Funding cuts to HIV/AIDS programs in many African countries in the United States could lead to hundreds of thousands of deaths on the continent, health professionals and aid organizations warn.
In South Africa alone, a US funding suspension could lead to 500,000 deaths over the next decade, officials at the Tuts HIV Centre in Desmond said Thursday.
The warning comes when the country begins to feel the impact of massive US aid cuts. Shortly after taking office on January 20th, President Donald Trump issued a drastic executive order that suspended foreign aid assistance over an early 90-day period. This week, the Trump administration cut 90% of foreign contracts funded by the US Aid Agency (USAID) and fired thousands of Washington staff.
And on Thursday, news came the Trump administration decided to suspend funding for UNAIDS, the UN's HIV/AIDS program that serves communities around the world.
In a report this week, UNAIDS said at least 55 countries around the world have reported funding cuts to HIV programs, including some of African countries. This included the suspension of 55 HIV projects that received the US President's AIDS Relief Emergency Plan (PEPFAR) or some US funding.
African countries are the biggest burden of the HIV epidemic, with an estimated 25 million people living with HIV in sub-Saharan Africa, out of a total of 38 million people living with HIV worldwide.
According to UNAIDS, Pepfar, launched in 2003, is believed to have saved 26 million lives. The program has spent about $120 billion since its inception.
Here's what you need to know about how reducing aid to HIV/AIDS programmes is affecting African countries:
What do experts and aid organizations say?
On Thursday, Linda Gailbecker, chief operating officer of the Desmond Tutu HIV Centre, told reporters that cutting funding to South Africa would have a devastating impact.
Bekker issued a statement this week after being notified by the US State Department that the grants under USAID had been cancelled. According to AFP News Agency, the notification states that grants will no longer match “US priorities” and will end for “the convenience and benefits of the US government.”
But Bekker said the outcome of the decision would be disastrous.
“We'll see our lives lost,” authorities said. “Loss of funds and up to half a million new infections will result in more than half a million unnecessary deaths.”
Already, HIV services in many African countries are in disarray, including prevention, testing and treatment services, according to the United Nations. Hundreds of thousands of people who once had free access to important antiretroviral therapy (ART) have blocked infected people's viral load to undetectable levels and blocked medications that help them live a healthy life.
Shortly after the announcement of the aid cut, the US Secretary of State issued an emergency exemption to resume humanitarian assistance that “saves life” rather than a prevention program, including HIV treatment, to stop pregnant or breastfeeding women from spreading mothers to their children. Additionally, blocks on funding for UNAIDS can exacerbate the resource challenges faced by nonprofits seeking to serve patients and vulnerable communities.
Projects related to “gender ideology” or diversity, transgender surgery, or family planning are prohibited under the exemption. Organizations are invited to submit a 30-day work plan and budget for review and approval before approval.
It is unclear whether the organization has yet to be cleared under the new rules. But officials say there is a huge confusion about how abandonment will be carried out on the ground, whether approved or approved, as testing, prevention and treatment projects often complement each other and now they have to be demolished.
Additionally, many of the US implementation partners involved in running the program are either out of function or reducing capacity.
What is the burden of aid in Africa? And how did the US support help?
According to the Global HIV Prevention Coalition, the United States was responsible for two-thirds of international funding in developing countries.
The main recipients are South Africa, the world's highest HIV burden country, with 7.5 million people. The high prevalence of this country is associated with low levels of education and awareness, especially in rural areas. 20% of HIV cases worldwide are in South Africa, and 20% of new HIV infections also occur domestically.
According to UNAIDS, South Africa has expanded the number of people accessing HIV treatment, with AIDS-related deaths down 66% since 2010.
The PEPFAR fund accounts for about 17% of South Africa's HIV budget ($400 million), but the South African government accounts for a majority, according to the national health ministry. According to the National Ministry of Health, the support helped ensure that around 5.5 million people receive antiretroviral (ARV) treatment annually.
Similarly, more than half of the HIV drugs purchased for the Democratic Republic of the Congo (DRC), Mozambique, Tanzania and Zambia are secured through US funding, according to the United Nations.
