Africa HIV deaths to mount, as Trump stops funding. Here's why

Al Jazeera

28-02-2025

United States funding cuts to HIV/AIDS programmes in many African countries could lead to hundreds of thousands of deaths on the continent, health experts and aid organisations have warned.
In South Africa alone, US funding halts could lead to 500,000 deaths in the next 10 years, an official of the Desmond Tutu HIV Center said on Thursday.
The warning comes as countries begin to feel the effect of massive US aid cuts. Just after taking office on January 20, President Donald Trump issued a sweeping executive order that paused foreign aid assistance for an initial duration of 90 days. This week, Trump's government cut 90 percent of foreign contracts funded by the US aid agency (USAID) and sacked thousands of its staff in Washington.
And on Thursday came news that the Trump administration had decided to stop funding UNAIDS, the UN's HIV/AIDS programme that serves communities around the world.
In a report this week, UNAIDS said at least 55 countries around the world had reported funding cuts to HIV programmes, including several in African countries. That included halts to 55 HIV projects supported by the US President's Emergency Plan for AIDS Relief (PEPFAR) or that received part US funding.
African countries bear the biggest burden of the HIV epidemic, with an estimated 25 million living with HIV in sub-Saharan Africa, out of the total 38 million people living with HIV worldwide.
PEPFAR, which started in 2003, is credited with saving 26 million lives, according to UNAIDS. The program's spending totals approximately $120bn since its inception.
Here's what to know about how aid cuts to HIV/AIDS programmes are affecting African countries:
What are experts and aid organisations saying?
On Thursday, Linda-Gail Bekker, chief operating officer of the Desmond Tutu HIV Center told reporters that funding cuts to South Africa will have a devastating impact.
Bekker made the statement after many South African aid groups were notified this week by the US Department of State that their grants under USAID had been cancelled. According to the AFP news agency, the notices read that the grants no longer aligned with 'US priorities' and would be terminated for the 'convenience and the interest of the US government'.
But Bekker said the consequences of that decision will be dire.
'We will see lives lost,' the official said. 'In excess of half a million unnecessary deaths will occur because of the loss of the funding, and up to a half a million new infections.'
Already, the United Nations said, HIV services in many African countries have been disrupted, including prevention, testing, and treatment services. Hundreds of thousands of people who once had free access to crucial antiretroviral treatment (ART) – medication that suppresses the viral load in infected people to undetectable levels and helps them lead healthy lives – have been cut off.
Shortly after the aid cut announcements, the US secretary of state issued an emergency waiver to resume 'life-saving' humanitarian assistance, including HIV treatment but not prevention programmes – unless they are for pregnant or breastfeeding women, presumably, to stop transmission from mother to child. And the block on funding UNAIDS will likely compound the resource challenges faced by nonprofits trying to serve patients and vulnerable communities.
Projects related to 'gender ideology' or diversity, transgender surgeries or family planning are forbidden under the waivers. Organisations have been invited to submit a 30-day work plan and budgets for review and approval before they can be approved.
It's unclear if any organisation has been cleared under the new rules yet. However, officials say there's massive confusion over how the waiver would be implemented on the ground, even with approval, as testing, prevention, and treatment projects often complement each other and would now have to be uncoupled.
In addition, many of the US implementing partners involved in the running of the programmes have either stopped working or are working at a reduced capacity.
What is the aid burden in Africa and how was US aid helping?
According to the Global HIV Prevention Coalition, the US was responsible for two-thirds of international financing in developing countries.
A major recipient is South Africa, the country with the highest HIV burden in the world at 7.5 million people. High prevalence in the country is linked to lower levels of education and awareness, especially in rural areas. Twenty percent of the world's HIV-infected persons are in South Africa, and 20 percent of new HIV infections also occur in the country.
South Africa has made progress in expanding the number of people accessing treatment for HIV, resulting in a 66 percent decrease in AIDS-related deaths since 2010. New HIV infections have also fallen by 58 percent, according to UNAIDS.
PEPFAR funds made up about 17 percent of South Africa's HIV budget ($400m), while the South African government took up the majority according to the country's health ministry. That support helped ensure that about 5.5 million people received antiretroviral (ARV) treatment yearly, according to the National Department of Health.
Similarly, more than half of HIV medicines bought for the Democratic Republic of Congo (DRC), Mozambique, Tanzania, and Zambia are secured through US funding, according to the UN.
