Millions Lack Treatment for HIV Due to Foreign Aid Freeze

The health of almost 20 million people, including 500,000 children, is in danger because H.I.V. organisations overseas have not received any cash since President Trump's wide block on foreign aid two weeks ago. The State Department's subsequent waivers have made it clear that the work can go forward, but the necessary funding and legal documentation are still lacking. There is little prospect that the crisis will be resolved fast, analysts cautioned, given the U.S.A.I.D., an American aid agency, is on the verge of closing and recalling officers stationed overseas. On Mr. Trump's first day in office, all foreign aid was suspended, including the $7.5 billion President's Emergency Plan for AIDS Relief, or PEPFAR, which provided funding for HIV treatment and services.

Up to 25 million individuals in 54 countries have received life-saving treatment because to PEPFAR, which was launched in 2003 during the George W. Bush administration and has garnered bipartisan support. When the program's five-year reauthorisation was due in 2023, it was renewed for an additional year despite an attempt by certain House Republicans to terminate it. Millions of people living with HIV would be at danger of serious sickness and early death if they did not receive treatment. Additionally, the lack of treatment could lead to the establishment of drug-resistant strains of HIV and threaten to undo the significant progress made against the virus in recent years; both outcomes could have an impact on the world, including the United States.

In order to ensure that what is theoretically feasible will actually occur, you must now determine how to operate with the system as it is," she added. A waiver for life-saving medications and medical services was granted by Secretary of State Marco Rubio on January 28, supposedly permitting the distribution of HIV medications. However, PEPFAR was not included in the waiver, therefore recipient organisations are still waiting for clarification. A memo seen by The New York Times on Sunday said more clearly that another State Department waiver would include HIV testing and treatment, as well as the prevention and treatment of opportunistic illnesses like tuberculosis. HIV prevention (except from pregnant and lactating women) and assistance for vulnerable and orphaned children were not covered in the memo.

The Centres for Disease Control and Prevention and U.S.A.I.D. implement around two-thirds of PEPFAR's grants, even though the State Department funds the program. Since the start of the freeze, neither agency has disbursed monies to grantees. In a Washington Post interview, Mr. Rubio seemed to accuse the recipient organisations of failing to implement the waiver, stating that he had "real questions about the competence" of the organisations. He remarked, "I wonder if they're purposefully undermining it to make a political point."

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However, many who are aware with PEPFAR's standards stated that his remarks were a betrayal of the intricacy of its approval process. "The State Department's messaging and guidance reveal a lack of understanding of how these programs operate — and a concerning lack of empathy for the millions of lives at stake," stated Jirair Ratevosian, the former PEPFAR director of staff during the Biden administration. For example, each program was forced to stop instantly by the stop-work orders. According to a senior official at a major international health organisation that gets PEPFAR funding, the organisations are now legally not allowed to move forward based on a generic memo and must wait for similarly clear instructions.

The official stated, "We must wait until we receive individual letters on each project that determine not only whether we can begin work, but also which work we can begin and with how much money." The individual requested anonymity out of concern for reprisals; PEPFAR provides 90% of the organization's funding. Additionally, the freeze is upsetting the network of smaller organisations who provide HIV services and treatment in low-income countries. Dr. Stellah Bosire, executive director of the Africa Centre for Health Systems and Gender Justice, said that 275 organisations in 11 sub-Saharan nations were surveyed over the course of the last week, and all of them reported that their programs or services had closed or were turning away individuals.

Mackenzie Knowles-Coursin, who served as deputy chief of communications at the U.S. mission in Nairobi until Monday, said the freeze has affected 40,000 medical professionals in Kenya, including doctors, nurses, and other healthcare workers. During a televised press conference last week, South Africa's health minister, Aaron Motsoaledi, stated that the funding halt will impact operations nationwide and the wages of over 15,000 health workers. A patchwork of grants is the foundation of certain organisations, with one source of financing used to pay employees and another to buy drugs. Clinics can become severely hampered by the disruption of even one supplier, which leaves them without staff to distribute prescriptions.

In contrast to treating adults, certain organisations administer medications to children, which calls for greater expertise. Drug resistance in children must be closely watched, and their prescriptions are customised based on their age, weight, and past exposure to antiretroviral treatments. For children who contracted HIV at birth, the infection can spread rapidly to cause disease and death as soon as eight to twelve weeks after birth, which is less time than the 90-day moratorium on foreign aid. Nearly every member of the U.S.A.I.D. global workforce was placed on leave by the Trump administration on Tuesday night, and those overseas were reminded to return to the United States within 30 days.

Elisha Dunn-Georgiou, president of the Global Health Council, a membership organisation of health groups, stated, "Institutional memory is being lost, which may be intentional, but it's also just creating a backlog of paperwork and paralysing the entire system." She questioned, "To whom do you ask questions?" "What is your next step?" Organisations worry they won't receive cash anytime soon given the lack of U.S.A.I.D. personnel to handle waiver applications. Some big international health organisations have already reduced their staff and operations because they are having trouble staying afloat. Resuming programs and getting back to something like normalcy could be difficult, even if the money is returned soon, according to Ms. Dunn-Georgiou. The expense of restarting something is high.