Trump's foreign aid retreat guts funding for HIV treatments

Japan Times

29-03-2025

Lucy Wambui first suspected she was HIV-positive in 2000, when her baby fell ill and died. At the time, treatment for the virus was too costly for many families in the Kenyan town where she lives, 120 miles (193 kilometers) from Nairobi.
"People used to sell their land to buy medicines,' she recalled. It wasn't until 2011 that she began antiviral therapy, thanks to free drugs available through the U.S.-funded President's Emergency Plan for AIDS Relief, or Pepfar.
Today, Wambui has two healthy teenagers and her infection is well controlled. But new policy priorities under U.S. President Donald Trump have cast fresh doubt over the future of Pepfar — and the lives and health of 20 million people across 55 countries who depend on the program started in 2003 by former U.S. President George W. Bush.
Congressional authorization for Pepfar expired on March 25.
Two months earlier, the U.S. State Department issued a stop-work order for foreign aid programs, including much of Pepfar, pending a 90-day review. While a limited waiver granted on Feb. 1 allowed some essential HIV services to resume, confusion over its scope has led to clinic closures, staff layoffs and interruptions in care across multiple countries.
In a further blow, Trump stopped funding thousands of health-care programs in Africa in February.
Programs hit by cuts received letters saying that officials at the U.S. Agency for International Development "determined your award is not aligned with Agency priorities and made a determination that continuing this program is not in the national interest.'
"This has been the most disruptive moment in HIV since the world came together to fight AIDS 25 years ago,' said Winnie Byanyima, executive director of the Joint United Nations Program on HIV/AIDS. "There is so much uncertainty now.'
A child counts numbers on a wall chart at the Nyumbani Children's Home, which cares for more than 100 children with HIV whose parents died of the disease, in the Karen district of Nairobi, Kenya, on Feb. 12. |
REUTERS
In 2016, global leaders pledged to end AIDS as a public health threat by 2030. With expanded testing, access to therapies, and prevention tools like pre-exposure prophylaxis or PrEP, the world began to envision the possibility of an AIDS-free generation. New infections fell 40% globally from 2010 through 2023.
But new research suggests that cuts by the U.S. and other major donors could unravel decades of progress — vaulting infections and deaths to levels not seen in more than two decades.
Last week, the World Health Organization warned that Kenya and seven other countries could run out of antiretroviral drugs in the coming months, with more at risk. Researchers tracking the fallout of Pepfar's suspension estimate that since Jan. 24, more than 26,000 adults and nearly 3,000 children have died as a result, with more occurring every few minutes.
Even before the U.S. actions, other donor countries had announced plans to scale back, contributing to a projected 24% drop in global HIV funding by 2026.
Sliding backward
A study published Thursday in the Lancet HIV medical journal warned that funding cuts could trigger a devastating reversal in the fight against the virus. Between 2025 and 2030, researchers estimate, up to 10.8 million additional infections and as many as 2.9 million related deaths could occur if support isn't restored.
Sub-Saharan Africa is expected to bear the heaviest toll, along with marginalized populations already at greater risk — including children, people who inject drugs, sex workers, and men who have sex with men.
UNAIDS executive director Winnie Byanyima delivers remarks on the impact of U.S. budget cuts on global HIV response during a news conference at the United Nations offices in Geneva on Monday. |
AFP-JIJI
"We don't really know what the impact of a very large number of people coming off lifelong treatment will be,' said Nick Scott, head of modeling and biostatistics at Melbourne's Burnet Institute and a coauthor of the study. "This situation is new.'
Daily HIV drugs usually keep the virus at undetectable levels, protecting the immune system and preventing transmission. But when treatment stops, the virus rebounds quickly, the person's health deteriorates — and they become infectious again.
'Double whammy'
"Stopping the drugs is a double whammy,' said Anthony Kelleher, an HIV physician-researcher and director of the Kirby Institute at the University of New South Wales in Sydney. "It's bad for the person's health, and it's bad for public health.'
A child sits as a nurse prepares to dispense antiretroviral drugs in Nairobi in February. |
REUTERS
Wambui, who worked as a counselor in 2007 under a USAID contract, remembers when patients couldn't receive HIV drugs until their disease had progressed to a late stage. Gradually, as patients got treatment earlier, HIV became more manageable.
"You'd forget you were even sick,' she said. "There was no need to go to the hospital.'
Cutting back access might lead some patients to ration their supplies. Taking incomplete doses has been known to foster drug-resistant strains.
"So even if the antiretrovirals come back, they may be ineffective because that person now harbors drug-resistant virus' which also may not respond to preventive therapy, Kelleher said. "Then we're back to safe sex and abstinence.'
Drug resistance doesn't stop at borders: the consequences will reach far beyond the countries most affected, threatening global health security.
Turning point
The crisis facing HIV programs reflects a deeper turning point in global health, said Javier Guzman, director of global health policy at the Center for Global Development. He pointed to broader cuts in official development assistance — not just in the U.S., but across Europe — as high-income countries shift focus to domestic priorities like defense.
"This is not a temporary issue that will be solved in a few months,' Guzman said. "Social investment is not going to be as high as it was before.'
Some countries — South Africa, Botswana and Kenya — are paying for most of their HIV programs domestically, with plans to become fully self-sufficient in the coming years, according to Byanyima, the UNAIDS leader. But the abrupt nature of the U.S. withdrawal has left even these health systems struggling to absorb programs such as Pepfar.
The cuts and firings are "essentially dismantling what's been an incredibly effective public health program just overnight,' said Judith Currier, co-director of the Center for AIDS Research and Education Center at the University of California, Los Angeles, and a member of Pepfar's scientific advisory board. "It won't be easy to just flip a switch and turn that back on.'
For Wambui, the idea of losing what's been built over two decades feels not just tragic — but senseless. The U.S. should be proud of what it has achieved, she said. "They have saved lives — not for one or two years — but for decades.'
"If I met Trump,' she said, "I would tell him not to allow the gains made from that fight over so many years to go to waste.'