This was the subject of discussion during the Ecumenical Pharmaceutical Network's Annual General Meeting held in Moshi, Tanzania from 5th to 8th October 2004. The Ecumenical Pharmaceutical Network (EPN) is a network of various agencies and organisation such as Christian Health Associations and hospitals, non-profit drug supply organisations and church-related development agencies from Africa, Asia, Europe, South America and the US.

The meeting, which brought together members from 22 countries from across the globe, took time to analyse PEPFAR.

"As a network of health care service providers, we express our deep concern over some aspects of PEPFAR which have been identified as generally applicable, but to varying degrees in individual beneficiary countries," says a statement released by the network.

Among the key issues raised include the genuineness of the US government to meet the PEPFAR objectives and to support existing initiatives to fight HIV/AIDS.

The controversy is founded upon the dilemma faced by many poor nations, organisations and people: should they accept the money and ignore the consequences of unilateral American controlled initiative or reject the money and let people continue to die because of lack of money to buy HIV/AIDS medication and other items?

The statement expresses the views of the 54 participants in the meeting, representing about as many organisations, and was signed by the co-ordinator, Dr. Eva M A Ombaka, and the Chair of the Network Mr. Albert Petersen. It recognised that the scaling up of medical assistance and the care of the men, women and children infected and affected by AIDS must continue.

The scale-up could certainly benefit immensely from the PEPFAR funds, amounting to 15 billion US dollars.

This initiative came into play at the State of the Union Address in January 2003, when President George W. Bush announced: "tonight I propose the emergency plan for AIDS relief - a work of mercy beyond all current international efforts. Seldom has history offered a greater opportunity to do so much for so many."

However, many needy countries, organisations and people living with AIDS have not accessed the money, thanks to the stringent regulations and the bureaucracy they encounter. Some of the challenging regulations include the insistence on US Food and Drug Administration (FDA) approval for all medicines purchased and the 'buy American' requirement for medicines other than ARVs.

PEPFAR's preference for expensive brand-name drugs as opposed to more affordable generic ARVs and drugs for opportunistic infections is another issue of concern. This makes it difficult for health institutions to continue providing brand-name drugs to patients at the end of PEPFAR programmes. In many cases, this works against the national policies of poor governments trying to provide affordable medicine to citizens.