role in preventing HIV transmission.
But limited funding, frequent drug stocks outs, too few CD4 count machines - which measure patients' immune strength - and understaffing in the public health sector continue to hamper plans to achieve universal ART access.
According to Alex Ario, programme manager at the health ministry's AIDS control programme, the financial gap in the public sector for 2013/2014 is about $29 million.
"WHO [the UN World Health Organization] is changing its treatment guidelines in the coming months in order to act on exciting new science that shows that treatment saves lives and is one of the most powerful HIV-prevention tools available. This means that in 2013, the number of people in Uganda clinically eligible for treatment will expand beyond just those whose CD4 is less than 350," Asia Russell, director of international policy at the Health Global Access Project (Health GAP), told IRIN. "Despite this, the draft Budget Framework Paper for the health sector proposes no increase in investment for HIV treatment."
"Ugandan civil society is calling on the government to substantially increase its investment in ART for financial year 2013/14 in order to save lives, slash rates of new infections, and begin to end the AIDS epidemic," she added.
Activists have also expressed disappointment in a local pharmaceutical plant - started in 2007 and jointly owned by a local company, Quality Chemicals Industries Limited (QCIL), and Indian generics giant Cipla Limited - that was expected to improve treatment access by providing cheaper ARVs locally. However, the factory's drugs have remained overpriced, and the plant is currently embroiled in a $17.8 million corruption scandal.
In a 20 December 2011 report to Uganda's President Yoweri Museveni, then acting government anti-graft boss Raphael Baku noted that between December 2009 and October 2010, the government's National Medical Stores (NMS) paid $17.8 million more than it should have to QCIL, in violation of its Memorandum of Understanding (MoU) with the government. The funds allocated for ARV procurement in the budget are intended for purchasing drugs manufactured by QCIL.
QCIL and NMS are accused of manipulating the MoU in order to achieve a 15 percent mark-up on imported drugs; the mark-up had actually been intended only for locally produced drugs. QCIL is also accused of continuing to sell imported drugs manufactured by Cipla to the government at inflated prices even after it started producing its own drugs.
QCIL denies the allegations.
The inspector general of government, anti-corruption activists and HIV activists have demanded the government recover the funds and prosecute those involved.
"Our government is good at creating institutions, but when it comes to implementing their recommendations, it fails," said Cissy Kagaba, the executive director the Anti-Corruption Coalition Uganda (ACCU). "We demand for an immediate action on the reports of the oversight government organs to specifically recovery all the monies lost. This is the taxpayers' money."
Asuman Lukwago, the permanent secretary at the Ministry of Health, told IRIN that action would be taken on the reports.
"[ARVs] should be readily available to all who need them because they are life-saving drugs. I think it is treacherous for someone to overprice the drugs because this makes them inaccessible to the most vulnerable, who will most likely end up dying," said Stephen Watiti, a senior medical officer at Mildmay Uganda, an HIV treatment centre close to the capital, Kampala.
New ways to fund HIV programmes
According to Ario, the government is seeking alternative ways to fund ARVs. "Strategies are being explored to increase domestic HIV funding, such as establishing the HIV Trust Fund," he said.
The Ugandan government recently developed a draft working paper on establishing this $1 billion fund for its HIV/AIDS programmes.
"I support the establishment of a trust fund by adding a levy on such items like beer, cigarettes, airtime or introducing an AIDS tax to make sure all money needed to sustain ART is available instead of depending on donors [for] 80-90 percent, as is the case at the moment," said Watiti.