Latest news with #Pepfar
News24
14 hours ago
- Health
- News24
It's the ‘Donald disease' that's making us sick
Our so-called HIV 'key populations' — men who have sex with men, transgender women, sex workers and people who inject drugs, and, in Africa also young women — have been hard-hit ever since the Trump administration stopped most of its HIV funding in February. Key populations have a much higher chance of getting HIV than general populations, which is why Pepfar, over the past decade, allocated most of its funds to programmes working with such groups. With the 12 specialised key population clinics in South Africa funded by the US government and now shuttered, getting treatment at government clinics has been difficult, if not impossible, for some. 'Hello, sis. How are you? I hope you're fine. I mean, I'm not.' A lot has been going on out there, he told Bhekisisa in the voicemail, one of the many we recently received. 'You know, I'm a gay guy. I have sex with other men, without wearing condoms now, because when I try to fetch them from my local clinic, I'm told I get judged and told I want too many. You know what's happening in our industry.' We will call him Nkosi. Because he has sex with men and because his industry is sex work and because no one in the small community where he lives knows that he is gay or what he does for work. He even has a 'girlfriend' so people will think he's straight. Sex work has always been a dangerous profession. But ever since the Trump administration stopped most of its HIV funding in February, it's become even more risky. The World Health Organisation says gay and bisexual men like Nkosi's chance of contracting HIV through sex is 26 higher than that of the general population. Male sex workers are even more likely to get infected with the virus. That is what makes sex workers, as well as gay and bisexual men, what researchers call a ' key population ' in the HIV world. Other key populations are gay and bisexual men, transgender people, people who inject drugs, and, in Africa, also young women between the ages of 15 and 24. Because so many new HIV infections happen in these groups, the US government's Aids fund, Pepfar, has, for the past decades, invested most of its funds in programmes working with these groups. But the 12 specialised clinics for key populations, supported by the US government's Aids fund, Pepfar, have now been shut down. Gone, too, are their health workers specially trained in how to work without discrimination. Gone is their tailor-made HIV treatment and testing services; their specialised mental health support; and the condoms and lubricants they handed out for protection against HIV and other sexually transmitted infections. Gone are the two-monthly anti-HIV jabs and that some of these clinics handed out as part of studies — and the daily anti-HIV pills, which they distributed without any judgement. Although government clinics also stock the daily anti-HIV pill, which, if used correctly, can reduce someone's chance of getting HIV through sex to close to 0, people like Nkosi, research shows, are often treated badly by health workers at state clinics, making them wary to return. Preventive medicines like the daily pill are called pre-exposure prophylaxis, or PrEP, because they stop infection by preventing a germ such as HIV from penetrating someone's cells. 'So sometimes I don't have PrEP,' says Nkosi. 'A partner can tell me he is on PrEP, but I don't trust that. Because where is he getting PrEP? Where am I going to get it? The black market? 'I don't know if it is even the real thing. Is it a counterfeit? Lube? That's another thing — you use everything, anything, as long as it's got jelly in it. The last time I did that I had an itchy penis for a week.' Nkosi calls the domino effect of the Trump administration's decision to pull funding 'the Donald disease because it is being caused by this guy, one man.' 'It's like crossing the freeway every day the way we're living now. One day, I know I'm gonna die.' What's with key populations? When Health Minister Aaron Motsoaledi called a press conference in May to present his '18 facts' about the crisis, eight of those points were about what government is doing to make sure the patients from those specialised clinics — over 63 300 patients — were taken care of and that their files have been transferred to the nearest government facility. But why is there so much focus on these communities? UNAids says more than half of all new infections in 2022, around the world, came from key populations — and infections don't stay within those groups. 'Even the most self-interested people should be heavily invested in treatment and prevention of these populations,' says Francois Venter, who heads up the health research organisation, Ezintsha, at Wits University. 'There's no clean, magical division between key populations and general populations. It's a Venn diagram of married men sleeping with sex workers, of drug-using populations interacting with your ostensibly innocent kids, gay men with your straight presenting son, all needing HIV prevention and treatment programmes.' Although we have medicines like PrEP to prevent people from getting infected with HIV and antiretroviral drugs (ARVs) for HIV-infected people, which, if taken correctly, reduce their chance of transmitting the virus to others to 0, having the medications available, is just a small part of the solution. What's more difficult is to get medication to people and to convince people to use it, and to use it correctly. Studies, for example, show that getting people to use the anti-HIV pill, also called oral PrEP, each day, has been a struggle — and those who do use it, often don't use it each day, the less often it's used, the less well it works. Moreover, United Nations targets that South Africa needs to reach by the end of 2025, show that we struggle with convincing people who know they're infected with