Latest news with #UNAIDS
Bloomberg
11 hours ago
- Health
- Bloomberg
UNAIDS Executive Director: ‘The HIV Response Is in Crisis'
Winnie Byanyima says her organization has lost almost 50% of its funding, a gap that is undermining global efforts to combat HIV/AIDS. By Are we unraveling years of progress on fighting HIV/AIDS? For the past two decades, the US has led the global response to a virus and disease that have together claimed more than 40 million lives. But there are still more than a million new infections every year; with no vaccine or cure, preventing further spread is critical. This is why there was so much alarm from campaigners and experts when the US Department of Government Efficiency, led by Elon Musk, started slashing foreign aid. In an interview last month, Musk himself told me that HIV-prevention programs were ongoing. But Winnie Byanyima, executive director of the Joint United Nations Programme on HIV and AIDS, tells a different story. Her organization is one of the key bodies fighting the virus globally — UNAIDS operates in nearly 100 countries — and Byanyima says the disruption she's seeing is both real and deadly. We spoke while Byanyima was on a visit to South Africa, where the rollout of one of the most promising HIV-prevention tools in a generation is now in doubt. 'Even if I get the next batch of medicines,' one aid worker in Soweto told her, 'they may expire because the two people I had who go out and reach people in their communities [are no longer there].' This interview has been edited for length and clarity. First of all, are you able to set the record straight? To what extent has your work at UNAIDS been affected by the DOGE-led cuts to USAID? First, globally, the HIV response is in crisis. Clinics have closed. Prevention services have halted. People are losing access to lifesaving medicines. People are scared. Our work as the UN leader of the global HIV response is also affected severely. We've lost close to 50% of our funding. It came from two pockets of the United States government. So we are also struggling to stay alive. But there is a crisis and a huge disruption, the biggest since the global response was created about 25 years ago. I know that Elon Musk has doubted that these disruptions are there,[and] has even said that if they are there, he would fix them. 1 I know he has left government, but I'll be happy to go with him anywhere in Africa or Asia to show him, or take any other American official to see what the real impacts are for people living with HIV and for people at risk of HIV, like gay men [or] women and girls in Africa. In our May conversation, Musk said he did not believe many HIV-prevention programs had stalled: 'If in fact this is true, which I doubt it is, then we'll fix it.' But he also questioned the assertion that cutting USAID would result in any fatalities, saying that recipient organizations 'don't even try to come up with a show orphan' to back up their claims of saving lives. When you say the HIV response globally is in crisis, how much of that is to do with US funding cuts? How great is America 's responsibility for that situation? Huge. The United States government and US taxpayers were contributing a lion's share of the support to developing countries to fight this disease, up to 73%. You might say, why the United States? Well, it's the wealthiest country in the world, and these are the poorest countries in the world. By pulling its funding away very quickly, the US didn't [give] these highly indebted countries — that are heavily impacted by [the] climate crisis, that have huge burdens of disease beyond HIV — enough time to be able to fill the gap. 2 UNAIDS created a portal to track the real-time effects of US funding cuts in the developing countries in which it operates, including observations from officials in the field. 'My greatest fear is that we will return to the dark days of the epidemic,' says the director of UNAIDS in Zambia. But what about other donors? What about rich countries in the Middle East or other G-7 countries or philanthropists with deep pockets? There have been two main sources of funding to support developing countries [on HIV/AIDS]. One is the American program, PEPFAR, the presidential initiative, and the other is called the Global Fund, where other donors — the Europeans, the Japanese, the Chinese — all put money together and help the developing countries. When the major contributor pulls out with little notice, things collapse. That is what has happened. In South Africa, which funds 80% of its own response and has been getting US support for only 17%, I visited a clinic in Soweto and saw the impact. A man who works [there] told me, 'Even if I get the next batch of medicines, they may expire because the two people I had who go out and reach people in their communities and bring them for service [are no longer there].' He's seeing a drop in the numbers of people coming forward to get what they need to prevent or to be treated. 