Trump aid cuts deal a blow to HIV prevention in Africa
Emmanuel Cherem, a 25-year-old gay man in Nigeria, tested positive for
HIV
two months after U.S. President Donald
Trump
's administration cut access for at-risk groups like gay men and injecting drug users to medication that prevents infection.
Cherem admits he should have been more careful about practicing safe sex but had become accustomed to using the U.S.-supplied pharmaceutical. The drug - known as Pre-Exposure Prophylaxis, or
PrEP
- is typically taken daily as a tablet and can reduce the risk of contracting HIV through sex by 99%.
"I blame myself... Taking care of myself is my first duty as a person," Cherem said at his gym in Awka, the capital of Nigeria's southeastern state of Anambra.
"I equally blame the Trump administration because, you know, these things were available, and then, without prior notice, these things were cut off."
Trump ordered a 90-day pause on foreign aid after taking office in January and halted grants by the U.S. Agency for International Development (USAID). The agency was responsible for implementing the bulk of the assistance under the President's Emergency Plan for AIDS Relief (
PEPFAR
), the world's leading HIV/AIDS initiative.
Sub-Saharan
Africa
remains the epicenter of the AIDS pandemic. Trump's cuts have restricted the availability of drugs that millions of Africans have taken to prevent infection - particularly vulnerable communities such as gay men and sex workers - as aid groups and public health systems in Africa strove to roll back the disease.
The number of initiations, or people who have taken at least one dose of the drug, rose in Africa from fewer than 700 in 2016 to more than 6 million by late 2024, according to PrEPWatch, a global tracker. More than 90% of new initiations last year were financed by PEPFAR, using cheap generic versions of the drug.
Sub-Saharan Africa had 390,000 AIDS-related deaths in 2023, or 62% of the global total, according to UNAIDS, the United Nations AIDS agency. However, progress has been made: that death toll was down by 56% from 2010, according to the World Health Organization.
Now, some of those who've lost access to the preventative medication because of U.S. cutbacks are already testing positive, according to 10 patients, health officials and activists.
Restrictions on PrEP have coincided with dwindling supplies of more widely used HIV prevention tools like condoms and lubricants "because of the US funding cuts", according to a UNAIDS fact sheet from May. The combination is creating what nine activists and three medical experts described as a major threat to prevention across the continent.
"I just see this as incredibly short-sighted because we were on a winning path," said Linda-Gail Bekker, an HIV expert at the University of Cape Town.
She said that many African governments did not have the resources to spend on PrEP drugs on top of treatment for HIV infections, risking a worsening of the pandemic.
"It's as predictable as if you take your eye off a smouldering bushfire and the wind is blowing: a bushfire will come back."
Trump has said that the United States pays disproportionately for foreign aid and he wants other countries to shoulder more of the burden, as he seeks to reduce U.S. government spending across the board. The U.S. disbursed $65 billion in foreign assistance last year, nearly half of it via USAID, according to government data.
"It's a question of who has primary responsibility for the health needs of citizens of other countries, and it's their own governments," said
Max Primorac
, a former senior USAID official who is now senior research fellow at The Heritage Foundation's Margaret Thatcher Center for Freedom.
"We all know, and this is a bipartisan issue, that aid dependency doesn't help these people - that the best solution is for these countries to be able to take over the responsibility of these programs."
A RISE IN CASES
UNAIDS says the permanent discontinuation of PEPFAR-supported prevention and treatment programs could lead to an additional 2,300 new HIV cases globally per day. There were 3,500 new cases per day in 2023.
Reuters spoke to 23 health workers, PrEP users and activists, nearly all of whom said that the increase in HIV infections since the funding cuts was impossible to quantify because many organisations working with vulnerable populations have been defunded.
A State Department waiver issued on February 1 allowed some PEPFAR activities to restart, but only covered HIV prevention for mother-to-child transmission.
That means PEPFAR-financed PrEP is no longer available for gay and bisexual men, sex workers and injecting drug users who are especially exposed to the virus. Many African governments had specifically targeted these groups in their PrEP programs.
A spokesperson for the State Department, which oversees USAID and the PEPFAR program, told Reuters it "continues to support lifesaving HIV testing, care and treatment, and prevention of mother to child transmission services approved 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," the spokesperson said.
The spokesperson did not directly respond to a question about why the waiver had excluded vulnerable groups from PrEP distribution.
In East and Southern Africa, the sub-region that accounts for more than half of all people living with HIV, the U.S. had been funding nearly 45% of HIV prevention programming, UNAIDS said in March.
