Insights from Bush Institute global health expert Hannah Johnson
PEPFAR partners around the world are struggling to restart programming, despite the State Department’s waiver to allow PEPFAR’s life-saving work to continue. As I recently wrote, these partners include local clinics, grassroots organizations, and faith-based initiatives. They include hospitals treating children with HIV and clinics providing antiretroviral drugs to pregnant women to prevent transmission to their babies.
After reviewing USAID grants, the administration terminated nearly 90% of its overall awards to implementers in the field, creating ripple effects that impact PEPFAR. Approximately 60% of PEPFAR’s funding had been going through USAID. As a result, many of the 20 million people around the world who rely on PEPFAR for antiretroviral medication are at imminent risk of losing access to life-saving treatment.
PEPFAR has saved 26 million lives and 7.8 million babies in the past 21 years. The waiver for PEPFAR alone is essentially ineffective if partners on the ground cannot receive funding to deliver treatment and screening. It’s critical that PEPFAR’s work resumes immediately, before lives are lost.
Figure of the week
601,000
That’s the number of HIV-related deaths that would occur in the next 10 years in South Africa alone if PEPFAR were eliminated, according to a new study in the Annals of Internal Medicine. The study also estimates that 565,000 new HIV infections would occur in South Africa in the same time period. While PEPFAR currently supports only 18% of South Africa’s budget to fight HIV, it remains an essential health service. In countries with significant challenges to their economic and health systems, this percentage is much higher. The researchers cite South Africa as just one example of the consequences of ending PEPFAR, a move that would cost many more lives across the many countries it serves. In STAT magazine, lead researchers Anne Neilan and Linda-Gail Bekker discussed the paper, as well as the urgent need to shore up funding for PEPFAR.
Ally Updates
According to a recent update from UNAIDS, many community-led programs that provide HIV testing and treatment services have not received waivers, and their work has been disrupted. Some examples include:
- In Mozambique, the suspension of salaries for community health workers and HIV test counselors funded by PEPFAR has led to a nationwide disruption in HIV testing. As a result, most regions lack access to testing services, new patient registrations have been halted, and support for individuals managing their treatment has been significantly affected.
- In Ghana, civil society organizations that rely on PEPFAR funding have completely stopped delivering services to individuals living with HIV.
- In Botswana, critical HIV services have been discontinued, including testing centers operated under the PEPFAR-backed ‘Tebelopele’ initiative and programs like DREAMS, which support adolescent girls and young women.
- In Rwanda, essential HIV prevention efforts at both community and healthcare facility levels have not received waivers, leaving high-risk groups, such as adolescent girls and young women, without necessary services.
Bush Institute Insights
In my recent two-minute take for the Bush Institute, I provided examples of some of the most heartbreaking PEPFAR program freezes. Late last week, one organization was instructed to cease HIV programming in Lesotho, Eswatini, and Tanzania that treats 10,000 pregnant women and 10,000 children with HIV. A Christian maternity clinic in Cote D’Ivoire specialized in treating mothers and children living with HIV reported that they are not able to access the PEPFAR network to procure and distribute life-saving antiretroviral medication. As a result of the freeze and subsequent terminations, Ukraine and Haiti have dangerously low supplies of antiretroviral medication, and other countries are quickly approaching that status.
In the News
- Christianity Today reported on the challenges facing hospitals and clinics in Africa affected by the foreign aid freeze. A Tanzanian clinic treating 300 children with HIV is struggling to secure antiretrovirals and a hospital in Eswatini that provides HIV and tuberculosis treatment has stopped operations.
- A Reuters report zoomed into the effect of the USAID cuts on South Africa, where HIV prevention programs that target women and children have been cut, and experts fear a resurgence of the HIV epidemic.
- In a Science article, experts warn that the termination of U.S. foreign aid, including PEPFAR funding sources, will have devastating consequences for global HIV/AIDS efforts. Epidemiologist Peter Piot predicts that Zimbabwe and Zambia may soon run out of anti-HIV drugs, and Lynne Wilkinson of International AIDS Society warned that HIV and tuberculosis programs could unravel.
- amfAR released the results of a survey to PEPFAR funding recipients: 86% of partners said their clients would lose access to HIV treatments in the next month if the funding freeze is not lifted, and 36% reported that their operations had completely shut down.