3 This is backed up by recent Bloomberg reporting from South Africa, which has the world's largest HIV-treatment program with 80% of 7.8 million infected people on medication. So we are seeing that even in a country that's not so dependent, there are disruptions. Even in a country where the will is so strong, like South Africa, you're still seeing a gap that is definitely going to result in more new infections and more deaths. We know from our modeling that if the gap is not filled by other funding, in the next four years we are going to see up to 6.6 million additional new infections and additional deaths of 4.2 million. And that's in addition to what we were already estimating. PEPFAR, the program that you are referring to, 4 is the responsibility of the State Department. Marco Rubio, the Secretary of State, says 85% of PEPFAR is functional. PEPFAR stands for the President's Emergency Plan for AIDS Relief. It was a US policy choice that began during the George W. Bush administration in 2003, and has since then provided cumulative funding of $120 billion for HIV/AIDS treatment. That's roughly as much as the US government spends on its Supplemental Nutrition Assistance Program (food stamps) in a single year. It isn't exactly that because the PEPFAR program on the ground is implemented by two parts of the American government, the CDC [Centers for Disease Control and Prevention] in Atlanta and USAID. Now USAID has been shut. So there's no work that was done by USAID that's going on right now, though some work by the CDC is still going on. 'I say to President Trump: You are a man who likes to do a deal. Here's a deal.' But over and above that, there has been confusion. First, the cut was a stop-work order for everything. Then, within a week — and we thank the American administration for realizing that this was going to cost lives — they said it can come back, but only some of it. We see testing and treatment coming back by the CDC. We don't see much progress on prevention. So in many places, prevention clinics where people get their condoms, their PrEP, vaginal ring, whatever — these are not open. So we do see many gaps, particularly for women and girls in Africa, gay men, sex workers and people who inject drugs. They have their special clinics; those too have closed. It seems then that you think the statement '85% of PEPFAR is functional' is inaccurate, or misleading. It is inaccurate to the extent that the impact for the very low-income countries is huge. Our own data shows us that the impact is much bigger than that. 5 We asked the State Department to respond to UNAIDS' assertion that many HIV-prevention programs supported by the US have stalled. They told us they continue to support testing, care, treatment and prevention of mother-to-child transmission, and that an estimated 85% of beneficiaries could be receiving lifesaving treatment and prevention of mother-to-child transmission. All other PEPFAR-funded services are under review. Did you have any contact with Elon Musk's team at DOGE? We appealed to him publicly. I am very loud on social media and said I'm happy to meet him and take him to see. Anyway, he's left government. We are addressing ourselves now to the American government to say, 'You started something strong.' A Republican government, President Bush, came out at a time of the worst pandemic of the century and [began] a program to save lives. Right now, there are tools that could end this pandemic, and I say to President Trump: You are a man who likes to do a deal. Here's a deal. There is an American innovation called lenacapavir that's 100% effective to stop infections. An American innovation that creates American jobs that could be rolled out and we could cut down new infections almost to zero. Why not do this? That would be another Republican president bringing a revolution on prevention. This could be a win-win. Get the Bloomberg Weekend newsletter. Big ideas and open questions in the fascinating places where finance, life and culture meet. Sign Up By continuing, I agree to the Privacy Policy and Terms of Service. It is a US pharmaceutical company, Gilead, that's behind lenacapavir, which has been through lots of trials. But there would still be an issue, wouldn't there? It is likely to be extremely expensive. Wouldn't access to the drug possibly be like antiretrovirals in their early years, when they were out of the reach of the world's poorest people? You are right. We are hearing rumors in the media of $25,000 per person per year, and [if] it comes out at that price, then it will not bring new infections down to zero. 6 When they first came out, antiretrovirals used to treat HIV infections could cost more than $10,000 a year, but they eventually became widely available thanks to the work of aid organizations. Now lencapavir promises to provide six-month protection from infection, eliminating the need to take daily pills. On June 18, Gilead said that lenacapavir, marketed as Yeztugo, has a list price of $28,218 per year. It sounds as if this has been an extraordinary rollercoaster. You had immense hope that 2025 could be a breakthrough year, and instead you spent the first half of it almost battling for the organization's survival? That's true. I'm letting people go. People who have, over 20 years, built the experience to support this response. It's sad and it's unnecessary considering the billions that are being spent on building up new weapons systems and fighting wars. My core budget was not even $150 million [a year], but now it's been slashed