‘€œUS government funding is going to come down dramatically over the next five years,’€ warned Dr Roxana Rogers, USAID South Africa Health Team leader last week.

‘€œThere is not a friendly feeling in the US towards more funding for HIV/AIDS,’€ Rogers told a meeting in Cape Town on the future of US assistance for HIV/AIDS, hosted by the US-based Council on Foreign Relations.

Almost a million South Africans will soon be on lifelong antiretroviral treatment and this number will triple in the next decade if government keeps to its implementation plan.

Yet the prospect of government being able to meet its promise of treating 80 percent of those who need it by 2011 is being threatened by a lack of funds.

In the current budget year, the US President’€™s Emergency Plan for AIDS Relief (Pepfar) contribution was over R4,3-billion, while government’€™s total contribution was R5-billion, according Treasury official Dr Mark Blecher.

Two months ago, the US government announced that it would be giving South Africa an extra $120 million (approximately R900 million) ‘€œin direct response to a request from President Jacob Zuma’€ to ‘€œprocure ARVs will help ensure that there are adequate stocks on hand to meet the growing demand for ARVs in South Africa’€.

However, Rogers indicated that this contribution had been ‘€œexceptional’€ and was not likely to be repeated.

Scenario planning by Treasury indicates that the demand for treatment and care will peak in 2021, when the country would need close to R30-billion. At present, 40 percent of the HIV/AIDS budget goes to antiretroviral treatment.

‘€œWe are facing a double whammy of having to rapidly scale-up spending on HIV/AIDS at the same time that we have to replace donor funds,’€ said Dr Keith Cloete of the Western Cape Treasury.

‘€œFor the next five to 10 years, we need additional funds. This is not the time to pull out funds as programmes are going to collapse,’€ said Cloete.

Rogers said that the looming budget cuts were ‘€œkeeping us up at night’€ as Pepfar funded the salaries of many of the healthworkers who were implementing government’€™s HIV/AIDS plan.

She said that USAID officials in South Africa, and the US Global AIDS Ambassador, understood that this country was the ‘€œepicentre of the epidemic’€ and wanted funding for to continue but said South Africa should provide the US with more reports about its successes in addressing the epidemic.

Prof Helen Rees, Reproductive Health and HIV Research Unit director, warned that if Pepfar funding stopped, the fight against HIV/AIDS would ‘€œgo backwards’€ and called for a ‘€œdialogue with the US government’€ rather than simply accepting that the funds were to be cut.

However, Dr Thurma Goldman, director of the US Centers for Disease Control in southern Africa, said the plan was not to ‘€œrapidly reduce’€ funds.

‘€œWe are talking about a transition from emergency funding to a transition to mentoring a sustainable programme,’€ said Goldman.

‘€œThere will be decreased funding for South Africa but this does not have to mean scaling down. By belt-tightening and rationalising services, we can turn this into a sustainable programme.’€

Blecher conceded ‘€œweak coordination between between provincial and donor funded services’€ and ‘€œfragmentation between large numbers of organisations’€ undermined the implementation of a common plan.

He recommended the development of a five-year plan and clear partnership based on an agreed division of ‘€œresponsibilities, services and funding’€.

Meanwhile, Professor Alan Whiteside from Health Economics and HIV/AIDS Research Division at the University of KwaZulu-Natal, said that donor funding typically had a three- to five-year time scale, and South Africa needed to move to more sustainable health development funding.

‘€œWe need to get more for our money and be more imaginative. We are an AIDS-afflicted country so we should develop an AIDS economy. We could be training two million people to assist those living with HIV,’€ said Whiteside.