Latest news with #Pepfar
The Independent
3 days ago
- Politics
- The Independent
Congress should be ashamed over helping Trump cutting foreign aid, activists say
The US Congress should be ashamed by its role in helping Donald Trump claw back billions of dollars in foreign aid funding already allocated to projects around the world, activists have said. The House of Representatives recently narrowly voted through a request to claw back $9.4 billion (£7bn) of funds – known as rescissions – with $8bn of that coming from foreign aid. It is the first step to making these cuts permanent. Programmes operating in 14 African countries have told The Independent they have been denied ring-fenced funding since Trump re-entered the White House in January and issued executive orders to slash aid spending, something HIV advocacy group, the Aids Vaccine Advocacy Coalition (AVAC) has claimed was 'illegal' and 'immoral'. Each year, US legislators vote through a budget setting out what the government must spend on different activities. By not spending money already allocated by Congress on foreign aid projects, Trump had been acted beyond the powers of the presidency, said Prof Lawrence Gostin, a law professor at Georgetown University. A federal judge ruled in Marc h that Trump had overstepped in withholding funds and that his government owed aid recipients money for work done in the first few weeks of his presidency, before contracts were cancelled. That case is currently being appealed by the government. 'The president has no power to unilaterally withhold funding already allocated by Congress,' he said. However, using a 'rare vote of Congress to rescind the funds it has already allocated' allows Trump to withhold the promised money legally. 'And to its shame, the House of Representatives has done just that,' Prof Gostin said. The package of cuts must now go to the Senate for a vote before becoming law. It has been suggested that he Senate will pick up the bill next month, but may try to tweak the contents. Thursday's vote was a, 'pretty clear example that [lawmakers] are happy to roll over and give the president what he wants,' said Mitchell Warren, executive director of AVAC which sued the government. 'They still acted illegally and immorally,' Mr Warren claimed. 'This process does not change that'. Until it was allowed to expire at the end of March, the US President's Emergency Plan for Aids Relief (Pepfar), which forms the backbone of the world's HIV response, set out in law that 10 per cent of its funds must be spent on orphans and vulnerable children. But since January, projects across Sub-Saharan Africa have not seen any of the promised funds, The Independent has learned, leaving vulnerable children without vital services to prevent HIV, access nutrition and report sexual violence. It's one example of the cuts which look set to become permanent, through claw backs of existing funds and a new budget proposed this month. Based on Trump's proposed budget for next year, the majority of specialised support for orphans and vulnerable children (OVC) aside from basic medical treatment, are likely to be permanently excluded from receiving future US funds. These wider support services have been shown to protect children from contracting HIV and successfully link HIV-positive children to treatment. Project Hope in Namibia, which linked children in rural communities with HIV treatment and prevention, is another programme to have its OVC funding under Pepfar withheld since January. Early data showed children with HIV enrolled in Project Hope Namibia's programme were more likely to have the levels of virus in their blood brought down to undetectable levels – 96 per cent in January compared with 85 per cent the previous September. Suppressing the virus means they won't get sick or be able to infect others. 'They don't understand those programmes are lifesaving,' Leila Nimatallah, vice president of US advocacy group First Focus on Children, said. More than half of children with untreated HIV will die before their second birthday. 'Illegal and immoral' A State Department official said Pepfar continued to support 'lifesaving HIV testing, care and treatment' including for orphans and vulnerable children, but that all other services are currently being reviewed. But that's not how people working on the ground see things playing out. 'We will expect children to be dying who are not supposed to be dying,' said Desmond Otieno, project coordinator at HIV service the Integrated Development Facility in Kenya. The US has withheld money previously promised to IDF Kenya for services including medication counselling and psychological support since Trump took office, and the facility has already recorded deaths of children who were no longer able to access medication. 'That is the most outrageous [thing]' Mr Otieno said. The State Department spokesperson added that all foreign assistance programmes 'should be reduced over time' as they achieve their mission and move countries 'toward self-reliance". Project Hope in Namibia says its plan to make sure its services could be maintained by the local government by 2028 had been scuppered by the programmes abrupt ending, however. The process of transferring responsibility over including training up local staff will now be a lot harder, achieving exactly the opposite of this goal. Ms Nimatallah said she was calling on the Senate to 'reject this cruel rescissions package'. 'By passing this bill, Congress is taking back funding that it had already appropriated for the prevention of suffering and death of children under five from dirty water, infectious disease, and malnutrition,' she said, as well as funds 'set aside to protect Aids orphans from hunger and sex trafficking. 'The long and short of it is that the United States has turned its back on these children that it has promised to care for'.