HIV, to take treatment — and stay on it. Researchers estimate that of South Africa's 8-million people with HIV, 1.1-million people who have been diagnosed with HIV, are not on treatment. Some of the 1.1-million choose not to start treatment, but an even larger proportion, who do go on treatment, cycle in and out of it. READ | 'It erases the very existence of people like me': Activists tackle doctors' anti-trans stance Pepfar programmes funded thousands of 'foot soldiers', such as community health workers, adherence counsellors, data collectors and youth workers, who went into communities with mobile clinics to find people who stopped their treatment, or to make ARVs easier to get by making it possible for people to collect their medicine from community halls, shops or private pharmacies close to where they live. That's why having lost at least half of those workers — we're likely to lose the other half at the end of the US financial year in September — is such a tragedy. And why, if we do nothing to replace them, modelling studies show, there's a high chance that we see up to almost 300 000 extra HIV infections over the next four years and a 38% increase in Aids deaths. The difficulty with state clinics and key populations Government clinics are mostly not geared towards key populations, because they serve everyone. And because many health workers' own prejudices so often interfere with the way in which they treat patients such as sex workers, gay and bisexual men, or teens who ask for condoms or PrEP, such groups frequently feel uncomfortable to use state health services. Stigma and discrimination in public clinics — doled out by security guards, cleaners, health workers and patients in waiting rooms — keep people away from HIV treatment and prevention. Researchers who surveyed over 9 000 people in key populations found that less than half, and in some cases not even a quarter, said they were treated well; about one in five said they were blocked from getting services. Motsoaledi says he's trying to fix that by now training 1 012 clinicians and 2 377 non-clinician workers at government facilities in non-discriminatory healthcare. But despite similar trainings having been conducted for years already, discrimination remains rife. Because funding cuts mean already understaffed government health clinics now have even fewer staff, many people with HIV, or those wanting PrEP, have to travel further for treatment, or wait in long queues. As politicians, activists and researchers duke it out from labs and clinics and press conferences, many of those most at risk, like Nkosi, have been left to fend for themselves. Here are some of their stories — we collected the stories via voice notes with the help of health workers who worked for Pepfar programmes that have now been defunded. Female sex worker: 'My child is going to be infected' 'Yoh, life is very hard. Since all this happened, life has been very, very hard.' 'I have tried to go to the public clinic for my medication. But as sex workers, we are not being helped. We are scared to go to the government clinic to treat sexually transmitted infections because we are seen as dirty people who go and sleep around. We even struggle to get condoms. We are now forced to do business without protection because it is only our source of income and it's the way that we put food on the table. My worry now is that I am pregnant and my child is going to be infected because I'm not taking my ARVs, and I have defaulted for two months now.' READ | Elon Musk's estranged trans daughter, Vivian, makes bold modelling debut Transgender woman: 'The future is dark' 'I'm a transgender woman. My pronouns are she.' 'When the clinic closed, I was about to run out of medication so I went to the government clinic in my area. I introduced myself to the receptionist and the lady asked me what kind of treatment I was taking. I told her ARVs and that I'm virally suppressed [when people use their treatment correctly the virus can't replicate, leaving so little virus in their bodies that they can't infect others], so I can't transmit HIV to others. 'The lady told me that they can't help me, and I need to bring the transfer letter. I told her that the clinic is closed so I don't have the transfer letter. I asked to speak to the manager and the manager also refused to help me. The manager! How can she let someone who is HIV-positive go home without medication? 'I had to call one of my friends and she gave me one container. If you're not taking your medication consistently, you're going to get sick, you're gonna die. And the future? The future is dark.' Migrant farm worker: 'Lose my job? Or risk my health?' 'When we were told that the clinic was closed, I was actually in another town trying to get a seasonal job on the farms. But when I went to the nearest clinic, I was told that I needed to get a transfer letter. So, I ended up sharing medication with friends. But then their medication also ran out. 'Then I got a job on the farm. Before the mobile clinics came to the farms and we had our clinical sessions there. The nurse was there, the social worker was there. Now we went to the clinic and spent the whole day there because we had to follow the queues. And because our jobs were not permanent jobs, you know, you just get a job if you apply by the gate. So, if you are not there by the gate on that day, then the boss will automatically think that you are no longer interested in the job, so they employ someone else. 'I went to the government clinic and asked to get at least three months' supply. But the clinic said no because it was my first initiation, so I had to come back. So, I went back to the farm to see if I could still have my job. I found that I was no longer employed because they had to take up someone else. 'What am I going to do? If I go to the clinic, I stand a chance of losing my job. If I stay at my job I am at risk of getting sick.'