Of the 20 countries that are most reliant on US aid for HIV/AIDs programmes, 17 are in Africa, the UN says.
They include: DRC, Mozambique, Tanzania, Zambia, Uganda, Nigeria, Rwanda, Angola, Kenya, Ukraine, Burkina Faso, Burundi, Zimbabwe, Togo, Côte d'Ivoire, Eswatini, and Benin.
The other three are Haiti, El Salvador and Nepal.
Which HIV programmes have been cut in Africa?
South Africa: Several HIV treatment clinics have been shut, including in rural areas of KwaZulu-Natal, which has about 1.9 million people living with HIV and is the worst-affected region in the country. That has caused an influx of patients to other overstretched general public facilities, according to reports by The Associated Press agency. Facilities such as Engage Men's Health in Johannesburg, which supported gay men, or the Tswane HIV/tuberculosis clinic in Pretoria have been closed. In total, about 222,000 people living with HIV, including 7,445 children under the age of 15, face disruptions in their daily antiretroviral therapy supplies, according to UNAIDS.
In Ivory Coast, where the US supported more than 400,000 adults and children living with AIDS, 516 health facilities have been completely shut down, according to the UN. Eighty-five percent of people on HIV treatment are affected, and more than 8,600 staff, including doctors, nurses, and midwives affected.
An orphanage in rural Botswana, catering to children living with HIV, has been shut down, according to reporting by The New York Times.
In Mozambique, the UN says HIV testing is no longer available in most parts of the country, and community workers, educators, and counsellors who worked with PEPFAR-funded projects have stopped receiving payments.
In Tanzania, community health workers, educators, and counsellors funded by PEPFAR have lost their jobs.
An HIV vaccine trial led by BRILLIANT Consortium, a medical research organisation in South Africa, and with $45m in funding support from USAID, has been paused, according to Stat News. The trial aimed to produce neutralising antibodies that could potentially fight off HIV. It was supposed to launch in late January, with 48 participants across three countries: Uganda, Kenya and South Africa.
How are countries responding?
South Africa has sought to allay fears that the funding gap was a death sentence to HIV prevention programmes, pledging to strengthen its health system and care. Earlier this month, President Cyril Ramaphosa said his administration was working on local solutions.
'We are looking at various interventions to address the immediate needs and ensure the continuity of essential services,' he said.
One of those interventions was kickstarted in Soweto, one of the hardest-hit suburbs on February 25, under the Health Ministry. The ' HIV Treatment Campaign ' wants to persuade 1.1 million people already living with HIV, but who are not on treatment, to be enrolled in treatment programmes by December.
Meanwhile, in Nigeria, the government in February approved about $3.3m to buy HIV treatment packs and fill the funding gaps over the next four months. A government committee focused on finding alternative financial support has also been launched.
Can African countries find alternative funding sources?
One major alternative to USAID is likely to be UNAIDS. The UN agency recently praised South Africa's new intervention initiative and said it will work with the government to ensure the continuity of HIV services.
'This plan protects the human rights of people living with HIV, offering them hope and an opportunity to live healthy and fulfilling lives,' the agency said in a statement, adding it was 'inspiring.'
But with the US not only suspending its own HIV prevention support but also stopping the funding for UNAIDS, it is unclear whether the UN agency will be able to help countries like South Africa.
Meanwhile, experts are calling on other Western countries, especially the European Union, to step up and fill the gaps.
'The EU and its member states collectively represent the largest global provider of ODA (official development assistance),' analyst Coline Le Piouff of the European Council on Foreign Relations wrote in a paper published on the organisation's website.
'As such, the bloc should harness the strength that comes from acting together and speaking as one voice,' Le Pious wrote.
In 2023, the EU donated 95.9 billion euros ($100bn) in foreign assistance, majorly to aid Ukraine, COVID-19, and climate change efforts.
In addition, private aid organisations, such as the Bill and Melinda Gates Foundation, may also have to fill in funding gaps, such as in research, some health experts say.
'They may chip in, but this is up to them because they also have their priorities,' Anna Roca, professor of epidemiology at the London School of Hygiene and Tropical Medicine told Clinical Trials Arena, a US publication focused on clinical research.
'It's not going to be easy to suddenly increase funding for something that was not part of the foundation's agenda. The Bill and Melinda Gates Foundation is already co-funding drug development with USAID, so some research may be able to continue. It's hard to say at the moment that if USAID is not there, how the industry is going to respond – we will have to see,' she added.