
PEPFAR keeps millions of people with HIV alive and may be spared from Trump spending cuts
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Fears of an AIDS resurgence
Today, many babies are born infection-free to mothers with HIV — the U.S. State Department says PEPFAR has been responsible for 5.5 million such births — and most people around the world no longer see an infection as a death sentence.
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Governments in Africa and elsewhere had even begun to worry about complacency as people, especially youths, took the widespread availability of HIV drugs for granted. In another significant step forward, the U.S. Food and Drug Administration recently approved for use the world's only twice-a-year shot to prevent HIV.
But the abrupt U.S. aid cuts have health officials in developing countries warning of a return to the early days of the AIDS pandemic, when drugs were nonexistent or severely limited and clinics were filled with the dying. PEPFAR was launched in 2004 in response to those grim scenes.
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Also known as the U.S. President's Emergency Plan for AIDS Relief, the program has partnered with nonprofit groups to provide HIV medication — including the preventative PrEP — to millions around the world. It has strengthened national health care systems, cared for children orphaned by AIDS and provided job training for people at risk. It has played an important role in testing for and tracking HIV infections.
HIV/AIDS has no cure, and it has killed over 40 million people globally over the years. Now the U.N. agency on AIDS is warning that analysis suggests 4 million additional AIDS-related deaths between now and 2029, including 300,000 additional children's deaths, if programs permanently lose PEPFAR's support.
From widespread support to baseless claims
Since PEPFAR's creation by Congress and Republican President George W. Bush, the program has largely enjoyed support across the political spectrum — and gratitude from countries whose health systems have been poorly equipped to care for millions with HIV.
But misinformation has crept in. The Heritage Foundation, an influential conservative Washington think tank, accused the Biden administration of using PEPFAR 'to promote its domestic radical social agenda overseas.' Conservatives claimed there were efforts to integrate abortion with HIV/AIDS prevention, a claim the Biden administration denied. Similar claims linger under the Trump administration.
Trump and his officials also claim widespread waste and fraud as they seek to dismantle U.S. foreign aid. But PEPFAR has been repeatedly scrutinized. Last year, the government said the State Department's Office of Inspector General had conducted 80 audits, inspections, and special reviews that included oversight of PEPFAR programs, 'including 21 thematic reviews and audits specifically focused on PEPFAR.'
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Impossible to replace US funding
The $400 million proposed cut to PEPFAR still could be restored, in part or in full, as the bill on spending cuts faces a final vote in the Senate, a vote in the House of Representatives and Trump's signature before a Friday deadline.
'We must stay vigilant,' International AIDS Society President Beatriz Grinsztejn said in a statement Wednesday after PEPFAR appeared to be spared.
No matter what, countries and health experts say it will be impossible to fill the funding gap left by the overall U.S. withdrawal of billions of dollars in aid for the global HIV response, including via PEPFAR.
Last month, a UNAIDS report said the abrupt cuts have 'destabilized supply chains, led to the closure of health facilities, left thousands of health clinics without staff, set back prevention programs, disrupted HIV testing efforts and forced many community organizations to reduce or halt their HIV activities.'
South Africa, where more people live with HIV than anywhere else in the world, has said 12 specialized HIV clinics that were funded by the U.S. have had to close down and over 8,000 health workers in its national HIV program are out of work.
Now health workers there and elsewhere are trying to track down an unknown number of people who have lost access to HIV medication. The stakes are deadly. Stopping the drugs allows the virus to start multiplying again. HIV can rebound to detectable levels in people's blood in just a few weeks, putting sexual partners at risk. The virus could even become drug-resistant.
'It has really been hectic for us,' said Mbonisiwe Hlongwane, manager of the HIV program at the Bertha Gxowa public hospital in Germiston, east of Johannesburg. And the uncertainty only continues.
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Associated Press writer Mogomotsi Magome in Johannesburg contributed reporting.
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Axios
19 minutes ago
- Axios
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News24
20 minutes ago
- News24
Small win for activists, but SA's HIV projects won't be reopened
The $400 million that the United States Congress removed from a list of programmes from which the Trump administration wants to cut funds, doesn't cancel the cuts to global HIV and TB programmes made in February. HIV projects that have closed in South Africa, which were formerly funded by the US government, won't restart as a result of this decision. The 'limited Pepfar waiver' that President Donald Trump announced in February remains in place. The $400 million that the United States (US) Congress removed from a list of programmes from which the Trump administration will now take back previously approved but unspent funds doesn't mean that the cuts to global HIV and TB programmes in February, including those in South Africa, are now reversed. HIV projects that have closed in South Africa, which were formerly funded by the US government, won't restart as a result of this decision. In fact, quite the opposite. 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Opposition from within Trump's Republican Party against nonevidence-based cuts to a programme that has, for two decades, been supported by both the Democrats and Republicans and has saved over 25 million lives, is now at last emerging. 'It's a small win within the bigger context, but nonetheless, a huge win for advocacy, and a reminder that activism is powerful and alive, and making an impact,' Jirair Ratevosian, a former head of staff at Pepfar and fellow at Duke University's Global Health Institute, told Bhekisisa at last week's Conference on HIV Science in Kigali. Around $8 billion of the money was for foreign aid and development programmes, including global health, and just over $1 billion for public broadcast stations that the Trump administration has accused of being biased because they're too liberal. Marko Milivojevic/Pixnio via Bhekisisa But the Rescissions Act is, in itself, bad news. 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Three months later, in June, he decided he wanted to change some of that and submitted a $9.4-billion rescission request, which the House of Representatives (it has five more Republican than Democrat members) passed on 12 June. When it was the Senate's turn to vote on this, some Republican senators weren't happy with the $400-million Pepfar cut, signalling they wouldn't sign off on the deal unless the Pepfar part was removed. Because there was a danger of them swinging the vote, the Republicans removed the $400 million from the Rescissions Bill and got the House to pass that too. All that's left is for Trump to now sign the Act. 2. What was the $400 million that was removed from the Rescissions Act for? In short, no one really knows, because the Trump administration hasn't said what it was for - or what it plans to do with it. But what we do know is that the US law that governs rescissions, the Impoundment Control Act, says that the president can only request that Congress takes back funding that it previously approved, if the money has not yet been obligated - that means funds hadn't yet been given to a particular recipient, for instance, an HIV project in South Africa. We also know that the $400-million was part of the financial budget for 2025, says Warren, but because the law gives Pepfar permission to spend money over five years, that money doesn't have to be legally spent until 2029. 3. What will the $400 million now be used for? Again, no one knows. We don't even know if it will be used, because over the past few months, the Trump administration's main strategy has 'simply been to illegally impound funds - by announcing a 'funding freeze' or 'programmatic review' with no public notice at all - and force those harmed by the impoundments to pursue relief in court', the Centre on Budget and Policy Priorities explains in an analysis. But we do know what the money can't be used for. Unless the rules of Trump's 'limited waiver' are changed, Pepfar funds can mostly not be spent on any of the evidence-based strategies it paid for before Trump was elected in January. Pepfar used to focus on groups of people and areas where people have the highest chance of getting infected with HIV - that way, the programme got the biggest bang for its buck. 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We didn't think we lived in an earthquake zone, but January 20 (when Trump retook office) taught us: You need to be prepared for that earthquake and you therefore need a different infrastructure. 'In an earthquake you don't build back the same thing. You build better, something that is more resilient.' Show Comments ()

3 hours ago
The US fertility rate reached a new low in 2024, CDC data shows
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