TimesLIVE
a day ago
- Health
- TimesLIVE
It's the ‘Donald disease' that's making us sick
As stakeholders duke it out, those with most to lose from HIV funding cuts tell Bhekisisa they have been left to fend for themselves — bad news for all of us By 'Hello, sis. How are you? I hope you're fine. I mean, I'm not.' A lot has been going on out there, he told Bhekisisa in the voicemail, one of the many we recently received. 'You know, I'm a gay guy. I have sex with other men, without wearing condoms now, because when I try to fetch them from my local clinic, I'm told I get judged and told I want too many. You know what's happening in our industry,' he said. We will call him Nkosi. Because he has sex with men and because his industry is sex work and because no-one in the small community where he lives knows that he is gay or what he does for work. He even has a 'girlfriend' so people will think he's straight. Sex work has always been a dangerous profession. But ever since the Trump administration stopped most of its HIV funding in February, it's become even more risky. The World Health Organization says gay and bisexual men like Nkosi's chance of contracting HIV through sex is 26 times higher than that of the general population. Male sex workers are even more likely to get infected with the virus. That is what makes sex workers, as well as gay and bisexual men, what researchers call a ' key population ' in the HIV world. Other key populations are transgender people, people who inject drugs, and, in Africa, also young women between the ages of 15 and 24. Because so many new HIV infections happen in these groups, the US government's Aids fund, Pepfar, has, for the past decades, invested most of its funds in programmes working with these groups. But the 12 specialised clinics for key populations, supported by Pepfar, have now been shut down. Gone, too, are their health workers specially trained in how to work without discrimination. Gone is their tailor-made HIV treatment and testing services; their specialised mental health support; and the condoms and lubricants they handed out for protection against HIV and other sexually transmitted infections. Gone are the two-monthly anti-HIV jabs that some of these clinics handed out as part of studies — and the daily anti-HIV pills, which they distributed without judgement. Though government clinics also stock the daily anti-HIV pill, which, if used correctly, can reduce someone's chance of getting HIV through sex to close to 0, people like Nkosi, research shows, are often treated badly by health workers at state clinics, making them wary to return. Preventive medicines like the daily pill are called pre-exposure prophylaxis, or PrEP, because they stop infection by preventing a germ such as HIV from penetrating someone's cells. 'So sometimes I don't have PrEP,' says Nkosi. 'A partner can tell me he is on PrEP, but I don't trust that. Because where is he getting PrEP? Where am I going to get it? The black market? I don't know if it is even the real thing. Is it a counterfeit? Lube? That's another thing — you use everything, anything, as long as it's got jelly in it. The last time I did that I had an itchy penis for a week.' Nkosi calls the domino effect of the Trump administration's decision to pull funding 'the Donald disease, because it is being caused by this guy, one man. It's like crossing the freeway every day the way we're living now. One day, I know I'm gonna die.' What's with key populations? But why is there so much focus on these communities? UNAids says more than half of all new infections in 2022, around the world, came from key populations — and infections don't stay within those groups. 'Even the most self-interested people should be heavily invested in treatment and prevention of these populations,' says Francois Venter, who heads up the health research organisation, Ezintsha, at Wits University. 'There's no clean, magical division between key populations and general populations. It's a Venn diagram of married men sleeping with sex workers, of drug-using populations interacting with your ostensibly innocent kids, gay men with your straight-presenting son, all needing HIV prevention and treatment programmes.' Though we have medicines like PrEP to prevent people from getting infected with HIV and antiretroviral drugs (ARVs) for HIV-infected people, which, if taken correctly, reduce their chance of transmitting the virus to others to 0, having the medications available is just a small part of the solution. What's more difficult is to get medication to people and to convince people to use it, and to use it correctly. Researchers estimate that of South Africa's 8-million people with HIV, 1.1-million are not on treatment. Some of the 1.1-million choose not to start treatment, but an even larger proportion, who do go on treatment, cycle in and out of it Studies, for example, show that getting people to use the anti-HIV pill, also called oral PrEP, each day, has been a struggle — and those who do use it, often don't use it each day. The less often it's used, the less well it works. Moreover, UN targets that South Africa needs to reach by the end of 2025, show that we struggle to convince people who know they're infected with HIV, to take treatment — and stay on it. Researchers estimate that of South Africa's 8-million people with HIV, 1.1-million are not on treatment. Some of the 1.1-million choose not to start treatment, but an even larger proportion, who do go on treatment, cycle in and out of it. Pepfar programmes funded thousands of 'foot soldiers', such as community health workers, adherence counsellors, data collectors and youth workers, who went into communities with mobile clinics to find people who stopped their treatment, or to make ARVs easier to get by making