U.S. President Donald Trump’s foreign aid freeze “for the convenience” of the United States is having a devastating impact on the global campaign to combat HIV/AIDS, putting millions of lives at risk and jeopardizing years of progress in prevention, treatment, and awareness campaigns.
The Trump administration ended a long-standing agreement to support UNAIDS, the United Nations' program on HIV/AIDS treatment and prevention. The U.S. also cut funding to AIDS programs in South Africa, a nation with one of the highest rates of HIV infection – some 7.8 million people, or 13% of the population, according to government data.
U.N. Secretary-General António Guterres told reporters on Friday that many programs combatting HIV/AIDS, tuberculosis, malaria and cholera have stopped. He warned that "going through with these cuts will make the world less healthy, less safe and less prosperous."
The Trump administration sent termination notices on Thursday saying the grants were not in line with current U.S. priorities and were cancelled “for the convenience of the U.S. government.”
UNAIDS warned that more than 6 million people could die from HIV/AIDS over the next four years if the U.S. cancels the President’s Emergency Plan for AIDS Relief, or PEPFAR.
“We will see lives lost,” Linda-Gail Bekker, head of the Desmond Tutu HIV Foundation, told reporters of the impacts on South Africa over the next decade. “In excess of half a million unnecessary deaths will occur because of the loss of the funding and up to a half a million new infections.”
The U.S. government launched PEPFAR in 2003 under President George W. Bush to combat the global HIV/AIDS epidemic. It’s the largest commitment by any nation to address a single disease by paying for HIV prevention, testing, and care services, and supporting health systems in over 50 countries.
PEPFAR has been administered by the embattled U.S. Agency For International Development, or USAID, and its future remains in doubt.
The developing world has counted on Washington for much of its AIDS treatment and prevention funding, and it's been especially hard hit by the dismantling of USAID, which administered most U.S. foreign aid and development assistance.
Some clinical services granted emergency waivers
A new report by UNAIDS points to Ivory Coast, a country where U.S. funding accounted for more than half of the AIDS response, as emblematic of what the developing world is up against as Washington cuts off decades of foreign aid.
Trump’s stop-work order triggered a total shutdown of services funded by PEPFAR, which covered 516 health facilities in 70% of the health districts in Ivory Coast and 85% of people living with HIV on treatment, or some 265,000 people.
More than 8,600 staff were directly affected, including 597 clinical workers – doctors, nurses and midwives – and 3,591 community workers. Meanwhile, the distribution of medicines and the transport of diagnostic samples “ground to a halt.”
While some U.S.-funded services resumed two weeks ago after waivers were granted, most prevention services for people at high risk – including adolescent girls, young women and key populations – remained shut.
Country reports over the past week showed that emergency waivers granted by the Trump administration led to a resumption of at least some clinical services, such as HIV treatment and transmission prevention, in many of the countries that depend on U.S. funding, according to UNAIDS.
But with USAID in chaos, and with key U.S. government systems and staff responsible for distributing funds either offline or working at reduced capacity, it’s impossible to know how long the funding will last, and how it could be delivered.
Even if some funding is restored, however, Trump’s new rules make critical layers of the AIDS response ineligible for funding, including many HIV prevention and community-led services for at-risk populations.
Life-saving treatments for women and girls stopped
UNAIDS says the gathering and analysis of AIDS data is now disrupted in many countries, eroding the quantity and quality of prevention, testing and treatment services. Health care workers are up against increased workloads, while patients have to endure longer wait times to get the life-saving services they need.
Also cut was funding for surveys in more than 90 low- and middle-income countries that often were the sole source of crucial data on population, health, HIV and nutrition.
Programs that focus on gender equality and transgender populations will likely be excluded from any U.S. funding, and community-led services for people infected with AIDS are endangered in many developing countries that depend on U.S. funding, UNAIDS says.
In Mozambique, for example, staff paid through PEPFAR funding are no longer working, and HIV testing is unavailable in most of the country. In Kenya, organizations engaged in AIDS response face mass layoffs, and in Botswana, many HIV testing centers for adolescent girls and young women are shuttered.
UNFPA, the United Nations reproductive and sexual health agency, said it also received notice that the U.S. was canceling 48 grants worth $377 million in funding. Grants administered by USAID provided maternal health care, protection from violence, rape treatment and other humanitarian care in 25 nations, including Afghanistan, Chad, Congo, Haiti, Mali, Sudan, Syria and Ukraine.
UNFPA's executive director, Dr. Natalia Kanem, said on Friday the vast majority of U.S. funding supported the agency's work in emergency settings, and the termination included 16 grants for which UNFPA received a humanitarian waiver.
Over the last four years, she said, its work prevented 17,000 maternal deaths, 9 million unintended pregnancies and nearly 3 million unsafe abortions by expanding access to voluntary family planning. The agency reached 13 million women and young people with sexual and reproductive health services like cervical cancer screening, contraception counseling, and prenatal and safe childbirth care.
"This devastating decision will force thousands of health clinics to close. Women in crisis zones will be forced to give birth without medicines, midwives or equipment, putting their lives and their babies’ lives in jeopardy," said Kanem. "Rape survivors will be denied counseling and medical care. Midwives delivering babies in the world’s worst humanitarian crises will lose their ability to function. Shipments of life-saving medical supplies to refugee camps will be disrupted."
This story has been updated with additional details.