The Guardian
5 days ago
- Health
- The Guardian
‘I don't want my boy to be positive': pregnant women face sky-high viral loads as cuts hit HIV care in Africa
Aphelele Mafilika was born HIV positive in 2004. Put on antiretrovirals (ARVs) as a baby, she has been on the life-saving medication ever since and has lived a normal life. No longer. 'Now, I have a problem,' she says. For most of her life her viral load (the amount of HIV in her blood) has been undetectable. 'When I went for my February clinic visit, I didn't get my pills. They told me 'shortage of staff' and 'come back another day'. I came back a few times, but it was the same story.' Mafilika, who is seven months pregnant, took no ARVs in March or April. She finally managed to get a batch in mid-May but by then her viral load was sky high. 'It has never been high like this,' she says. 'It is too risky for my unborn baby.' The risk of transmitting the virus to her child during delivery or while breastfeeding is much higher if her HIV is detectable. 'My fear is that I will get sick more, I will get other infections like TB. And my fear for my baby is too big,' she adds. 'I don't want my boy to be positive.' Mafilika knows first-hand the mental struggles of growing up with HIV: 'At school they teased me,' she says. 'They would say, 'You are positive … Why are you always going to the clinic? Why are you eating pills?'' Sister Sibongile Mqaba, who has worked in the same clinic in Cape Town for 32 years, is hopeful that Mafilika will get her viral load down before she delivers. But Mafilika is not the only patient struggling to get treatment since the suspension of most Pepfar (President's Emergency Plan for Aids Relief) funding to South Africa. Since initial cuts in January, US president Donald Trump has made further significant reductions. South Africa's health minister, Aaron Motsoaledi, has complicated matters by insisting that the country's HIV programme is 'not collapsing' and assuring the public that there is no shortage of ARVs. While it appears US funding cuts have not significantly dented ARV supply, Mafilika's story illustrates that access to treatment is about more than pharmaceutical supply. The abrupt stop-work order issued to Anova Health Institute, the largest recipient of Pepfar funding in South Africa, on 25 January meant that her local clinic didn't have sufficient staff to meet patient demand on the days she visited. It is not all about ARVs and Pepfar funding, either. Since 2016, Dr Dvora Joseph Davey, a US epidemiologist based in South Africa, has implemented several studies in government clinics in the Klipfontein area of Cape Town, all funded by the US National Institutes of Health (NIH). One study established that PrEP (pre-exposure prophylaxis, medication taken by HIV-negative people to prevent them acquiring HIV during sex) was safe for use by pregnant and breastfeeding women – a global first. Another study, called Scope-PP, which began in 2023, sought to optimise the rollout of PrEP in eight maternity clinics across Cape Town. On 1 May, Davey was informed that her NIH funding could no longer be given to foreign sub-awards or collaborators outside the US. Friday 30 May was the study's last day. The 18 women who were directly employed by the University of Cape Town as counsellors, interviewers, nurses, trainers and data collectors have all lost their jobs. The same is true for at least half of the 224 health workers around Cape Town who Davey's team had trained to provide PrEP for pregnant and breastfeeding women. 'Effective use of PrEP is about far more than simply taking a daily pill,' says Davey. 'Counselling, testing and support are all just as important.' As an associate professor at the University of California, Los Angeles (UCLA), Davey receives funding awards from the NIH. For the past decade she has collaborated with the University of Cape Town via sub-awards, but the Trump administration has put a stop to this. 'I have over $300,000 [£222,000] granted to me via UCLA that I cannot get into South Africa,' she says. It's a similar story across the country: a Médecins Sans Frontières report shows that in South Africa alone Trump's funding cuts have put at least 27 HIV trials and 20 TB trials at risk. South Africa is possibly the most important place in the world for HIV research. Not only does it have more people living with HIV than any other country, but it also has world-class medical infrastructure. 