On October 9, the House Foreign Affairs Subcommittee on Africa and Global Health held a hearing to address concerns that the President’s Emergency Plan for AIDS Relief (PEPFAR) does not provide enough nutritional support. PEPFAR’s current authorization (P.L. 108-25) expires at the end of FY2008.
Chair Donald Payne (D-NJ) noted that 854 million people are undernourished, 206 million of them in Africa, according to the Food and Agricultural Organization. “People who are not getting enough food are vulnerable to HIV/AIDS infections in two ways,” he said. “First, hungry people are more likely to engage in risky behavior in order to get food. Second, malnutrition weakens immunity to infections of all sorts, including HIV. Therefore, I would argue that adequate food and nutrition has a role to play in prevention.” He noted that the Office of the Global AIDS Coordinator has tried to jointly plan countries’ needs so that agencies with the greatest ability to do so can fulfill them. But, he said, “Our food aid programs are not as well-funded on the development side as they should be, so USAID [United States Agency for International Development] does not always have adequate resources to respond.”
Ambassador Mark Dybul, U.S. Global AIDS coordinator, noted that PEPFAR provides nutritional assessments and counseling, micronutrient supplements, food aid, and help with regaining livelihood. He said PEPFAR supports “therapeutic and supplementary feeding for antiretroviral treatment patients who are clinically malnourished at entry, and food security assessments with linkages to, and support for, food security and livelihood assistance for patients and their families.” But the challenge is cost: The most common antiretroviral treatment program costs $89 per person per year, while “basic supplemental feeding” costs between $118 and almost $130 per year. Currently, most food support comes from Title II of the Food for Peace program (P.L. 480), which provided an estimated $50 million in FY2006 for HIV-infected and -affected PEPFAR beneficiaries.
Rep. Payne, after hearing concerns about cost, said, “Maybe $30 billion [for reauthorization] is not enough; maybe we’re looking at $45 billion…We might start kicking this around, ways to more seriously address this.” PEPFAR was originally authorized at $3 billion per year for FY2003 to FY2008.
Dr. Robert Einterz, who founded the Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH), one of the largest HIV/AIDS control systems in sub-Saharan Africa, said the prospect of “dependency” was a concern in providing food aid. “In fact, many patients regain the means to food security, but for others food security remains elusive even when their immune status has returned to normal…Simply stated, AMPATH decided it was ethically preferable to be found providing food when evidence determines it is unnecessary than to proceed without nutritional support and eventually realize food support was in fact a vital component of care.” He said the organization relied on a “patchwork of contributions,” but said international donors needed to commit new funds to maintain the food aid program.
Annemarie Reilly, chief of staff of Catholic Relief Services (CRS), echoed Dr. Einterz’s call for additional funding. She proposed increasing Title II food relief appropriations and providing for a budget for food within PEPFAR. “The number one issue that we hear from people living with HIV and AIDS and their families in the 52 countries where we have HIV-specific programs is lack of food and the money to purchase it,” she said. She noted that poor nutrition makes HIV drugs less effective, and that people with HIV/AIDS are less able to work outside the home to provide food for their families.
CRS has a program in Kenya, for example, to buy food for PEPFAR-supported patients. But Ms. Reilly said, “When food is given only to the patient…individual food rations are usually shared with the rest of the household diminishing the intended benefit to the individual. As a result, CRS strives to use other resources from Title II, WFP [World Food Program], and our private funds to distribute basket rations to families and households affected by HIV.” Emphasizing the need to target underlying causes of hunger, she asked, “What happens after a client receives food rations for several months and they are still without a means of livelihood?”
Walleligne Beriye, country director for Ethiopia from Project Concern International, also testified.