by almost half. It's a sad moment, but we won't give up. I'm inspired by the governments and the people in countries [that] aren't giving up. They are stretching themselves, volunteering, doing things differently. We've got to keep people alive. So we are pushing on. We will continue fighting. I read that you are having to fight on another front at this moment, a personal front. You grew up in Uganda, you served your country as a political leader before you moved into international work, 7 and your husband is a longtime opposition leader in Uganda. Is it the case that he remains imprisoned, as we speak, on very serious charges? Byanyima has had quite a career. She was a flight engineer for Uganda Airlines, a combatant (alongside her husband) in the National Resistance Army and Uganda's ambassador to France from 1989 until 1994. She helped draft Uganda's 1995 constitution, and served two consecutive terms as a member of parliament before serving in leadership roles at the African Union and Oxfam International. She became executive director of UNAIDS in August 2019. That is true, Mishal. My country has struggled through crises since independence. We thought we had turned the corner through a revolution that brought back democracy, but we've seen reversals in the last 10 to 15 years. My husband has been an opposition leader for the last 25 years. But for most of those, he's been in and out of jail — always criminalized, but always being exonerated by the courts. Last November he was abducted from neighboring Kenya and taken across the border. It's now six months he's been in jail. He hasn't been tried. For a long time he was not even charged, he was just illegally being held. He's not the only political prisoner, but we have the international human rights organizations supporting his cause, supporting that he should be released on bail, so that he can fight whatever charge they may have against him. 8 In February, Byanyima's husband Kizza Besigye was charged with treason over an alleged plot to overthrow Ugandan President Yoweri Museveni. Besigye has unsuccessfully tried to unseat Museveni — who has been in power since 1986 — in four elections. How is he and are you able to be in contact with him? We are in contact with him and able to visit him. But he's not in a good condition. He's in a tiny cell where you can hardly even sit by his bedside, there's not enough room. So yes, I am angry at how he's being treated. I'm angry at the illegality that the president has shown. The Supreme Court decided that as a civilian, he should not be tried by the military. [President Yoweri Museveni] reversed it by bringing a law before Parliament to allow civilians to be tried by the military. 'No one anywhere — in any country in the world, rich or poor — should take freedom for granted, should assume that because they're enjoying human rights, because there's rule of law at a certain point in time, that it'll always be there.' Didn't he used to be a friend of yours, President Museveni? He is a family friend. I first met him when I was little. He was always in and out of the family home. He was a friend of my parents. This is just about politics and power. President Museveni has never quite accepted the idea of being a democratically elected leader who respects an opposition and competes with them fairly. I wonder what this leads you to conclude about the nature of power and authority. Your generation knows what dictatorship was like when you were growing up, the time of Idi Amin. You ended up having to leave Uganda, you came back, and you were part of building institutional governance. What are the lessons of how to build a nation to ensure structures that safeguard people's rights? You raise a very important point. No one anywhere — in any country in the world, rich or poor — should take freedom for granted, should assume that because they're enjoying human rights, because there's rule of law at a certain point in time, that it'll always be there. You can have reversals. Sudden reversals or slow reversals, but reversals do happen. You must always be working as a citizen, doing your duty to protect your constitution, to defend the rule of law, to defend the human rights of others, not just for yourself. May I close, Winnie, by asking you what gives you strength? To be battling on these two fronts — one professional, one personal — at the same time, it would take a lot out of anyone. It is tough, but the truth is that I have lived a life of struggle. I don't say my life was always rough. I've had, and I still have, very many happy moments. But at every point I have had to be a part of struggles, to make lives better — for myself and for others. What's happening to me on the personal front, what's happening on the professional side, I see them all as a struggle for justice. Justice for my husband, justice for people living with HIV, justice for those who are denied their rights because of their sexual orientation, because of who they are. So I live day by day and think everybody has their load to carry. And that's mine. Mishal Husain is Editor at Large for Bloomberg Weekend. More On Bloomberg
Scoop
5 days ago
- Health
- Scoop
Will We Rise To #endAIDS Challenge Or Stumble Withering Away The Gains In HIV Response?
