By Rebecca Adams
CQ HealthBeat Associate Editor
Many AIDS policy analysts assume that Congress may not have time to reauthorize major global HIV-AIDS programs this year. But one organization is determined to keep pushing for it by taking foreign patients to lobby Capitol Hill next week.
The AIDS Healthcare Foundation, which runs treatment clinics around the globe, is bringing in patients and providers from Haiti, South Africa, Uganda, Nigeria and Vietnam to press lawmakers of both parties to renew the President’s Emergency Plan for AIDS Relief, known as PEPFAR.
Even federal officials have expressed some doubts about whether lawmakers will pass a reauthorization this year. Some HIV-AIDS activists are sanguine about the lack of momentum around updating the law, saying that it is working fine as it is and that they expect appropriators to keep funding it. They worry that reauthorization might actually be dangerous, because Republicans could cut funding or try to add policy riders that advocates oppose (See related story, CQ HealthBeat, April 30, 2013).
But the AIDS Healthcare Foundation sees an opportunity for shifting PEPFAR funds to the areas that they are involved in — testing and treating patients. Currently, the group estimates that about one-fourth of that money goes toward those activities, down from about half in 2006.
The group is also asking appropriators to include report language that would urge the Department of State “to seek to devote 75 percent of PEPFAR dollars to antiretroviral drug and medical treatment and HIV testing.” The organization also wants a provision saying, “The committee urges the Department to implement a yearly per-patient contribution for AIDS treatment of $275.00,” which is approximately the amount of money that it takes for the organization to provide treatment through its clinics.
The suggested provision also would say: “The committee is concerned about the amount of funds being spent on administrative costs throughout PEPFAR, both within the Department and by providers and host countries. … In a time of fiscal constraint, capping administrative costs at the 10 percent would provide a greater share of dollars to invest in programs. The committee urges the Department to adopt a 10 percent cap on administrative costs, and requests a report be submitted to the committees on appropriations no later than January 15, 2014, on the amount and percentage of administrative and overhead costs being spent at the Department.”
Administrative costs are capped in many domestic AIDS programs at about 10 percent for some grants and contracts.
The group’s language assumes that appropriators would provide $7.73 billion for PEPFAR, which is higher than President Barack Obama’s budget request.
The AIDS Healthcare Foundation general counsel Tom Myers notes that treatment sharply reduces the chances that a patient will pass on the virus to someone else, because patients receiving medicine are much less infectious. He said that by cutting the per-person and administrative costs, PEPFAR can help more people without spending more money.
Myers acknowledges that many AIDS advocates don’t agree with all of the group’s positions, but he is hoping that the 50 meetings with lawmakers in both parties next week will pay off.
“Hopefully we can persuade people to take the time to reauthorize the program and tailor the law to make a great program better,” said Myers.
PEPFAR was created by President George W. Bush in 2003 and has been lauded by global health policy experts affiliated with both parties.