Of the 20 countries that rely most on US aid for the HIV/AIDS program, 17 are in Africa, the United Nations says.
Includes DRC, Mozambique, Tanzania, Zambia, Uganda, Nigeria, Rwanda, Angola, Kenya, Ukraine, Burkina Faso, Burundi, Zimbabwe, Togo, Kotedo Iboia, Eswatini and Benin.
The other three are Haiti, El Salvador and Nepal.
Which HIV programs have been reduced in Africa?
South Africa: Several HIV treatment clinics, including rural areas on Kwazulu-Natal, have been closed, with around 1.9 million people living with HIV, making it the worst area in the country. This has caused patients to flow into other public facilities, according to an Associated Press report. Facilities such as Engagement Men's Health in Johannesburg that supported gay men, or Tswane HIV/TB clinic in Pretoria are closed. In total, around 222,000 people live in HIV, including 7,445 children under the age of 15. According to the United Nations, 516 medical facilities have been completely closed as the United States supported more than 400,000 adults and children living with AIDS. 85% of people receiving HIV treatment are affected, with over 8,600 staff members, including doctors, nurses and midwives. A report by the New York Times shows that rural orphanages in Botswana, which cater to children living with HIV, are closed. In Mozambique, HIV testing is no longer available in most parts of the country, and community workers, educators and counselors who worked with the PEPFAR-funded project have stopped receiving payments, according to the UN. In Tanzania, healthcare workers, educators and counselors in the PEPFAR-funded community have been lost. According to Stat News, the South African medical research organization has suspended a $45 million HIV vaccine trial funded by USAID. The study was intended to generate neutralizing antibodies that could combat HIV. It is supposed to be released in late January and has 48 participants in three countries: Uganda, Kenya and South Africa.
How does the country respond?
South Africa has sought to alleviate fears that the funding gap is a death sentence for the HIV prevention programme and that it is pledging to strengthen its health system and care. Earlier this month, President Cyril Ramaphosa said his administration is working on a local solution.
“We are considering a variety of interventions to address immediate needs and ensure continuity of essential services,” he said.
One of these interventions began on February 25th in Soweto, one of the most intensely hit suburbs. The “HIV Treatment Campaign” wants to persuade 1.1 million people who already live with HIV, but those who are not in treatment will be enrolled in the treatment program by December.
Meanwhile, in Nigeria, the government in February approved about $3.3 million to purchase HIV treatment packs over the next four months to close the funding gap. A government committee has also been launched, focusing on finding alternative financial support.
Can African countries find alternative sources of funding?
One of the main options for USAID may be UNAIDS. The UN agency recently praised South Africa's new intervention initiative and said it would work with the government to ensure the continuity of HIV services.
“This plan protects the human rights of those living with HIV and provides them with the hope and opportunity to live a healthy and fulfilling life,” the agency said in a statement, adding that it was “inspired.”
However, it is unclear whether the United Nations agencies can help countries like South Africa, not only will the US suspend its own HIV prevention assistance, but not only will it stop UNAIDS funding.
Meanwhile, experts are calling on other Western countries, particularly the European Union, to close the gap.
“The EU and its member states collectively represent the largest global provider of ODA (official development aid),” wrote Colleen Le Piuf, an analyst with the European Council of Foreign Relations, written in a paper published on the organization's website.
“In this way, Brock should take advantage of the strength that comes from acting together and speaking as a single voice,” writes Le Pious.
In 2023, the EU donated 95.9 billion euros ($100 billion) of foreign aid to support efforts primarily in Ukraine, Covid-19 and climate change.
Additionally, private aid organizations such as the bill and the Melinda Gates Foundation may have to close the funding gaps, such as research, some health experts say.
“They may tip, but they have priorities, so this is up to them,” Anna Roca, an epidemiology professor at the London School of Hygiene, told Clinical Trial Arena, a US publication focusing on clinical research.
“It's not easy to suddenly increase funding for something that isn't part of the foundation's agenda. The bill and the Melinda Gates Foundation have already jointly launched drug development with USAID, so there's a possibility that some research can continue. Without USAID there, it's hard to say how the industry will respond – we have to look,” she added.