Some countries like Malawi, Zimbabwe and Mozambique were almost entirely dependent on PEPFAR for their HIV prevention programs, the agency said. In some wealthier nations, like South Africa and Kenya, PEPFAR represented less than 25% of spending on HIV prevention.
Russell Vought
, the director of the U.S. Office of Management and Budget, told a Congressional committee on June 4 that, due to high U.S. debt levels, Africa needed to shoulder more of the burden in fighting AIDS.
Asked specifically about restrictions on HIV prevention programs, Vought said: "We believe that many of these nonprofits are not geared toward the viewpoints of the administration." His office did not respond to a request for further details.
'I PRAY TRUMP CHANGES HIS POLICY'
Reuters spoke to four PrEP users in Nigeria, all gay or bisexual men, who have tested positive for HIV since January when they stopped being able to obtain more pills, after practicing unsafe sex.
Hearty Empowerment and Rights (HER) Initiative, a community-based organisation in southeastern Nigeria, worked with other groups that provide HIV/AIDS services to confirm the men's diagnosis and help secure treatment for them, said executive director Festus Alex Chinaza.
In Asaba, the capital of Nigeria's Delta state, Echezona, a 30-year-old gay man who took PrEP pills daily for more than three years, is struggling to come to terms with his HIV-positive test result, which he received in early May. He regrets that he had unprotected sex.
"I just pray and wish that Trump actually changes his policy and everything comes back to normal so that the spread and transmission of the virus would be reduced," said Echezona, who asked to be identified only by his first name for fear of stigma.
Like the other three men, he described being told by staff at community-based clinics that PrEP was only available to pregnant and lactating women, in line with the Trump administration guidelines.
Nigeria has an adult HIV prevalence rate of 1.3% and an estimated 2 million people living with HIV, the fourth-highest total globally, according to UNAIDS.
But for so-called key populations, the rates are much higher: 25% for men who have sex with men, according to a survey completed in 2021.
The Nigerian health ministry did not respond to a request for comment on the effects of the Trump administration's cuts to HIV prevention services.
South Africa - which has an estimated 7.7 million people living with HIV, according to UNAIDS, the highest number in the world - pays for its own PrEP pills.
But some clinics where so-called key populations obtained them relied on PEPFAR grants and have been forced to close in recent months.
PrEP is also available for free at public health centers, but gay men and sex workers often avoid such facilities, fearing discrimination and harassment, nine activists said.
Francois Venter, executive director of the Ezintsha medical research center at the University of the Witwatersrand in Johannesburg, said PrEP distribution from public sector clinics in the city had shown almost no increase since the Trump cuts.
Foster Mohale, spokesperson for South Africa's health ministry, said the ministry was "not aware" of reports that key populations were avoiding health facilities due to stigma.
"We have sensitized health officials across the country to create (a) conducive environment for all healthcare seekers/clients to access the service without feeling judged or discriminated against," he said.
(Reporting and writing by Robbie Corey-BouletAdditional reporting by
Seun Sanni
in Awka, Nigeria,
Nellie Peyton
in Johannesburg, Amindeh Blaise Atabong in Yaounde, Ange Adihe Kasongo in Kinshasa, Maxwell Akalaare Adombila in Accra and Jennifer Rigby in London. Editing by Daniel Flynn)
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Time of India
4 hours ago
- Time of India
Trump aid cuts deal a blow to HIV prevention in Africa
Emmanuel Cherem, a 25-year-old gay man in Nigeria, tested positive for HIV two months after U.S. President Donald Trump 's administration cut access for at-risk groups like gay men and injecting drug users to medication that prevents infection. Cherem admits he should have been more careful about practicing safe sex but had become accustomed to using the U.S.-supplied pharmaceutical. The drug - known as Pre-Exposure Prophylaxis, or PrEP - is typically taken daily as a tablet and can reduce the risk of contracting HIV through sex by 99%. "I blame myself... Taking care of myself is my first duty as a person," Cherem said at his gym in Awka, the capital of Nigeria's southeastern state of Anambra. "I equally blame the Trump administration because, you know, these things were available, and then, without prior notice, these things were cut off." Trump ordered a 90-day pause on foreign aid after taking office in January and halted grants by the U.S. Agency for International Development (USAID). The agency was responsible for implementing the bulk of the assistance under the President's Emergency Plan for AIDS Relief ( PEPFAR ), the world's leading HIV/AIDS initiative. Sub-Saharan Africa remains the epicenter of the AIDS pandemic. Trump's cuts have restricted the availability of drugs that millions of Africans have taken to prevent infection - particularly vulnerable communities such as gay men and sex workers - as aid groups and public health systems in Africa strove to roll back the disease. The number of initiations, or people who have taken at