'We can do meaningful research in a small community with 1,000 participants,' says Davey. 'To achieve the same outcomes in the US we would need 100,000 participants and millions and millions of dollars.' Recent analysis shows that every $1 of NIH funding generates approximately $2.56 of economic activity. Then there is the impact on participants' lives. In the absence of intervention, the rate of mother-to-child transmission of HIV during birth and while breastfeeding can range from 15 to 45%. With the inclusion of antiretroviral drugs during and after pregnancy the rate is less than 2%. South Africa had achieved a significant reduction in mother-to-child HIV transmission, with the rate dropping to 2.6% in 2024 from almost 15% in 2008. 'We were well on track to eliminate infant HIV,' says Davey. 'But without PrEP, ART [antiretroviral treatment] and other interventions, we will see rates of mother-to-child transmission increase.' One study of 50,461 infants born to HIV-positive mothers in the Western Cape, where Cape Town is located, found that among pregnant women with elevated viral load (not on ART, or recently acquired HIV), 18% of infants were born with HIV. 'We don't want to go back to those days,' Davey says. In all of 2024, three babies were born with HIV in the clinics in Davey's study. In the first five months of this year, even before cuts have fully taken effect, there have already been three cases. What's more, 'closing these trials early violates the ethical standards we work by', says Davey. 'When a patient starts in the study, we promise to provide treatment and counselling until the end of the study. We've had to stop our study early and transition people back to the clinic to get their PrEP. And often the clinic doesn't have the nurses and counsellors or the PrEP.' One such patient is Vuyisile Ndungane. She came to the clinic in 2024 during her second pregnancy and was told about PrEP by Lindelwa Dube, a counsellor trained by Davey. 'The moment Lindelwa introduced me to PrEP, I decided to use it till I gave birth,' says Ndungane. 'She helped me so much.' As part of the study, Ndungane was given counselling about the importance of knowing her partner's HIV status and given oral HIV self-tests. 'When my baby was four months old, I asked my husband to test,' she says. 'He was happy to test, he wanted us to help each other.' His test came back positive. 'He was sad and surprised and angry,' says Ndungane. 'In the beginning I was not OK. I wanted to know the truth. He eventually told me he was busy in the time when I was pregnant. He did not specify exactly, but he became transparent.' Dube helped Ndungane through this crisis, coaching her on how best to handle the situation and encouraging her and her husband to come into the clinic for counselling. 'Most men don't want to go to the clinic,' says Ndungane. 'But the moment he got the counselling from them he realised … 'I did something wrong … I have to put my family first.'' He is now on ARVs and his viral load is undetectable. 'Now, I am fine,' says Ndungane, who is still HIV negative. 'But without PrEP I would not be fine. I don't want to lie.' Ndungane only heard about the PrEP study's imminent closure on the day the Guardian spoke to her. She remains hopeful that she and her husband will be able to get their medications 'for ever'. Sister Mqaba, who will be losing her job at the end of June, does not share the same optimism. 'My fear is mortality is going to be very high,' she says. Mqaba knows what an uncontrolled epidemic looks like, having lived through the late 1990s and early 2000s, when infections were rife and no treatment was available. (Even after ART had been developed and used in the global north, South Africa's president then, Thabo Mbeki, refused to provide it through the state health system.) 'In the bad days, you could diagnose people just by looking at them,' says Mqaba. 'They looked so sick. Now you don't see that. But we are going to go back there. We are going to see mothers dying again, when they are pregnant or when they have just given birth. We are going to see babies born HIV positive.'
News24
06-06-2025
- 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
06-06-2025
- 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
05-06-2025
- 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.