Press Release – CNS The recent funding cuts by the US have further exacerbated the problems. UNAIDS projects that there would be an additional 6.6 million new HIV infections and 4.2 million deaths by 2029 just because of the shortfall created by US funding cuts. June 13, 2025 We have all the scientifically proven tools to end AIDS. It is about ensuring that these tools reach people who need them the most, through a sustainable HIV response, so said Dr Adeeba Kamarulzaman, the well known infectious diseases expert form Malaysia and a former President of International AIDS Society (IAS). She was speaking at the plenary of the 10th Asia Pacific AIDS and Co-infections Conference (APACC 2025) in Tokyo, Japan. The world is indeed at the crossroads, in terms of the global response to HIV today. The Asia Pacific region has 3/4 of the world's population and 6.7 million people living with HIV. The region accounts for almost a quarter of the annual new HIV infections globally (23%), making it the world's second-largest HIV epidemic after Eastern and Southern Africa. The recent funding cuts by the US have further exacerbated the problems. UNAIDS projects that there would be an additional 6.6 million new HIV infections and 4.2 million deaths by 2029 just because of the shortfall created by US funding cuts. Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries is so unacceptable if we take into account the promise of SDGs by all governments worldwide. 'So, will the world rise to the challenge, to make the future response affordable, or will we stumble, throwing away the progress of the last two decades and creating a drain on future resources of countries?' wondered Eamonn Murphy, Regional Director, UNAIDS for the Asia Pacific and Eastern Europe and Central Asia. Speaking at APACC 2025, Murphy called for prioritising four other dimensions of sustainability- political leadership, enabling laws and policies, element of services and solutions and having proper systems in place, apart from financial stability. HIV prevention as cornerstone of sustainable HIV response UNAIDS leader Eamonn Murphy also stressed upon making prevention as the cornerstone of a sustainable HIV response. 'To end AIDS as a public health emergency we need a far stronger focus on prevention, and not just on keeping people living with HIV alive and well. New infections are like a leaking tap – 'every drop in the bucket' is another individual requiring a life on treatment. The only way to ensure a sustainable response is to stop this flow.' As per latest UNAIDS data, globally between 2010 and 2023, there was a 39% decline in new HIV infections. However, the rate of decline in Asia Pacific was three times slower than this by 13% during the same period. There were 300,000 new infections – one every two minutes -in 2023 in this region. Also, since 2010, the new HIV infections amongst gay men and other men who have sex with men across the region, have increased by 33%. Build more effective and efficient HIV programmes Eamonn laments that countries are investing too little in scaling up HIV prevention. 'While there is a high political commitment to fund treatment, there is limited will to invest in prevention.' 'Four out of every five new HIV infections occur among key populations. However, only one third of these communities have access to HIV prevention services. Key population led HIV prevention services are severely underfunded with less than 15% of HIV resources going into interventions for key populations,' he said. This is despite the proven evidence that key population led HIV service delivery model has been critical to bridge the gap between the public health services and those unreached. For example, 80% of PrEP (Pre-Exposure Prophylaxis for HIV prevention) is delivered by clinics run by key populations in Thailand. Thai PrEP rollout is the largest rollout in Asia Pacific region. Key populations or communities remain the largest provider and carer for those on PrEP even today in the land of smiles. Eamonn Murphy of UNAIDS added: 'PrEP related HIV prevention services largely remain donor dependent. PrEP, social contracting and other differentiated or innovative services mostly remain as pilot projects, and not continued at a scale to have impact on national or regional epidemics. For example, there is a 98% gap to the region's PrEP target of reaching 8.2 million people by 2025.' PrEP – Pre-Exposure Prophylaxis for HIV, refers to medicines used to reduce the risk of HIV acquisition for HIV-negative people. They were first approved by US FDA in 2012. Long walk to integrated health responses Even though financial sustainability is important there is need for improvements in the system integration, in legal and social environments, and in community engagement and leaderships, says Dr Adeeba. 