PEPFAR keeps millions of people with HIV alive and may be spared from Trump spending cuts
Advertisement
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.
Get Starting Point
A guide through the most important stories of the morning, delivered Monday through Friday.
Enter Email
Sign Up
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.
Advertisement
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.'
Advertisement
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.
Advertisement
Associated Press writer Mogomotsi Magome in Johannesburg contributed reporting.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Axios
19 minutes ago
- Axios
This Medicare change is giving hospitals heartburn
Hospitals found an unpleasant surprise buried in a proposed 913-page Medicare payment rule last week: a Trump administration plan to speed up — by a decade — the recovery of $7.8 billion in improper cuts to facilities' discount drug reimbursement. Why it matters: The change comes out to over $1 billion less than expected in Medicare payment next year, with more reductions going forward. Reduced Medicare payment would be a double whammy, hitting just as sweeping changes to Medicaid are expected to put new financial pressures on facilities. "It's piling on," Maureen Testoni, CEO of 340B Health, which advocates on behalf of hospitals that participate in the discount drug program, told Axios. Facilities that rely on these federal programs are "definitely going to reach unsustainability." Some industry groups are already threatening to sue to halt the plan if it's finalized, saying it punishes hospitals for a mistake that Medicare itself made between 2018 and 2022. The new timeline for clawbacks would jeopardize hospitals' ability to care for patients in need, Testoni said in a statement. Follow the money: The clawback stems from a Supreme Court ruling that overturned a nearly 30% cut the first Trump administration made in payments to safety-net providers in the 340B federal discount drug program, after research showed some could profit inappropriately off the program. Medicare repaid $9 billion to make the affected hospitals whole early last year. The problem was that Medicare budgeting anticipated future savings from the 30% cut boosted pay for hospital outpatient services other than dispensing drugs. To avoid adding to total Medicare spending, the Biden administration devised a plan to claw back $7.8 billion in increased reimbursements from hospitals over 16 years. Now, the administration wants to reduce that timeline by a decade, arguing the quicker process would make the burden on hospitals more closely reflect the benefits they previously received. A more drawn-out process could also be complicated by hospital closures, it said. That translates into a bigger annual clawback for hospitals already operating on tight margins. The Centers for Medicare and Medicaid Services also notified hospitals last week that it plans to conduct a survey early next year on their costs for acquiring drugs, including rebates and discounts that hospitals receive under the federal 340B discount drug program. The notice doesn't explicitly say that the survey will be used to justify future cuts to hospitals' reimbursement. But industry executives say that's the subtext, especially in light of the 2022 Supreme Court decision. Between the lines: Hospital participation in 340B has grown significantly over the past two decades. Nonprofit and public hospitals that qualify for the program say it enables them to provide charity care. But critics say it's gotten too big and charge that some hospitals abuse the program. Conservative think tanks that have the Trump administration's ear, like Paragon Health Institute, have recommended overhauling the way Medicare pays for discounted drugs. What they're saying: The American Hospital Association hinted it could sue the administration if it moves forward with accelerated clawbacks. "The proposed recoupment is both illegal and unwise, and it should not be finalized," Ashley Thompson, AHA's senior vice president of public policy analysis and development, said in a statement. The Association of American Medical Colleges also said that speeding up the clawbacks "will have catastrophic effects on patients nationwide." What to watch:"We expect significant pushback in the comments to this proposed rule and that the final rule may be less aggressive," Chris Meekins, managing director at Raymond James and health official in the first Trump administration, wrote in an analyst note.
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. The 'limited Pepfar (President's Emergency Plan for Aids Relief) waiver' that US President Donald Trump announced in February remains in place. That means no HIV-prevention activities, unless they intend to stop pregnant and breastfeeding women from infecting their babies, can be paid for with US government money, and projects that make it easier for teen girls and young women in Africa, trans people, sex workers, injecting drug users and gay and bisexual men - groups of people that have a higher chance of getting HIV than the general population - cannot be funded. READ | 'Systemic shock': SA's HIV viral load testing fell 21% in wake of Pepfar cuts - UNAIDS Without a proper explanation for it, the $400 million seems to be a random amount that Trump's administration picked to take back from Pepfar, a US government programme which funds Aids projects in poorer countries with high HIV infection rates, such as South Africa. The amount is about 8.5% of Pepfar's $4.725-billion budget for this financial year and was part of a larger $9.4-billion 'rescissions package' - that has now been reduced to $9 billion and passed as the HR4 Rescissions Act of 2025. Rescissions happen when the presidential administration wants to cancel funding that was approved by Congress and use it for something else. What the decision to remove the $400 million from the package does, however, mean is that activism could finally be starting to pay off. Activists have had hundreds of meetings with US senators and Congress committee chairs. There have been 'Save Pepfar' social media campaigns, and plenty of media coverage about the devastating consequences of the funding cuts. READ | Motsoaledi urges unity, assures HIV/Aids programme stability amid US Pepfar funding pullout Tens of modelling studies have also projected what could happen if the lost funds are not replaced. 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. 'It opens the floodgates for the Trump administration to say: 'We don't want this or that in the budget that Congress approved,' says Mitchell Warren, the head of international advocacy organisation, Avac. 