What’s the context?
Despite the resumption of some HIV treatment programmes, US cuts to funding have disrupted treatment and prevention of the disease.
BERLIN – Six months after U.S. President Donald Trump slashed funds for HIV prevention across the world, health advocates say decades of progress against the virus are at stake and millions of lives could be lost.
After freezing all U.S. foreign aid in January, the Trump administration issued a waiver the following month that allowed the two-decade-old President’s Emergency Plan for AIDS Relief (PEPFAR) to resume funding “life-saving” services and part of existing HIV prevention efforts.
But experts say the disruption caused by the pause to global HIV work and the broader foreign aid cuts, including shutting down the U.S. Agency for International Development (USAID), has undermined efforts to treat and prevent the disease.
Context spoke to Jennifer Kates, senior vice president and director of global health and HIV policy at KFF, a non-profit based in San Francisco, about the impact of Trump’s cuts on HIV treatment, testing and tracking services across the world.
After Trump froze foreign aid, his administration allowed some HIV treatment services to resume. Has treatment returned to the levels it was at before his inauguration?
The aid cuts that began at the beginning of this second Trump administration included a pretty abrupt ‘stop-work order.’ All services had to be stopped, whatever they were, for a period of time. And then a waiver allowed PEPFAR specifically to provide ‘life-saving’ treatment and some other services.
Even with that, it’s been very challenging for even treatment to be delivered in some places. The administration has cut many of the projects that it had in place. Since the U.S. had been or is the largest donor to HIV services globally, when it pulls back even a little, it can have an effect.
This was a big pullback.
How have Trump’s cuts impacted HIV treatment services across the world, even with the return of PEPFAR funding?
Technically, PEPFAR was able to resume ‘life-saving’ interventions: antiretroviral treatment, testing, that kind of thing.
In reality, a few challenges existed and still do. One was that communicating what was allowed was very hard, in part because the administration basically dissolved USAID, which was one of the main U.S. implementing agencies for PEPFAR.
So the actual people in the U.S. government who were very much day-to-day involved in communicating with the field and providing technical and other support were not available.
In addition, the administration did go ahead and cancel a lot of projects. Some of those were HIV treatment programmes. In addition, they cancelled other projects that allowed, for example, transportation and storage of that treatment.
So if you are trying to deliver treatment, but you have no way to transport that treatment, or there’s no community health worker to help deliver the medication or to monitor it, it’s very difficult.
It’s not just a pill. It’s not just, ‘Here’s your pill, and there’s no connection to the healthcare system.’ When those things got disrupted, it even affected existing treatment.
Some reports suggest HIV cases may be rising among at-risk groups who lost access to pre-exposure prophylaxis, or PrEP, medicine, including gay and bisexual men and trans women. Why is it hard to track the spread?
HIV is a virus that has what’s called a fairly long incubation period. That means you could be infected with it and not know it for a very long time. If infections are rising, we often notice that too late.
And that’s why PrEP, for example, is such an important intervention because it allows people who at least know they are at risk to take a pill and prevent that risk.
In many of the countries where PEPFAR has operated, data and surveillance systems have been disrupted. PEPFAR is known for its support for very strong data systems. If testing capacity goes down, people won’t necessarily have access to find out if they’re positive.
The data systems are used to get data from sites, to analyse the data, to do the processing (and for) lab results. If any of that is disrupted, the whole system is at risk.
This interview has been edited for brevity and clarity.
(Rerporting by Enrique Anarte; Editing by Kim Harrisberg and Ayla Jean Yackley.)