it possible for people to collect their medicine from community halls, shops or private pharmacies close to where they live. That's why having lost at least half of those workers — we're likely to lose the other half at the end of the US financial year in September — is such a tragedy. And why, if we do nothing to replace them, modelling studies show, there's a high chance that we see up to almost 300,000 extra HIV infections over the next four years and a 38% increase in Aids deaths. The difficulty with state clinics and key populations Government clinics are mostly not geared towards key populations, because they serve everyone. And because many health workers' own prejudices so often interfere with the way they treat patients such as sex workers, gay and bisexual men, or teens who ask for condoms or PrEP, such groups frequently feel uncomfortable to use state health services. Stigma and discrimination in public clinics — doled out by security guards, cleaners, health workers and patients in waiting rooms — keep people away from HIV treatment and prevention. Researchers who surveyed more than 9,000 people in key populations found that less than half, and in some cases not even a quarter, said they were treated well; about one in five said they were blocked from getting services. Motsoaledi says he's trying to fix that by now training 1,012 clinicians and 2,377 non-clinician workers at government facilities in non-discriminatory healthcare. But despite similar trainings having been conducted for years already, discrimination remains rife. Because funding cuts mean already understaffed government health clinics now have even fewer staff, many people with HIV, or those wanting PrEP, have to travel further for treatment, or wait in long queues. As politicians, activists and researchers duke it out from labs and clinics and press conferences, many of those most at risk, like Nkosi, have been left to fend for themselves. Here are some of their stories — we collected the stories via voice notes with the help of health workers who worked for Pepfar programmes that have now been defunded. Female sex worker: 'My child is going to be infected' 'Yoh, life is very hard. Since all this happened, life has been very, very hard. 'I have tried to go to the public clinic for my medication. But as sex workers, we are not being helped. We are scared to go to the government clinic to treat sexually transmitted infections because we are seen as dirty people who go and sleep around. We even struggle to get condoms. We are now forced to do business without protection because it is our only source of income and it's the way that we put food on the table. My worry now is that I am pregnant and my child is going to be infected because I'm not taking my ARVs, and I have defaulted for two months now.' Transgender woman: 'The future is dark' 'I'm a transgender woman. My pronouns are she. 'When the clinic closed, I was about to run out of medication so I went to the government clinic in my area. I introduced myself to the receptionist and the lady asked me what kind of treatment I was taking. I told her ARVs and that I'm virally suppressed [when people use their treatment correctly the virus can't replicate, leaving so little virus in their bodies that they can't infect others], so I can't transmit HIV to others. 'The lady told me that they can't help me and I need to bring the transfer letter. I told her that the clinic is closed so I don't have the transfer letter. I asked to speak to the manager and the manager also refused to help me. The manager! How can she let someone who is HIV-positive go home without medication? 'I had to call one of my friends and she gave me one container. If you're not taking your medication consistently, you're going to get sick, you're gonna die. And the future? The future is dark.' Migrant farm worker: 'Lose my job? Or risk my health?' 'When we were told that the clinic was closed, I was actually in another town trying to get a seasonal job on the farms. But when I went to the nearest clinic, I was told that I needed to get a transfer letter. So I ended up sharing medication with friends. But then their medication also ran out. 'Then I got a job on the farm. Before the mobile clinics came to the farms and we had our clinical sessions there. The nurse was there, the social worker was there. Now we went to the clinic and spent the whole day there because we had to follow the queues. And because our jobs were not permanent jobs, you know, you just get a job if you apply by the gate. So if you are not there by the gate on that day, then the boss will automatically think that you are no longer interested in the job, so they employ someone else. 'I went to the government clinic and asked to get at least three months' supply. But the clinic said no because it was my first initiation so I had to come back. So I went back to the farm to see if I could still have my job. I found that I was no longer employed because they had to take up someone else. 'What am I going to do? If I go to the clinic, I stand a chance of losing my job. If I stay at my job I am at risk of getting sick.' Trans woman: 'I'll just stay home and die' 'Accessing treatment is difficult because of the long queues. Even that security guard keeps on telling me to go away when I ask for lubricants and he tells me every time there's no lubricants. 'We need the trans clinic back. I need to speak to somebody, a psychologist. On Tuesdays we had our psychologist come in, and the doctor. But now I don't have the funds to go and see even a psychologist. 'It is bad. It is super bad. I don't know when I last took my meds. Another friend of mine just decided, oh, OK, since the clinic is closed and I no longer have medication, I'll just stay home and die.'
