Twenty million people face death due to aid cuts

Shares0Facebook0 Tweet0 Pin0 Print0 Email0 LinkedIn0

Millions of people are adversely affected by Donald Trump and Elon Musk slashing aid. Below are the global numbers from the United States President’s Emergency Plan for Aids Relief, known as PEPFAR. These were released at the end of 2024.

20,6 million people received life-saving antiretroviral treatment (over five million of them live in South Africa).
2,5 million people were newly enrolled on PrEP during 2024. (PrEP is taken regularly to prevent HIV infection. This is especially important for women who may not have the social power to insist that their male partners use a condom.)
2,3 million adolescent girls and young women were reached with comprehensive HIV prevention services.
83,8 million people were provided with HIV testing services in 2024.
6,6 million orphans, vulnerable children and their caregivers received critical care and support.
342 000 health workers were directly supported by PEPFAR.

This came to a grinding halt. In a carefully worded statement, the United Nations Aids organisation said on 29 January 2025:

In recent days, the US Department of State announced an immediate 90-day funding pause for all foreign assistance, including for funding and services supported by PEPFAR. The executive order announcing a “90-day pause in United States foreign development assistance for assessment of programmatic efficiencies and consistency with United States foreign policy” was one of the first major foreign policy decisions of the new administration.

The order came down hard and clear. Stop.

Antiretroviral medicines (ARVs in HIV speak) that had already been packed for individual users could not be dispensed. Mobile clinics were not allowed to go to work. After an international outcry, the Trump team seemed to realise their mistake. UNAIDS says in the same statement:

The United States Secretary of State, Marco Rubio, has approved an “Emergency Humanitarian Waiver”, which will allow people to continue accessing HIV treatment funded by the US across 55 countries worldwide. More than 20 million people living with HIV, representing two-thirds of all people living with HIV receiving treatment globally, are directly supported by the United States President's Emergency Plan for Aids Relief (PEPFAR) – the world’s leading HIV initiative.

The waiver sounds wonderful, but in reality individual organisations are still incapable of providing care, because no new directives have been issued to them, despite the waiver. While the order to stop was clear and direct, the same type of communication for further instructions has not yet reached the organisations at the coalface. Work has stopped and remains suspended.

Individuals are scared to speak out, because they fear retribution. One healthcare provider in the Eastern Cape said: “The situation is as clear as mud.”

An explanation from within the USA

Governments and other aid organisations are scrambling to help, but finding and providing alternatives is hard, even impossible, at such short notice. The Foundation for Aids Research, amfAR, has provided reasons in an information sheet, which is available here.

In many cases, PEPFAR-supported healthcare workers may be the only staff of particular cadres at a given health facility. For instance, most smaller primary health centres will only have a single pharmacist, meaning that even if there are other staff providing clinical services, they have no legal mechanism to dispense medications during the stoppage. Likewise, the suspension of laboratory services will have systematic impacts on the entire HIV response in a country, regardless of whether there are clinicians funded through domestic governments or other funders. Importantly, the stoppage will affect an interwoven group of healthcare providers rather than a single group of workers.

In simple English, even in cases where there are healthcare workers paid for by the government, medication cannot be handed out.

But what is PEPFAR and what does it do?

On 5 February 2025, the PEPFAR website was still operational. Their mission statement read:

The Bureau of Global Health Security and Diplomacy leads, manages and oversees the US President’s Emergency Plan for Aids Relief (PEPFAR). Through PEPFAR, the US government has invested over $110 billion in the global HIV/Aids response, the largest commitment by any nation to address a single disease in history – saving 26 million lives, preventing millions of HIV infections, and accelerating progress toward controlling the global HIV/Aids pandemic in more than 50 countries.

The information below comes from a PEPFAR info sheet, dated December 2024, which I downloaded. It can be accessed here.

Since 2003, the US President’s Emergency Plan for Aids Relief (PEPFAR) has been steadfast in supporting lifesaving treatment for people living with HIV, saving 26 million lives and enabling 7,8 million babies to be born HIV-free.

… Viral load testing coverage and suppression among people on treatment continues to increase for children and remains high among adults – 95% of adults and 89% of children are currently virally suppressed.

This in incredible. When people are virally suppressed, they can live healthy lives, similar to any HIV-negative person. They can have sex without infecting their partner. This is known as U=U, or Undetectable = Untransmittable in HIV speak. Read more about it here.

PEPFAR’s work has been undermined

In order to remain virally suppressed, individuals have to take their antiretroviral medicines daily. In simplistic terms, an individual missing only one dose per month could allow the virus to begin developing resistance against the treatment. (To read the technical details, here is a detailed academic study on the matter.)

That means that 20,6 million people are by now in danger of developing resistance to their ARVs. By the time of writing, some individuals may already have been without ARVs for two weeks. Each day, this number is growing. Even if treatment were to continue immediately, it would already be too late for many.

What is more: “If you stop taking HIV medicines, your HIV can rebound to a detectable level within one to two weeks, and you may pass HIV to your sex partners.” This quote comes from page 10 of the U=U booklet mentioned earlier.

More than 20 million people worldwide face death due to Trump’s aid cuts. According to amfAR, five million of them live in South Africa. Each one of them could soon begin infecting their sex partners as well.

Litnet