'Addressing the legal and social environment, which the key populations find themselves in terms of coming forward for prevention, as well as treatment, is one area that requires much attention.' With legal barriers to HIV response existing in 39 countries of Asia Pacific, key populations are criminalised in many countries. These barriers include criminalising sex work or same-sex relations, or criminalising drug use, criminalising transmission of, or non-disclosure of HIV transmission, and restricting entry and stay of people living with HIV in the country. All these legal and social impediments have resulted in poor outcomes of HIV response in those countries. Dr Adeeba also advocates for community engagement and leadership by involving communities not only in the designing of programmes, but also community based monitoring through peer led interventions- like in Thailand, which has great examples of key population led clinics and anti retroviral treatment. Role of academia As researchers and scientists, we must continue to advocate and stand firm in terms of the importance of science. Otherwise how else are we going to get the breakthroughs, like the importance of lifesaving antiretroviral therapies for treatment as prevention. HIV treatment works as prevention because science has proven that there is zero risk of any further HIV transmission from those people with HIV who are receiving the treatment, remain virally suppressed and have undetectable equals untransmittable to be true in their lives. But the role of researchers does not end here. We then need to scale it up and the best way is through implementation research, says Dr Adeeba. PopART Dr Adeeba cited the example of one of the largest HIV implementation research studies- the HPTN 071 or PopART- a community-based, randomised study that was conducted during 2013-2018 across 21 high HIV burden, resource-limited urban settings in South Africa and Zambia, with a total estimated population of 1 million. The name PopART, stands for Population Effects of Antiretroviral Therapy to reduce HIV Transmission, because the study focused on evaluating the impact of a combination HIV prevention package, including universal test and treat, on community-level HIV incidence. The study aimed to determine how a community-wide approach to HIV prevention, including the use of antiretroviral therapy, could reduce the spread of the virus at a population level. This PopART intervention with lifesaving antiretroviral therapy reduced HIV incidence by 30%, achieved 90% testing coverage, and increased viral suppression at population level even in remote parts of Africa. It demonstrated feasibility of scaling community based universal test and treat and influenced WHO guidelines on test and treat. Dr Adeeba rightly insists that 'Another very important role of researchers and academicians is to not just advocate with political leaders but also with pharmaceutical companies in making all the new advances accessible to countries that need them most. For example, the price of Human Papilloma Virus (HPV) vaccine, which has been around for a long time, is still extremely high, and inaccessible to many parts of the world. So, this is another important role that we as scientists and researchers must play- advocate to ensure sustainability of the HIV response, particularly in this day and age where financial resources are limited'. Women with HIV are up to 6 times higher risk of HPV related cervical cancer. What next? With a decline in international donor support, it becomes all the more necessary for countries to transition to more sustainable domestic driven HIV financing. UNAIDS leader Eamonn cites some good practice examples from the Asia Pacific region to see what sustainable responses could look like. 'Thailand has shown the model of integrating HIV services, introducing universal health coverage, and scaling up social contracting to reach the community organisations. and we need to pick up on that to share with other countries. Thailand already covers 90% funding of their responses and is developing a sustainability roadmap for the remainder. India is another example of progressive public policy to uphold the human rights of people in the HIV key populations, and they fund over 95% of their funding. In Malaysia, we find an example of diversified domestic resource mobilisation that targets the private sector. We can learn from these and other examples that make the right mix in different countries. We know what to do, the time of cherry picking in sustainability strategies is over. We must act now to enforce all relevant best practices and to keep the hope of ending AIDS alive.' Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here
Scoop
5 days ago
- Health
- Scoop
Will We Rise To #endAIDS Challenge Or Stumble Withering Away The Gains In HIV Response?
