'Confusion' in South Africa over US HIV funding
Some South African organizations that assist people with HIV are in limbo, after the United States put a 90-day freeze on most foreign aid. The U.S. State Department later added a waiver for "lifesaving" aid, but NGOs that have already shut their doors say the next steps aren't clear, and they are worried this could set back years of progress.
South Africa has the highest number of HIV-positive people in the world — about 8 million — but has also been a huge success story in terms of treatment and preventing new infections.
That's largely due to the money poured into expert HIV care here, 17% of which comes from a U.S. program called the President's Emergency Plan for AIDS Relief, also known as PEPFAR.
But, a 90-day foreign aid funding freeze is in effect, following an executive order by U.S. President Donald Trump last month to check if U.S.-funded programs overseas are aligned with U.S. policies. This has caused some confusion in South Africa with health care organizations and their patients.
Thamsanqa Siyo, an HIV-positive transgender woman in South Africa, is anxious.
"People are frustrated, they're living in fear, they don't know what's going to happen," said Siyo. "They don't know if it's stopped temporarily or not temporarily."
The Cape Town clinic that Siyo used to go to has now been closed for two weeks.
While the State Department has issued a waiver to continue paying for "lifesaving" services, what that includes remains unclear to many South African organizations that receive funding from PEPFAR.
U.S. Secretary of State Marco Rubio said this week that the waiver was clear.
"If it saves lives, if it's emergency lifesaving aid — food, medicine, whatever — they have a waiver," said Rubio. "I don't know how much clearer we can be."
The State Department also issued written clarification and guidance on February 1 regarding which activities are and are not covered by the waiver for PEPFAR programs.
The South African government said it was blindsided by the U.S. aid freeze, according to Health Minister Aaron Motsoaledi, who convened a meeting about PEPFAR on Wednesday.
Motsoaledi also said he has sought clarity on the waiver.
"If you say American money cannot be used for LGBTQWI+ and we do the counseling and testing and somebody who falls within that category, transgender, tests positive, can they not be helped?" he asked. "Even if it's lifesaving?"
Linda-Gail Bekker is a doctor and scientist who heads the Desmond Tutu HIV Center in South Africa.
"This is not one homogenous picture," said Bekker. "In some places, it's parts of services that have been stopped. In other places, the whole clinic, if it was supplied by PEPFAR, has been closed down."
She also said that some transgender health services have been completely closed, and in other areas, counselors haven't been able to come in.
In addition, she said some services and drugs are no longer available, such as community-based testing and pre-exposure prophylaxis, a medicine that prevents people at high risk from contracting HIV.
Ling Sheperd, who works for Triangle Project, an nongovernmental organization that provides services for the queer community, said there's a risk of "undoing decades of progress."
"The impact is devastating," said Sheperd. "The PEPFAR funding has been a lifeline for millions and it ensures access to HIV treatment, prevention services, and of course community-based health care. And without it we are seeing interruptions in medication supply, clinics are scaling back services, and community health workers have literally been losing their livelihoods."
About 5.5 million South Africans are on anti-retroviral medication for HIV. Motsoaledi noted that most of that is funded by the government here.
However, he said, a PEPFAR shortfall will affect training, facilities and service delivery. The government said it is working on contingency plans that would reduce dependence on foreign aid in the HIV sector.
On Wednesday, a group of health organizations sent a letter to the South African government saying at least 900,000 patients with HIV were directly affected by the U.S. stop-work orders.
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