Two weeks after President Trump freezes with foreign aid, HIV groups overseas have not received funding, putting the health of more than 20 million people, including half a million children. The subsequent exemption from the State Department made it clear that work could continue, but the funds and legal documents to do so are still missing.
Experts warned that there is little hope that the situation will be resolved quickly due to the closure of the US aid agency known as USAID and the recall of officials posted overseas.
HIV treatment and services were funded through the president's emergency plan for AIDS relief, a $7.5 billion program that was frozen along with all foreign aid on Trump's first inauguration day.
Since its inception in 2003 during the George W. Bush administration, Pepfer has enjoyed bipartisan support, providing life-saving treatments to up to 25 million people in 54 countries. The program was scheduled for five years to be reapproved in 2023. It survived efforts by some House Republicans to end it and was renewed for a year.
Without treatment, millions of people with HIV are at risk of severe illness and premature death. The loss of treatment could also reverse the dramatic advances made against HIV in recent years, which could promote the emergence of drug-resistant strains of HIV. Both results could have global impacts, including in the US.
Christine Stegling, deputy executive director of UNAIDS for the United Nations HIV sector, said the suspension of aid and USAID stripping has resulted in a “system shock.”
“Now you need to see how you can operate the system to see what theoretically is possible actually happening,” she said.
On January 28th, Secretary of State Marco Rubio issued a life-saving drug and medical services exemption that superficially enables the distribution of HIV drugs. However, the exemption did not name Pepfer and the recipient organization was waiting for clarity.
On Sunday, another State Department exemption covered HIV testing and treatment, as well as the prevention and treatment of opportunistic infections such as tuberculosis, according to a memo from the New York Times. The memo did not include HIV prevention or support for orphans or vulnerable children, except for pregnant and breastfeeding women.
PEPFAR is funded by the State Department, but about two-thirds of its grants are implemented through the USAID and the Centers for Disease Control and Prevention. Neither organization has released funds to grantees since the freeze began.
In an interview with The Washington Post, Rubio appeared to blame the recipient organization for not acting on the exemption, saying there were “real questions about the group's capabilities.” “I wonder if they're intentionally blocking it with the aim of creating a political point,” he said.
However, experts familiar with Pepfar's requirements said his comments confirm the complexity of the approval system.
“The message and guidance from the State Department reveals ignorance about how these programs work and an incredible lack of compassion for the lives of millions at risk,” Biden said. said Jirair Ratevosian, who served as Pepfer's chief of staff in the administration.
For example, a stopwork order forced each program to be stopped immediately. According to senior officials at large global health organizations receiving PEPFAR funds, organizations must now wait for similarly explicit instructions and cannot proceed based on general memos.
“Unless you can start work, you'll have to wait until you receive individual letters for each project, you'll be able to wait to see which work you can start and how much money you can use to tell them,” the official said. Ta. Officials asked not to be named for fear of retaliation. 90% of the organization's money comes from Pepfar.
The freeze is also disrupting a network of small organizations providing HIV treatment and services in low-income countries.
Dr. Stellah Bosire, executive director of the African Health System Centre, reports that their programs and services have been shut down or people have been stolen, with 275 in 11 sub-Saharan countries over the past week. All of the research has been reported in the organization. Gender justice.
At least 70 organizations reported disruptions in HIV prevention, testing and treatment services, and 41 people said programs have been shut down. “Without immediate intervention, these terminations of funding could lead to a catastrophic reversal of public health advances,” Dr. Bosia said in an email.
In Kenya, 40,000 doctors, nurses and other healthcare workers have been affected by the freeze. In South Africa, the halt of fundraising would affect the salaries of more than 15,000 health workers and operations across the country, according to the country's health minister Aaron Mossoaredi at a televised press conference last week. I mentioned it.
Some organizations rely on a patchwork of grants with funding flows from one donor applied to purchase drugs and another stream applied to payment staff. By suspending one source, you may bump into the clinic, leaving you without any medication to soak the medication or dispense the workers.
Uganda's major population consortium, an umbrella organisation that provides HIV treatment and other services, has lost 70% of its funds. It closed 30 of the 54 drop-in centres nationwide that distribute drugs and ended contracts for 28 of its 35 staff.
The organization received approximately $200,000 a year from the CDC via Makerere University's Institute of Infectious Diseases and a $8 million grant over five years from USAID. Follow Trump's executive orders on diversity, equity, inclusivity and accessibility.
In 2023, Uganda enacted a drastic law that committed consensual sex among same-sex adults, while also building same-sex relationships while punishing HIV for the deaths and building same-sex relationships. This forced many Ugandans out of their homes and fired from their jobs.
“The cases of human rights abuses were not really late, but now there is a real concern,” said Richard Rusimbo, director of Uganda's major population consortium.
“We don't even have the capabilities or tools we need to actually deal with some of these issues,” he said.
Some organizations distribute medicines to children who need more skills than treating adults. Pediatric drugs are tailored to age, weight and prior exposure to antiretroviral drugs, and children should be monitored carefully for drug resistance.
In children who have acquired HIV at birth, infection can progress to the disease very quickly, with death occurring as early as 8-12 weeks after birth.
On Tuesday night, the Trump administration put almost all of USAID's global workforce on vacation, recalling people who were listed overseas to return to the United States within 30 days.
“There's a loss of memory for the institution, which may be intentional, but it's creating only a backlog of documents, paralyzing the entire system,” says Global Health Council, a member organization for the health group. said Elisha Dan Jojou, president. 。
“Who would you ask?” she said. “How do you move to the next step?”
If USAID staff doesn't process their exemption applications, the organization fears that their funds will not be displayed immediately. Even large global health organizations struggle to float. Some have already cut programs and staff.
Even if funds come back quickly, it may not be easy to resume the program and return to something similar to normalcy, Dan Jojo said.
“It's expensive to resume something, so I don't really know if that's possible yet,” she said.
Lindsay Chutel and Stephanie Noren reported.