least one dose of the drug, rose in Africa from fewer than 700 in 2016 to more than 6 million by late 2024, according to PrEPWatch, a global tracker. More than 90% of new initiations last year were financed by PEPFAR, using cheap generic versions of the drug. Sub-Saharan Africa had 390,000 AIDS-related deaths in 2023, or 62% of the global total, according to UNAIDS, the United Nations AIDS agency. However, progress has been made: that death toll was down by 56% from 2010, according to the World Health Organization. Now, some of those who've lost access to the preventative medication because of U.S. cutbacks are already testing positive, according to 10 patients, health officials and activists. Restrictions on PrEP have coincided with dwindling supplies of more widely used HIV prevention tools like condoms and lubricants "because of the US funding cuts", according to a UNAIDS fact sheet from May. The combination is creating what nine activists and three medical experts described as a major threat to prevention across the continent. "I just see this as incredibly short-sighted because we were on a winning path," said Linda-Gail Bekker, an HIV expert at the University of Cape Town. She said that many African governments did not have the resources to spend on PrEP drugs on top of treatment for HIV infections, risking a worsening of the pandemic. "It's as predictable as if you take your eye off a smouldering bushfire and the wind is blowing: a bushfire will come back." Trump has said that the United States pays disproportionately for foreign aid and he wants other countries to shoulder more of the burden, as he seeks to reduce U.S. government spending across the board. The U.S. disbursed $65 billion in foreign assistance last year, nearly half of it via USAID, according to government data. "It's a question of who has primary responsibility for the health needs of citizens of other countries, and it's their own governments," said Max Primorac , a former senior USAID official who is now senior research fellow at The Heritage Foundation's Margaret Thatcher Center for Freedom. "We all know, and this is a bipartisan issue, that aid dependency doesn't help these people - that the best solution is for these countries to be able to take over the responsibility of these programs." A RISE IN CASES UNAIDS says the permanent discontinuation of PEPFAR-supported prevention and treatment programs could lead to an additional 2,300 new HIV cases globally per day. There were 3,500 new cases per day in 2023. Reuters spoke to 23 health workers, PrEP users and activists, nearly all of whom said that the increase in HIV infections since the funding cuts was impossible to quantify because many organisations working with vulnerable populations have been defunded. A State Department waiver issued on February 1 allowed some PEPFAR activities to restart, but only covered HIV prevention for mother-to-child transmission. That means PEPFAR-financed PrEP is no longer available for gay and bisexual men, sex workers and injecting drug users who are especially exposed to the virus. Many African governments had specifically targeted these groups in their PrEP programs. A spokesperson for the State Department, which oversees USAID and the PEPFAR program, told Reuters it "continues to support lifesaving HIV testing, care and treatment, and prevention of mother to child transmission services approved 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," the spokesperson said. The spokesperson did not directly respond to a question about why the waiver had excluded vulnerable groups from PrEP distribution. In East and Southern Africa, the sub-region that accounts for more than half of all people living with HIV, the U.S. had been funding nearly 45% of HIV prevention programming, UNAIDS said in March. Some countries like Malawi, Zimbabwe and Mozambique were almost entirely dependent on PEPFAR for their HIV prevention programs, the agency said. In some wealthier nations, like South Africa and Kenya, PEPFAR represented less than 25% of spending on HIV prevention. Russell Vought , the director of the U.S. Office of Management and Budget, told a Congressional committee on June 4 that, due to high U.S. debt levels, Africa needed to shoulder more of the burden in fighting AIDS. Asked specifically about restrictions on HIV prevention programs, Vought said: "We believe that many of these nonprofits are not geared toward the viewpoints of the administration." His office did not respond to a request for further details. 'I PRAY TRUMP CHANGES HIS POLICY' Reuters spoke to four PrEP users in Nigeria, all gay or bisexual men, who have tested positive for HIV since January when they stopped being able to obtain more pills, after practicing unsafe sex. Hearty Empowerment and Rights (HER) Initiative, a community-based organisation in southeastern Nigeria, worked with other groups that provide HIV/AIDS services to confirm the men's diagnosis and help secure treatment for them, said executive director Festus Alex Chinaza. In Asaba, the capital of Nigeria's Delta state, Echezona, a 30-year-old gay man who took PrEP pills daily for more than three years, is struggling to come to terms with his HIV-positive test result, which he received in early May. He regrets that he had unprotected sex. "I just pray and wish that Trump actually changes his policy and everything comes back to normal so that the spread and transmission of the virus would be reduced," said