June 13, 2025 We have all the scientifically proven tools to end AIDS. It is about ensuring that these tools reach people who need them the most, through a sustainable HIV response, so said Dr Adeeba Kamarulzaman, the well known infectious diseases expert form Malaysia and a former President of International AIDS Society (IAS). She was speaking at the plenary of the 10th Asia Pacific AIDS and Co-infections Conference (APACC 2025) in Tokyo, Japan. The world is indeed at the crossroads, in terms of the global response to HIV today. The Asia Pacific region has 3/4 of the world's population and 6.7 million people living with HIV. The region accounts for almost a quarter of the annual new HIV infections globally (23%), making it the world's second-largest HIV epidemic after Eastern and Southern Africa. The recent funding cuts by the US have further exacerbated the problems. UNAIDS projects that there would be an additional 6.6 million new HIV infections and 4.2 million deaths by 2029 just because of the shortfall created by US funding cuts. Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries is so unacceptable if we take into account the promise of SDGs by all governments worldwide. 'So, will the world rise to the challenge, to make the future response affordable, or will we stumble, throwing away the progress of the last two decades and creating a drain on future resources of countries?' wondered Eamonn Murphy, Regional Director, UNAIDS for the Asia Pacific and Eastern Europe and Central Asia. Speaking at APACC 2025, Murphy called for prioritising four other dimensions of sustainability- political leadership, enabling laws and policies, element of services and solutions and having proper systems in place, apart from financial stability. HIV prevention as cornerstone of sustainable HIV response UNAIDS leader Eamonn Murphy also stressed upon making prevention as the cornerstone of a sustainable HIV response. "To end AIDS as a public health emergency we need a far stronger focus on prevention, and not just on keeping people living with HIV alive and well. New infections are like a leaking tap - "every drop in the bucket" is another individual requiring a life on treatment. The only way to ensure a sustainable response is to stop this flow." As per latest UNAIDS data, globally between 2010 and 2023, there was a 39% decline in new HIV infections. However, the rate of decline in Asia Pacific was three times slower than this by 13% during the same period. There were 300,000 new infections - one every two minutes -in 2023 in this region. Also, since 2010, the new HIV infections amongst gay men and other men who have sex with men across the region, have increased by 33%. Build more effective and efficient HIV programmes Eamonn laments that countries are investing too little in scaling up HIV prevention. 'While there is a high political commitment to fund treatment, there is limited will to invest in prevention." "Four out of every five new HIV infections occur among key populations. However, only one third of these communities have access to HIV prevention services. Key population led HIV prevention services are severely underfunded with less than 15% of HIV resources going into interventions for key populations," he said. This is despite the proven evidence that key population led HIV service delivery model has been critical to bridge the gap between the public health services and those unreached. For example, 80% of PrEP (Pre-Exposure Prophylaxis for HIV prevention) is delivered by clinics run by key populations in Thailand. Thai PrEP rollout is the largest rollout in Asia Pacific region. Key populations or communities remain the largest provider and carer for those on PrEP even today in the land of smiles. Eamonn Murphy of UNAIDS added: "PrEP related HIV prevention services largely remain donor dependent. PrEP, social contracting and other differentiated or innovative services mostly remain as pilot projects, and not continued at a scale to have impact on national or regional epidemics. For example, there is a 98% gap to the region's PrEP target of reaching 8.2 million people by 2025." PrEP - Pre-Exposure Prophylaxis for HIV, refers to medicines used to reduce the risk of HIV acquisition for HIV-negative people. They were first approved by US FDA in 2012. Long walk to integrated health responses Even though financial sustainability is important there is need for improvements in the system integration, in legal and social environments, and in community engagement and leaderships, says Dr Adeeba. "Addressing the legal and social environment, which the key populations find themselves in terms of coming forward for prevention, as well as treatment, is one area that requires much attention." With legal barriers to HIV response existing in 39 countries of Asia Pacific, key populations are criminalised in many countries. These barriers include criminalising sex work or same-sex relations, or criminalising drug use, criminalising transmission of, or non-disclosure of HIV transmission, and restricting entry and stay of people living with HIV in the country. All these legal and social impediments have resulted in poor outcomes of HIV response in those countries. Dr Adeeba also advocates for community engagement and leadership by involving communities not only in the designing of programmes, but also community based monitoring through peer led interventions- like in