Failure to provide essential data or to serve especially vulnerable groups will result in deep cuts in US anti-Aids funding for Kenya and Tanzania, a global development NGO said on Wednesday.
The President's Emergency Programme for Aids Relief (Pepfar), a US initiative launched in 2003, plans to reduce spending for Kenya from 2018's level of $505 million to $395 million in 2020.
For Tanzania, Pepfar funding is set to drop from $512 million to $395 million.
“With these cuts, Pepfar is intensifying its message that if a country is not making progress toward specific targets, either for programmatic or policy reasons, then the money will go elsewhere,” noted the development group known as Devex.
Lagging completion of a nationwide survey of HIV prevalence appears to be the main reason for reduced US support for Kenya's Aids-control programmes.
Until Kenya produces this data, Pepfar will be unable to decide how best to target aid for the country, US Global Aids Coordinator Deborah Birx warned earlier this year.
At issue is Kenya's Population-Based HIV Impact Assessment (Kenphia) survey that is supposed to provide detailed information on the state of the country's Aids epidemic.
“We remain concerned about the lack of transparency in the Kenphia survey data as there are other [similar] surveys that began after Kenya’s, were larger in scope, and we already have full data available for planning and budgeting,” Ms Birx wrote in a memo to US Ambassador to Kenya Kyle McCarter.
The most recent weekly update on Kenphia's website covers the period from November 24 to December 7 of last year.
However, Ms Birx lauds Kenya's overall performance.
“Kenya has made enormous strides in the fight against HIV and has completed or is nearing completion of many Pepfar programme goals,” she told Ambassador McCarter.
“We believe that Kenya may be close to achieving viral load suppression and declines in incidence,” Ms Birx added.
"Everyone in Kenya is alarmed with the cut," Nelson Otwoma, director of a network supporting Kenyans with HIV, told Devex.
Kenya relies heavily on Pepfar for Aids testing and treatment.
The Washington-based Centre for Global Development calculates that donor funding, mainly from the US government, has historically accounted for nearly three-quarters of Kenya's spending on HIV/Aids programmes.
Globally, Pepfar has allocated more than $80 billion for bilateral anti-Aids programmes in the past 15 years — four times the amount disbursed by the United Nations' Fund to Fight Aids, Tuberculosis and Malaria.
Mr Otwoma said he was especially concerned about the impact of Pepfar cuts on “key populations” such as sex workers and men who have sex with men.
“If Pepfar left them, the government will not take them up,” he told Devex.
The Tanzanian government's “growing intolerance of marginalised groups” is the main factor behind Pepfar's funding reductions for that country, Devex reported.
In a January memo to the top US diplomat in Tanzania, Ms Birx observed that “formal and informal policy developments in Tanzania undermine efforts to diagnose and treat persons most vulnerable to HIV infection.”
She specifically cited “arrests of sexual minorities, anti-contraception messaging, and the expulsion of pregnant adolescent girls and young women from school.”
Tanzania is also failing to meet performance expectations for its HIV/Aids initiatives, Ms Birx added.
Tanzania's own estimates indicate that only 61 percent of its citizens living with HIV are aware of their infection with the Aids-causing virus, the US official pointed out.
“This result, the lowest in Eastern Africa, is deeply disappointing in light of the cumulative $4.5 billion investment of US tax dollars since 2004,” Ms Birx said.
The planned cuts in spending will not result in withdrawal of life-saving anti-retroviral treatment for any HIV patients benefiting from US assistance, Pepfar has pledged.
The programme is also increasing its support for women and girls in countries served by Pepfar.
The US announced at an international women's conference held in Canada earlier this month that Pepfar will invest $2 billion to help prevent females from contracting HIV.