Echezona, who asked to be identified only by his first name for fear of stigma. Like the other three men, he described being told by staff at community-based clinics that PrEP was only available to pregnant and lactating women, in line with the Trump administration guidelines. Nigeria has an adult HIV prevalence rate of 1.3% and an estimated 2 million people living with HIV, the fourth-highest total globally, according to UNAIDS. But for so-called key populations, the rates are much higher: 25% for men who have sex with men, according to a survey completed in 2021. The Nigerian health ministry did not respond to a request for comment on the effects of the Trump administration's cuts to HIV prevention services. South Africa - which has an estimated 7.7 million people living with HIV, according to UNAIDS, the highest number in the world - pays for its own PrEP pills. But some clinics where so-called key populations obtained them relied on PEPFAR grants and have been forced to close in recent months. PrEP is also available for free at public health centers, but gay men and sex workers often avoid such facilities, fearing discrimination and harassment, nine activists said. Francois Venter, executive director of the Ezintsha medical research center at the University of the Witwatersrand in Johannesburg, said PrEP distribution from public sector clinics in the city had shown almost no increase since the Trump cuts. Foster Mohale, spokesperson for South Africa's health ministry, said the ministry was "not aware" of reports that key populations were avoiding health facilities due to stigma. "We have sensitized health officials across the country to create (a) conducive environment for all healthcare seekers/clients to access the service without feeling judged or discriminated against," he said. (Reporting and writing by Robbie Corey-BouletAdditional reporting by Seun Sanni in Awka, Nigeria, Nellie Peyton in Johannesburg, Amindeh Blaise Atabong in Yaounde, Ange Adihe Kasongo in Kinshasa, Maxwell Akalaare Adombila in Accra and Jennifer Rigby in London. Editing by Daniel Flynn)
Time of India
9 hours ago
- Time of India
A shot of hope
New HIV medicine is powerful – but can everyone afford it? A new medicine called lenacapavir has just been approved in the US to help stop people from getting HIV, the virus that causes AIDS. That's big news! Even though fewer people are getting HIV today than in the 1990s, around 13 lakh (1.3 million) people still get infected every year around the world. Lenacapavir is special because you only need two shots a year – not a pill every day like older medicines. That's great for people who forget daily pills or feel embarrassed taking them. And it's almost 100% effective at stopping HIV in adults and teens. But there's a big problem: the cost. In the US, it sells for over ₹23 lakh a year! Even rich countries find that hard to afford. The company that makes it, Gilead, is working with more than 100 poorer countries to help them make cheaper versions. Still, many African countries where HIV is most common may struggle to get it to the people who need it most. Scientists have been trying to create a proper HIV vaccine for decades, but HIV keeps mutating – changing too fast for one shot to work. New mRNA vaccines (like the ones used for Covid) are being tested, but funding cuts in the US have slowed down this research. That's why lenacapavir gives us hope. But hope only works if everyone, everywhere, can afford it. Facebook Twitter Linkedin Email Disclaimer Views expressed above are the author's own.
Time of India
9 hours ago
- Time of India
Dose of hope
Times of India's Edit Page team comprises senior journalists with wide-ranging interests who debate and opine on the news and issues of the day. To really help, new HIV vax has to be made cheap A pill to treat multidrug-resistant HIV, lenacapavir, has been approved by US drug regulator FDA as a preventive vaccine. This is a huge deal – incidence of HIV may have declined since 1990s but even today about 13L people globally are infected by the virus every year. But its price is an obstacle. Sold for $28,218 per year in US, it's prohibitive even for high-income nations. Pharma company Gilead that manufactures lenacapavir has reportedly tied up with over 100 middle- and low-income countries for manufacture of generics pending approvals. But access likely will still be tricky for poorer African countries that bear the HIV burden. Drugs to prevent HIV transmission have been around almost a decade, but a daily dosage regimen makes these unreliable. People forget and there's the stigma/doubt in partners that a daily dose is preventive. Lenacapavir needs to be taken just twice a year. Its long-lasting effect in preventing infection – almost 100% in adults and adolescents – is thus the best bet today. Also because HIV research in US bears the additional burden of Trump administration's slashed funds. An effective vaccine for HIV has been elusive for decades because of its rapid mutations. Several mRNA vaccines, like those developed for Covid and considered the most promising, are in clinical trials. But since Jan, under Trump's health secretary Bob Kennedy Jr, NIH stopped funding hundreds of such HIV vaccine-related research. This is what makes repurposed lenacapavir a lifeline, provided it's made affordable. Facebook Twitter Linkedin Email This piece appeared as an editorial opinion in the print edition of The Times of India.