Yahoo
a day ago
- Health
- Yahoo
Trump to slash funding for flagship US HIV programme by 40pc
America is proposing to cut its flagship anti-HIV programme by almost 40 per cent next year, according to new budget details that reveal sweeping reductions to global health spending. Details from Donald Trump's 2026 budget request show nearly a two-fifths fall in funding for the United States President's Emergency Plan for Aids Relief (Pepfar). The long-running programme is estimated to have saved more that 20 million lives in the past two decades, and is often cited as one of the world's most successful public health schemes. A recent analysis published in the Lancet found that as many as half a million more children could die from Aids by the end of the decade because of disruptions to Pepfar. The details on global health funding for the State Department, USAID agency, Centres for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH) also show deep cuts elsewhere. Analysis by the San Francisco-based KFF health policy charity found the government departments were planning a 55 per cent cut in separate tuberculosis funding, a 47 per cent cut in malaria funding and a 92 per cent cut in maternal health funding. The proposal also withdraws all £221m ($300m) given to Gavi, the vaccine alliance which provides jabs to children in poor countries. In total, the request for money for the American government's main global health funding account is £2.8bn ($3.8bn) in 2026, down from £7.4bn ($10bn) in 2025. Setting out the cuts, the State Department said the request for money 'eliminates funding for programmes that do not make Americans safer, such as family planning and reproductive health, neglected tropical diseases, and non-emergency nutrition'. Mr Trump's government upended US aid spending days after taking office, saying it would suspend all aid while projects were reviewed. It then proceeded to close hundreds of aid programmes, including Pepfar projects, resulting in lay-offs for thousands of health workers, particularly in Africa. The budget proposals now give a clear indication that Mr Trump intends to continue with sharp cuts and will quash any hopes that the funding taps could be switched back on again. A State Department explanation of the budget request uses the phrase 'America First' 37 times as it explains a new focus on cutting costs and protecting US national interests. For the 2026 fiscal year, which begins on Oct 1, the budget proposals request £2.1bn ($2.9bn) for Pepfar, a 38 per cent reduction from the £3.5bn ($4.7bn) requested in 2025. The State department said that after spending a total of £88bn ($120bn) in the past two decades, it was now focussing on finding a responsible 'off ramp' to hand over responsibility for the campaign against HIV to countries themselves. 'This [budget] request will allow the United States to accelerate the transition of HIV control programmes to recipient countries and increase international ownership of efforts to fight HIV/Aids.' Some projects may still be paid for by other government funds, but overall the KFF analysis found the budget included 'significant reductions in global health funding including the elimination of some programs and activities'. The details will prove a severe disappointment to aid projects who had hoped that despite Mr Trump's rhetoric, there was a chance funding could be renewed in the new fiscal year. Public health officials argue that continuing to fund global health projects to stamp out infectious diseases is still in America's best interests as infections often cross borders. One executive at a major South African anti-HIV organisation said: 'Nobody wins unless we all win. No one can make it out of this alone. This is how we achieve epidemic control.' Protect yourself and your family by learning more about Global Health Security Broaden your horizons with award-winning British journalism. Try The Telegraph free for 1 month with unlimited access to our award-winning website, exclusive app, money-saving offers and more.
