8/9/2019 Letter to Secretary of State Hillary Clinton

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11May2010

TheHonorableHillaryClinton

SecretaryofStateU.S.DepartmentofState

Washington,DCDearSecretaryClinton,

WewritewithgraveconcernabouttheurgentsituationregardingaccesstoARVtreatment

inUgandaasdocumentedinrecentlyintheNewYorkTimes,BostonGlobe,WallStreet

Journal,andNewsweek.Ugandahashadhugesuccesseswithtreatmentsavingthelivesof

HIV+peopleand,asstudieshaveshown,tensofthousandsofHIVchildrenbykeepingHIV

positiveparentsalive.1Asachampionforthelivesandrightsofwomen,youknowwellthe

impactofAIDSinAfricatheleadingkillerofwomenofmaternalage.YetinUgandait

seemstheU.S.isabandoningthegoalofreachingthoseinneedwithARVs.Several

PEPFARfundedclinicshavebeentoldtohaltenrollmentandthePEPFARAIDStreatmentbudgetinUgandahasbeenflatlined.InamemofromOctober29th,implementersweretoldbyUSgovernmentrepresentativesthat:

PEPFARUgandacannotcontinuetosupportscaleupofantiretroviraltreatment

withoutaplanfromtheGovernmentofUgandaonhowthepatientswillbe

sustainedInFY2010andFY2011,eachPartnershouldexpecttohaveasetflatlinedbudgetforARVprocurementthatshouldnotbeexceededwithoutdiscussion

andwrittenapprovalfromtheirfundingagencies.PEPFARImplementingPartnerswhodirectlyprovideantiretroviraltreatmentshouldonlyenrollnewARTpatientsif

theyaresurethatthesenewpatientscancontinuetobesupportedwithoutafuture

increaseinfundingInfillingtreatmentslotsthataremadeemptythroughattritioni.e.deathsandlosstofollowupestimatedat1230%annuallypriorityshouldbe

giventothesickestpatients,eligiblepregnantwomen,children,TB/HIVpatients,

andfamilymembersofpersonsonART.

WeurgentlyrequestthatyoudirectPEPFARtoissueanewmemo,rescindingthisordertohaltscaleupandthattheyimmediatelycommunicateastrategytoensure

cost-savingsandbudgetshiftstoallowthoseseekingtreatmenttoreceiveit.

Furthermore,wecallonyoutobeginnegotiationofafive-yearPEPFARPartnership

FrameworkimmediatelywithUganda.PartnershipFrameworkshavebeenusedin

othercountriesintheregiontoscaleuplifesavinginvestmentsintreatment,whileleveragingadditionalinvestmentsbycountrygovernments.Thisisanopportunitythat

mustbeseizedinUganda.

Wealsotakeexceptiontoapolicythatmakestreatmentslotsavailableonlytothoseclinics

wholosepatientstodeathandfollowupaprotocolthatpunishesqualityproviderswho

effectivelymanagetheirpatients.

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Wehavebeenparticularlyshockedtolearnthatsomeimplementershavebeentold

thattheycouldnotevenuseefficienciesinexistingbudgetsinordertoexpandtheirallotmentoftreatmentslots.

Hundredsofpeopleeachmontharealreadygoingfromclinictoclinicsearchingfor

treatment.Familiesarebeingforcedtochoosebetweendangerousresistanceinducingsharingofdrugsandlettingfamilymembersdie.Tensofthousandswaitinginlineforotherstodiearenotnewpatients,perse,butweretestedandputintocarethrough

PEPFARsupportwiththepromisethattreatmentwouldbeavailablewhenclinically

needed.Nowtheyareinsteadbeingturnedaway.Wenotethatwhilesomeimplementers

areenrollingnewpatientstheextremelylimitedtreatmentslotsavailablearefar

outstrippedbydemand.

WhenCongressreauthorizedPEPFARin2008,theintentwasclearlytocontinuescaling

upaccesstotreatment.ThePresidentatthetimepledgedtoprovide treatments to one-thirdof all those who desperately need them.

2Instead,Ugandaseemstobetheleadingedgeofa

treatmentslowdowninsomeofthehardesthitcountriesincludingNigeria,Zambia,theDemocraticRepublicofCongo,andothers.

WearenotsuggestingtheUnitedStatesgovernmentshouldertheburdenalone.WewouldurgeyouandthePresidenttotakeconcretestepstomobilizeotherdonorsinadditionto

expandingtheUSinvestmentintreatment.However,noneoftheseshouldserveasan

excusefornotdoingwhatwaspromisedcontinuingtheexpansionoflifesavingAIDStreatmentinUgandaandacrossAfrica.TheU.S.canandmustdomoreaspromised.

YouandtherestoftheAdministrationcankeepusonthepathofprogresstoward

defeatingAIDS.Weurgeyoutodoso.

Sincerely,

UnitedStates:

GlobalAIDSAlliance

HealthGAP

InternationalTreatmentPreparednessCoalition

PhysiciansforHumanRights

TreatmentActionGroup

Uganda:

ActionGroupforHealth,HumanRightsandHIV/AIDS(AGHAUganda)AIDSCareEducationandTraining(ACET)

CoalitionforHealthPromotionandSocialDevelopment(HEPSUganda)CommunityHealthandInformationNetwork(CHAIN)

GlobalCoalitionofWomenAgainstAIDSUganda(GCOWAH)

HealthWorkforceAdvocacyForumUganda(HWAF)

InternationalCommunityofWomenLivingwithHIVEasternAfricaICWEA)

JoyceFertilitySupportCentreUganda

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Media,Arts,andCultureResponsetoHIV/AIDS

MentalHealthUgandaNationalCareCentre(NACARE)

TheAIDSSupportOrganisation(TASO)UgandaCommunityBasedAssociationforChildWelfare(UCOBAC)

UgandaNetworkofAIDSServiceOrganisations(UNASO)UgandaNetworkofYoungPeopleLivingwithHIV/AIDS(UNYPA)UgandaYoungPositives

UgandaYouthinActionFoundation

CC:

AmbassadorEricGoosby,U.S.GlobalAIDSCoordinator

Sen.JohnKerry,Chairman,SenateForeignRelationsCommittee

Sen.RichardLugar,RankingMember,SenateForeignRelationsCommittee

Rep.HowardBerman,Chairman,HouseCommitteeonForeignAffairs

Rep.IleanaRosLehtinen,RankingMember,HouseCommitteeonForeignAffairs

1MerminJ,WereW,EkwaruJP,etal.MortalityinHIVinfectedUgandanadultsreceivingantiretroviral

treatmentandsurvivaloftheirHIVuninfectedchildren:aprospectivecohortstudy.Lancet2008:371:7529.2BarackObama:FightingHIV/AIDSWorldwide, www.barackobama.com/pdf/AIDSFactSheet.pdf