'It's trying to take the congressional power of the purse and put it in the executive branch to usurp the role of Congress in deciding how much money - and on what to spend it.' So how did this all happen, and does it hold any good in the long term for South Africa? We break it down. 1. How did we get here? In the US, Congress - which consists of the Senate and the House of Representatives - decides how much government money goes to who, just like Parliament does in South Africa. Both the Senate and the House have to pass budgets. But, as analysts at the Centre for Budget and Policy Priorities in Washington, DC point out, Trump wants more control over how his administration's money is spent. In March, he signed the 2025 budget that Congress approved into law. 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. In South Africa, for instance, Pepfar worked in the 27 districts with the highest infection rates and groups known as 'key populations' - sex workers, gay and bisexual men, trans people, injecting drug users and African women between the ages of 15 and 24 - that are much more likely to get newly infected with HIV than other South Africans. Now those projects, which studies show stopped many new infections, have been closed down and the Trump administration says it's not prepared to buy HIV prevention medicine for any group other than pregnant and breastfeeding women. 'It used to be all about evidence,' Warren says. 'Now it's all about ideology.' 4. What do scientists and activists want the $400 million to be used for? Ratevosian says this moment should be used to gain Republican support to change the waiver rules, so that Pepfar money can cover more of the populations and services needed for HIV prevention. Lenacapavir, a pricey twice-a-year anti-HIV jab, which scientists believe could help to stop HIV in its tracks if it's rolled out properly, could be used to convince Republican Congress members, says Ratevosian. 'Pepfar has long wanted to get countries to transition to taking more ownership [read: Pay more] for their HIV responses. So now activists are arguing: 'Preventing more new infections with the jab, will make it easier for countries to take ownership because the pandemic will be easier to manage.'' In December, Pepfar said it would join another organisation, the Global Fund for HIV, TB and Malaria to buy enough lenacapavir for two million people over three years. But in July, the Global Fund had to go ahead with the deal by itself, because Pepfar seemed to no longer be on board. Warren says: 'If I were in charge, I would take the $400 million and double the two million people the Global Fund is planning to cover, because that's how you build a market, prevent new infections more quickly and drive the price down.' 5. What will Pepfar look like in future? Trump's funding cuts didn't kill Pepfar - at least not in theory, but it's a shell of its former self. What it will look like, will depend on the size of its next budget (the Trump administration wants to cut it by 40% but, so far, the House hasn't agreed to that, (the Senate still needs to sit on it) and how much support Republicans who believe in Pepfar can gain to have waiver rules changed. But, Warren points out, 'we're not going to get pre-January projects back; we have to build something different. 'This has been the most seismic shift in democracy. 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
NEW YORK -- The fertility rate in the U.S. dropped to an all-time low in 2024 with less than 1.6 kids per woman, new federal data released Thursday shows. The U.S. was once among only a few developed countries with a rate that ensured each generation had enough children to replace itself — about 2.1 kids per woman. But it has been sliding in America for close to two decades as more women are waiting longer to have children or never taking that step at all. The new statistic is on par with fertility rates in western European countries, according to World Bank data. Alarmed by recent drops, the Trump administration has taken steps to increase falling birth rates, like issuing an executive order meant to expand access to and reduce costs of in vitro fertilization and backing the idea of 'baby bonuses' that might encourage more couples to have kids. But there's no reason to be alarmed, according to Leslie Root, a University of Colorado Boulder researcher focused on fertility and population policy. 'We're seeing this as part of an ongoing process of fertility delay. We know that the U.S. population is still growing, and we still have a natural increase — more births than deaths,' she said. The U.S. Centers for Disease Control and Prevention released the statistic for the total fertility rate with updated birth data for 2024. In the early 1960s, the U.S. total fertility rate was around 3.5, but plummeted to 1.7 by 1976 after the Baby Boom ended. It gradually rose to 2.1 in 2007 before falling again, aside from a 2014 uptick. The rate in 2023 was 1.621, and inched down in 2024 to 1.599, according to the CDC's National Center for Health Statistics. Birth rates are generally declining for women in most age groups — and that doesn't seem likely to change in the near future, said Karen Guzzo, director of the Carolina Population Center at the University of North Carolina. People are marrying later and also worried about their ability to have the money, health insurance and other resources needed to raise children in a stable environment. 'Worry is not a good moment to have kids,' and that's why birth rates in most age groups are not improving, she said. Asked about birth-promoting measures outlined by the Trump administration, Guzzo said they don't tackle larger needs like parental leave and affordable child care. 'The things that they are doing are really symbolic and not likely to budge things for real Americans,' she said. The CDC's new report, which is based on a more complete review of birth certificates than provisional data released earlier this year, also showed a 1% increase in births — about 33,000 more — last year compared to the prior year. That brought the yearly national total to just over 3.6 million babies born. But this is different: The provisional data indicated birth rate increases last year for women in their late 20s and 30s. However, the new report found birth rate declines for women in their 20s and early 30s, and no change for women in their late 30s. What happened? CDC officials said it was due to recalculations stemming from a change in the U.S. Census population estimates used to compute the birth rate. That's plausible, Root said. As the total population of women of childbearing age grew due to immigration, it offset small increases in births to women in those age groups, she said. ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