Telegraph
a day ago
- Business
- Telegraph
Trump to slash funding for flagship US HIV programme by 40pc
America is proposing to cut its flagship anti-HIV programme by almost 40 per cent next year, according to new budget details that reveal sweeping reductions to global health spending. Details from Donald Trump's 2026 budget request show nearly a two-fifths fall in funding for the United States President's Emergency Plan for Aids Relief (Pepfar). The long-running programme is estimated to have saved more that 20 million lives in the past two decades, and is often cited as one of the world's most successful public health schemes. A recent analysis published in the Lancet found that as many as half a million more children could die from Aids by the end of the decade because of disruptions to Pepfar. The details on global health funding for the State Department, USAID agency, Centres for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH) also show deep cuts elsewhere. Analysis by the San Francisco-based KFF health policy charity found the government departments were planning a 55 per cent cut in separate tuberculosis funding, a 47 per cent cut in malaria funding and a 92 per cent cut in maternal health funding. The proposal also withdraws all £221m ($300m) given to Gavi, the vaccine alliance which provides jabs to children in poor countries. In total, the request for money for the American government's main global health funding account is £2.8bn ($3.8bn) in 2026, down from £7.4bn ($10bn) in 2025. Setting out the cuts, the State Department said the request for money 'eliminates funding for programmes that do not make Americans safer, such as family planning and reproductive health, neglected tropical diseases, and non-emergency nutrition'. Mr Trump's government upended US aid spending days after taking office, saying it would suspend all aid while projects were reviewed. It then proceeded to close hundreds of aid programmes, including Pepfar projects, resulting in lay-offs for thousands of health workers, particularly in Africa. The budget proposals now give a clear indication that Mr Trump intends to continue with sharp cuts and will quash any hopes that the funding taps could be switched back on again. 'No one can make it out of this alone' A State Department explanation of the budget request uses the phrase 'America First' 37 times as it explains a new focus on cutting costs and protecting US national interests. For the 2026 fiscal year, which begins on Oct 1, the budget proposals request £2.1bn ($2.9bn) for Pepfar, a 38 per cent reduction from the £3.5bn ($4.7bn) requested in 2025. The State department said that after spending a total of £88bn ($120bn) in the past two decades, it was now focussing on finding a responsible 'off ramp' to hand over responsibility for the campaign against HIV to countries themselves. 'This [budget] request will allow the United States to accelerate the transition of HIV control programmes to recipient countries and increase international ownership of efforts to fight HIV/Aids.' Some projects may still be paid for by other government funds, but overall the KFF analysis found the budget included 'significant reductions in global health funding including the elimination of some programs and activities'. The details will prove a severe disappointment to aid projects who had hoped that despite Mr Trump's rhetoric, there was a chance funding could be renewed in the new fiscal year. Public health officials argue that continuing to fund global health projects to stamp out infectious diseases is still in America's best interests as infections often cross borders. One executive at a major South African anti-HIV organisation said: 'Nobody wins unless we all win. No one can make it out of this alone. This is how we achieve epidemic control.'
