US funding freeze ‘potentially catastrophic’ say AIDS organisations

United States (US) President Donald Trump has suspended United States Agency for International Development (USAID) in South Africa, among other countries, for a minimum of 90 days, which is likely to have a devastating effect on HIV and AIDS treatment and care programmes here, according to experts.

“The impact can be catastrophic,” said Dr Ali Bacher, the former chairperson of Right to Care in South Africa (2008-2022), a non-governmental organisation that works to make medicine and care available to HIV and AIDS patients. It effectively interrupts lifesaving HIV healthcare services for people whose healthcare treatment dare not be interrupted, he said.

“If the US government significantly cut the funding, the ramifications for thousands and thousands of South Africans, mainly black South Africans, is too costly to even contemplate,” said Bacher.

The interruption of regular treatment and closure of treatment clinics could potentially lead to the HIV virus mutating and patients’ immune systems deteriorating for lack of medication, allowing HIV to progress to AIDS.

“With interrupted, irregular, erratic, or no treatment of HIV, a person’s life expectancy is between 2.5 to 12 years,” Bacher said.

Trump ordered the temporary funding freeze, saying it was in America’s best interests to review USAID partnerships and determine if they align with US foreign policy. Elon Musk, who grew up in South Africa during the 80s HIV epidemic, is pushing for USAID to be scrapped as part of budget cuts, claiming the department is corrupted.

“South Africa has received roughly $8 billion in PEPFAR [President’s Emergency Plan for AIDS Relief] funding over the past two decades,” a Democratic Alliance press release calling for the lifting of the USAID suspension stated.

USAID functions as the humanitarian arm of the US government, and some argue that is what makes America great – its global work and formidable values. PEPFAR, which is implemented by USAID in South Africa, was launched by former Republican President George Bush in 2003. South Africa is one of the biggest recipients of PEPFAR funding, and since its inception and partnership with local non-governmental organisations, it has brought the South African HIV pandemic under control.

PEPFAR contributes 17% to South Africa’s budget for the management of the HIV pandemic, according to South African Health Minister Dr Aaron Motsoaledi in a recent media briefing.

Right to Care supports 245 primary health centres in Mpumalanga and the Free State, according to Bacher. The organisation’s R1.4 billion budget in 2022 “mainly came from Washington”, he said. “The benefit for life by Right to Care and Washington cannot be put down in words,” Bacher said. PEPFAR has saved more than 26 million lives since it started, and covers the antiretroviral (ARV) treatment of 20 million people.

Bryan Schimmel, who has lived with HIV for decades, reiterated that ARVs “aren’t a once-off cure, but have to be taken on a regular basis otherwise the virus mutates”.

The Foundation for AIDS Research (AmfAR) reported that 101 368 South Africans “pick up new supplies of ARVs every single day, 365 days per year”. The interruption of regular treatment is concerning as it will be difficult to get people back on treatment after the stop-work orders are lifted, the organisation said.

The order to stop work issued by USAID on 28 January has temporarily shut down PEPFAR-funded HIV clinics. According to News24, at least three PEPFAR-funded South African programmes “let staff and patients know they were temporarily shutting their doors last week”.

Said Schimmel, “Ninety days isn’t a short period in HIV terms” and the impact this stoppage will have on people’s lives “depends on how dire the person’s health was to begin with”.

Without access to testing and regular treatment, the virus can begin to mutate and attach to the white blood cells, weakening the immune system. This is how HIV develops into full blown AIDS, and there could be deadly consequences for many South Africans without access to treatment. Patients are being directed to government clinics, but the backlog of patients is further interrupting treatment and making receiving treatment more difficult than it should be.

Though Schimmel is proactive about his health and on private medical insurance, he said that for less fortunate South Africans, their health is “usually compromised in the first place”, which would put them more at risk. ARV treatment allows for healthy immune systems to prevent drug resistant HIV and stop the transmission of HIV to others once the infected individual’s viral load is undetectable.

Said Bacher, “It is very serious, and please G-d they don’t stop it overnight.” Unfortunately, the effects of the suspension of PEPFAR funding in South Africa may soon become obvious.