Following the executive order by US President Donald Trump to suspend foreign aid for 90 days, the US has since exempted funding for humanitarian aid including life-saving medicines. But it’s unclear what this means for South African programmes funded by the President’s Emergency Plan for AIDS Relief (PEPFAR).
Professor Linda-Gail Bekker, Deputy Director and Chief Operating Officer of the Desmond Tutu Health Foundation, and past president of the International AIDS Society, tells Health-e News that it’s unclear whether medicine for HIV falls within this waiver.
“Just about all PEPFAR-related programmes including treatment, care, prevention, research and development have received ‘Stop Work’ orders. To my knowledge none of those have been rescinded as yet,” she says.
The hard-line ‘Stop Work’ orders call for an immediate pause to any USAID-funded work. The result has been the closure of numerous NGOs providing HIV and sexual and reproductive health services to marginalised communities. These include Ivan Toms Centre for Health, the country’s first clinic for men who have sex with men, and Engage Men’s Health, which provides sexual health services.
PEPFAR in South Africa
South Africa has the largest HIV treatment programme with 5.5 million people receiving antiretrovirals paid for by the government. According to the health minister, the South African government funds approximately 74% of the HIV programme from domestic sources and 2% from the private sector. The country is one of the biggest beneficiaries of PEPFAR which contributes around 17% of South Africa’s HIV programme.
Professor Francois Venter, Executive Director of Ezintsha at the University of the Witwatersrand, says PEPFAR funding is a key part of the HIV service package.
“It’s important and often very strategic work, focused on key areas that the National Department of Health is often not great at executing – tracing people lost to follow up, services for key populations, information gathering, and plugging key gaps in the health services for people with HIV,” says Venter.
The potentially devastating ban comes amid far-reaching local fiscal constraints, a poor economic outlook and budget cuts across all government sectors, including within the Department of Health – with more cuts possible.
In the most recent adjustment budget released as part of the Medium-Term Budget Statement in November 2023, the amount dedicated to the District Health Grant, the main source of government funding for the HIV programme, included a reduction of the HIV budget by R285 million – to R1.29 billion per year.
“It is therefore crucial, more than ever, to further improve the allocative efficiency of the available resources for HIV,” Bekker emphasises.
Last push to end AIDS
The pause on US aid funds comes at a crucial time in the global push to end AIDS by 2030. To achieve this ambitious plan, countries have committed to the 95-95-95 goals: 95% of all people with HIV know their status; 95% of all people with HIV receive sustained antiretroviral therapy; and 95% of all people on ART have viral suppression.
“We’re struggling with the second 95 and have been for over a decade – and we need big interventions there – smart ones, new ones – it’s difficult to see how we will do that without the nimble, directed focus people like PEPFAR give us,” Venter says.
As of April 2024, progress stands at 95-80-93, with adult females at 96-84-94, adult males at 95-73-94, and children under 15 at 82-66-69, according to Bekker.
“The gaps in the system need to be closed – and the PEPFAR dollars provide the safety nets and additional technical support to do this.
“These tasks need an army of healthcare workers, both professional and lay, and PEPFAR was doing just that. And it goes beyond HIV to the particularly important ugly second cousin of HIV- tuberculosis. When HIV is not controlled then we light a fire under TB and the two epidemics feed off each other, says Bekker.
A blow to research
The biggest concern for Professor Glenda Gray, Director of the Infectious Disease and Oncology Research Institute at Wits University; and former CEO of the South African Medical Research Council, is the interruption of the HIV vaccine research being done by the Brilliant Consortium, (Bringing Innovation to Clinical and Laboratory research to end HIV In Africa through New vaccine Technology).
“It impacts our lab capacity in Africa, our ability to do deep research on immunogenicity, our clinical trial sites and the doctors and nurses we employ to manage them. Yes, it’s not directly about people’s lives (yet), but it stands to be a game changer.”
She described the impact of the Trump ban on HIV and TB programmes as ‘devastating.”
“Yes, PEPFAR only funded around one-fifth of the total HIV programme, but it was targeted at high-incidence groups and high-burden sites. By walking away from that you’re derailing efforts to control HIV.
“Walking away from research and development in Africa puts global security at risk,” she adds.
Turning a funding threat into an opportunity
An expert on HIV and global health, who asked not to be named, has come up with a bold plan to turn the “Trumpian” foreign funding madness on its head – and is actively canvassing Business Unity South Africa (BUSA) and the government.
He wants to create a local ‘Solidarity Fund’ for HIV and TB to ‘front load’ South Africa’s response to the intertwined pandemics while urging President Trump to significantly boost PEPFAR funding. The payoff for Trump would be the bragging rights that he effectively ended HIV in South Africa during his tenure.
“We need a practical and transactional response, not an emotional one. The key question is what can we give Trump in return for PEPFAR? He doesn’t care about fears or science. He cares about how he looks personally and politically. If he continues to fund South Africa over the next two to four years, with some negotiated provisos, we can bring the 95-95-95 UNAIDS goal forward by at least two years,” he suggests.
One of the key persuasive tools would be to decrease the number of new infections via the massive upscaling of a Lencapivir rollout (a single injection proven to offer six months of HIV protection).
“If we can persuade him of the efficacy of this; we can use it as a negotiating tool,” the source adds.
“We have to give him something – and that would be the boast that during his four-year administration, he was able to eliminate HIV in South Africa. Depending on how much we raise, we can mount an even bigger response – in other words, front load it. Trump loves the private sector which this would be. We need to reinvigorate the entire HIV programme. He doesn’t really care about how many people’s lives are saved. This is nothing else but politics.” – Health-e News
Source:
health-e.org.za
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