The South African government would like more control over more than $450-million donated to the country by the US President’s Emergency Plan for AIDS Relief (Pepfar), according to health minister Dr Manto Tshabalala Msimang.

“Our view is that external funding must be co-ordinated through government structures to achieve better outcomes,” Tshabalala Msimang told a high-level international Pepfar meeting earlier this week in Durban.

“Direct access by principal partners to Pepfar funding poses a serious co-ordination and harmonisation challenge,” said Tshabalala Msimang.

Pepfar “principal partners” working in South Africa include international aid agencies such as Absolute Return for Kids, non-governmental organisations including the Starfish Foundation and university research organisations.

The South African health minister also expressed her displeasure at the US government’s lack of consultation in setting up Pepfar, which was set up in 2003 by President George W Bush who pledged to spend at least $15-billion in fighting HIV/AIDS, mainly for 15 key countries, over five years.

“We were absolutely surprised when we saw that South Africa was one of the beneficiaries because we were not consulted,” Tshabalala Msimang told a press conference after the opening.

However, despite starting “on a wrong foot”, Tshabalala Msimang said her government and Pepfar officials were starting to “find one another and accommodate other African countries in dire need”.

Dr Mark Dybul, Acting US Global AIDS Co-ordinator, said that he understood Tshabalala-Msimang to be arguing for better co-ordination to support South Africa’s national programmes “and we agree with her completely”.

In an upbeat video message to delegates, US President Bush said that Pepfar was “the largest initiative in history established to combat a specific disease”.

“America has the unique ability and calling to defeat the disease,” said Bush. “Together, we will turn the tide against this disease.”

However, Helen Evans, deputy director of the Global Fund to Fight AIDS, TB and Malaria, said that “we will never turn the tide if we don’t put maximum effort into prevention”.

Evans said that between Pepfar and the Global Fund, 875 000 people were now on antiretroviral treatment, meaning that thousands of deaths had been averted.

Dybul told the opening plenary that although 25 million people had already died of AIDS, “we live in a time of great hope engendered by action”.

“For too long, the world has expressed sympathy without action. We need to rededicate ourselves to saving lives. There can be no higher calling.”

Speaking after the opening, Dybul said that Pepfar was a five-year programme simply because governments worked in five-year cycles, but that the US’s commitment to fighting HIV/AIDS would not stop after five years.

“Pepfar should be seen as the first of a new cycle of commitment,” said Dybul.

Kerry Cullinan – Health-e

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