The Independent
2 days ago
- Business
- The Independent
Millions of doses of ‘pandemic-ending' HIV jab at risk over Trump's aid cuts
Professor Linda-Gail Bekker recalls having 'shivers' when she found out that not one single woman given a revolutionary new jab in her medical trial had caught HIV. She told a global Aids summit last year that she 'literally burst into tears.' Now, she tells The Independent, that emotion has turned into an 'acute sense of despair '. The funding to get lenacapavir – a twice-yearly preventative jab that has been described as the nearest thing we have to an HIV vaccine – out to at least two million people around the globe is in question amid the turmoil accompanying Donald Trump decision to slash US aid spending. Lenacapavir stops HIV from replicating meaning that, as long as someone is on the drug, they are almost totally protected from developing the virus if they are exposed to it. Prof Bekker's study found a 96 per cent reduction in HIV overall - but in the arm of the trial looking at women and adolescent girls, there were no infections at all. Global funders, led by Pepfar and the Global Fund, in December promised to secure enough doses of the jab to protect at least two million people over three years. Its manufacturer Gilead says it will sell these at no profit, though it has not made the cost of a dose public. Gilead has also signed agreements with six pharmaceutical companies in India, Pakistan, Egypt, and the US to allow them to make generic versions of the drug in order to increase supply and drive down the cost of the jab. A significant chunk of the money to fund the doses of lenacapavir was set to come from the US-led global Aids response programme, the US President's Emergency Plan for Aids Relief (Pepfar). But this funding, and the future of Pepfar itself, is now uncertain. 'In all of the excitement [of the trial results] we were thinking, well, what do you do with [the] doses? What's the best way to use it?' Prof Bekker says. 'Suddenly, that is very much up in the air'. The other main funding source, the Global Fund to Fight AIDS, Tuberculosis and Malaria has said that it still aims to fund the doses of lenacapavir. Speaking to The Independent, however, Global Fund executive director Peter Sands tempers this by saying the success of his organisation's funding round coming up later this year would, 'determine how much scope we have for this'. The US was the Global Fund's biggest donor. Sands says that while he would 'love to say' the Global Fund could fill the gap, this would be contingent on how much money is raised from governments and private donors. "Despite all the uncertainties both around Pepfar and our own future funding, we are still very keen to deliver on the ambition,' Sands says. But, more funding than they have currently been pledged will be needed to, 'realise the full potential of lenacapavir'. At the World Health Organisation (WHO)'s annual decision-making meeting which concluded late last month, the United Nations' Aids agency (UNAIDS) called for 'urgent action to avoid millions of avoidable HIV infections and Aids-related deaths,' saying this included, 'access to long-acting injectables for HIV prevention which are almost 100 per cent effective at preventing infections' – a nod to lenacapavir. 'A missed opportunity' Prof Bekker played a crucial role in trialling the jab in eight countries including her home country of South Africa, and she was on the brink of seeing that breakthrough rolled out – it could have been in people's arms by the end of this year. Long-acting jabs like lenacapavir are not only about protecting individuals, they are a crucial part of ending the Aids pandemic, Prof Bekker explains. 'A six-monthly injectable is as close as we can get at this moment to a vaccine,' Prof Bekker says. Just like with a vaccine, it can help keep whole populations safe by stopping vulnerable people from catching the virus and then potentially spreading the virus to more people. 'You finally have something that could actually bring us to a conclusion [of the Aids crisis]. 'It just feels like such a calamitous missed opportunity,' she says. Overcoming stigma A daily preventative medicine – a combination of two drugs known collectively as pre-exposure prophylaxis (PrEP) – is already available and is very effective. But people without reliable access to healthcare find it harder to maintain a regime that involves regular pills. Girls, young women and LGBT+ people in Southern Africa can also face questioning from family members if they have packets of daily pills in their homes which indicate they are sexually active, and it can put women in relationships at higher risk of domestic violence. A six-monthly jab on the other hand can be maintained more discreetly and with less user error. Offering lenacapavir to young women – among the hardest to reach with HIV prevention - when they book into prenatal care can also prevent them from passing the virus onto their children. 'That is a good use of money, right?' Prof Bekker says. 'You're saving two infections; one of them a lifelong infection in a child that will need antivirals for the next 70 to 75 years'. 'They are young people in front of us. We can introduce them to Republican Congressmen if needed'. A State Department spokesperson said: 'Pepfar continues to support lifesaving HIV testing, care and treatment, and prevention of mother to child transmission services approved by the Secretary of State. 'As directed by the Secretary of State all other Pepfar-funded services are being reviewed for assessment of programmatic efficiencies and consistency with United States foreign policy. Pepfar, like all assistance programmes, should be reduced over time as it achieves its mission.' Ending Aids Figures previously reported by The Independent suggest Trump's slashing of foreign aid has derailed the projected end of the Aids pandemic and could lead to four million extra deaths by 2030. The latest global figures show there were 1.3 million new HIV infections and roughly 630,00 people dying from Aids around the world in 2023. Regardless of the cuts, before any doses can be made available, the drug has to be approved by regulators. The US Food and Drug Administration (FDA)'s decision is understood to be on track to approve the preventative jab on 19 June, followed by other national medicines regulators and the WHO. Before the cuts, an FDA approval would have marked the moment it would be full steam ahead to roll lenacapavir out to the people who need it most. But those approvals won't count for much if the money to pay for the drug and get it out to the people who need it doesn't materialise, as Prof Bekker fears. 'It does feel like this thing that could help us end the epidemic sooner is suddenly receding in the chaos'.
