PEPFAR and The Highly Inflated Target Numbers To Secure More Funding

It is unethical, abusive, calculated to manipulate and inflate numbers. They sit in meetings, in spaces where connivance, cunning, conspiracy and commerce can go on un deterred. They throw out well executed proposals by seasoned grass root health workers-cum community mobilisers. 

Instead, they prefer working with HIV Care naive mobilisers with whom they meet in fancy hotels to plan strategies. Mobilisers, who will not question orders but will follow them blindly. Even if it meant risking the life of those living with HIV or their beneficiaries who may require other HIV-related services. Exit poll HIV Programming is the in-thing and such organizations ready to do that are favoured by Implementing Partner Project Managers.

These mobilisers are now formed into groups and taken through a coaching session. This makes them long pipelines through which millions of PEPFAR funding are minted. There is a vicious brokerage within the US funded anti-HIV Prevention projects which has privatized gains and socialized pains.

There are two forms of intervention events.

The Terminal and Cascade event.

In the Terminal event, one deals with one aspect alone, say Circumcision. In this event, the attendant post circumcision services are left to the beneficiary.

In the Cascade event, all attendant services are provided. For instance, testing is followed by counseling, which is then followed by other services depending on the outcomes of the test and counselling decisions.

The UNAIDS 95:95:95/SDG 30 follows the Cascade event protocol.

However, this has been thrown out of the window by many organizations receiving PEPFAR funding. They now implement the Terminal even Protocol.

Those living with HIV, are left to suffer from say, adverse effects of medication. Planned visits where it is possible to check upon bedridden/bed-bound clients to elicit progress were discouraged.

It gets interesting.

The explanation given is that, observance of the step-by-step rituals of home visits, facilitating those on ARVs to go for Viral Load testing and addressing nutrition or housing hardships is old fashioned or obsolete. The reports are about steep targets. In order to facilitate this, organizations that were genuinely doing HIV care work were sidelined.

In their place, are those which can carry out mobilization work, for what has become a by-line. The TCS activities. The three things done are:

1. Get as many numbers of people to test (T)

2. Get as many numbers of people to circumcise (C) 

3. Get as many numbers of people to attend seminars (S)

Regrettably, HIV Prevention and care work has been hijacked by brokers of the business of steep targets. What used to be testing, counseling, confirmatory testing for those who have a positive diagnosis, linkage to ARV and psycho social support have been thrown out of the protocols. If you talk numbers then you are in. If you talk protocols and procedures, you are out!

It will not come as a surprise when we hear reports of spiking HIV prevalence in countries that had reigned in HIV.

This kind of mobilization and recruitment gives the right statistics but miss out in linking or connecting beneficiaries to the wide range of HIV Prevention and Care services. This approach will not cater for say, drug resistance issues or adverse drug effects or other hardships faced by people living with HIV.

Testing, circumcision and health education seminars were entry points into the treatment cascade, but now they are terminal stand alone events. Protocol and procedure encouraged goals that went hand in hand: the numbers of those who are aware of their status; the numbers of those who are taking ARVs; the numbers of those who are virally suppressed. This type of goal orientation has been thrown out for lists of attendance/exit poll kind of HIV Programming.

 A budget outline of one organization that received PEPFAR Funding shows cost centers below: 

S/N	Objective	Activity	Date	Where	Unit Cost	Frequency	Amount
1.	Remuneration to Mobilizer	Mobilizer to meet and bring in 25 candidates for HIV Testing	5th/ Jan	Kyamu	USD 10 per candidate	25	250
2.	Remuneration to Mobilizer	Mobilizer to meet and bring in 25 candidates for HIV Testing	5th/ Feb	Kyamu	USD 10 per candidate	25	250
3.	Remuneration to Mobilizer	Mobilizer to meet and bring in 100 candidates for a Health education seminar	15th/ Mar	Kyamu	USD 10 per candidate	100	1,000
4.	Remuneration to Mobilizer	Mobilizer to meet and bring in 100 participants for a health education seminar	18th/ Mar	Buwa	USD 10 per participant	100	1,000
5.	Remuneration to Mobilizer	Mobilizer to meet and bring in 10 candidates for Circumcision	25th/ Mar	Kyamu	USD 25 per candidate	25	250
6.	……….	………	…..	……….	………….	………	……….
7.	………..	………..	……..	……….	……….	………..	…………