Thailand, which has great examples of key population led clinics and anti retroviral treatment. Role of academia As researchers and scientists, we must continue to advocate and stand firm in terms of the importance of science. Otherwise how else are we going to get the breakthroughs, like the importance of lifesaving antiretroviral therapies for treatment as prevention. HIV treatment works as prevention because science has proven that there is zero risk of any further HIV transmission from those people with HIV who are receiving the treatment, remain virally suppressed and have undetectable equals untransmittable to be true in their lives. But the role of researchers does not end here. We then need to scale it up and the best way is through implementation research, says Dr Adeeba. PopART Dr Adeeba cited the example of one of the largest HIV implementation research studies- the HPTN 071 or PopART- a community-based, randomised study that was conducted during 2013-2018 across 21 high HIV burden, resource-limited urban settings in South Africa and Zambia, with a total estimated population of 1 million. The name PopART, stands for Population Effects of Antiretroviral Therapy to reduce HIV Transmission, because the study focused on evaluating the impact of a combination HIV prevention package, including universal test and treat, on community-level HIV incidence. The study aimed to determine how a community-wide approach to HIV prevention, including the use of antiretroviral therapy, could reduce the spread of the virus at a population level. This PopART intervention with lifesaving antiretroviral therapy reduced HIV incidence by 30%, achieved 90% testing coverage, and increased viral suppression at population level even in remote parts of Africa. It demonstrated feasibility of scaling community based universal test and treat and influenced WHO guidelines on test and treat. Dr Adeeba rightly insists that "Another very important role of researchers and academicians is to not just advocate with political leaders but also with pharmaceutical companies in making all the new advances accessible to countries that need them most. For example, the price of Human Papilloma Virus (HPV) vaccine, which has been around for a long time, is still extremely high, and inaccessible to many parts of the world. So, this is another important role that we as scientists and researchers must play- advocate to ensure sustainability of the HIV response, particularly in this day and age where financial resources are limited'. Women with HIV are up to 6 times higher risk of HPV related cervical cancer. What next? With a decline in international donor support, it becomes all the more necessary for countries to transition to more sustainable domestic driven HIV financing. UNAIDS leader Eamonn cites some good practice examples from the Asia Pacific region to see what sustainable responses could look like. 'Thailand has shown the model of integrating HIV services, introducing universal health coverage, and scaling up social contracting to reach the community organisations. and we need to pick up on that to share with other countries. Thailand already covers 90% funding of their responses and is developing a sustainability roadmap for the remainder. India is another example of progressive public policy to uphold the human rights of people in the HIV key populations, and they fund over 95% of their funding. In Malaysia, we find an example of diversified domestic resource mobilisation that targets the private sector. We can learn from these and other examples that make the right mix in different countries. We know what to do, the time of cherry picking in sustainability strategies is over. We must act now to enforce all relevant best practices and to keep the hope of ending AIDS alive." Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here
eNCA
6 days ago
- Health
- eNCA
South Africa at a crossroads: Can it keep up with a changing global health system?
JOHANNESBURG - South Africa is facing a pivotal moment in its public health history. As traditional global health funding models falter, the country must urgently rethink how it sustains its healthcare systems, continues its gains against HIV/AIDS, and ensures future generations are equipped to meet emerging challenges. This as foreign aid is shrinking and the need for domestic resilience is greater than ever. From US support to uncertainty For years South Africa was one of the largest beneficiaries of US health funding. Programmes like PEPFAR and NIH-backed research collaboration played a central role in expanding HIV/AIDS treatment, building public health infrastructure, and fuelling scientific discovery. But in US President Donald Trump's second term, the US has frozen nearly $900-million in global health funding, abruptly halting critical support to South Africa and other African nations. The results were immediate and devastating: Over 15,000 healthcare workers lost their jobs, and communities that had gained access to life-saving treatment suddenly found themselves cut off from care. UNAIDS: 'The world is off-track' Despite these setbacks, UNAIDS executive director Winnie Byanyima is urging countries like South Africa not to lose sight of the ultimate goal—zero new HIV infections by 2030. Speaking from Johannesburg, Byanyima acknowledged that global funding cuts have derailed progress in key regions. South Africa, once a leader in HIV/AIDS reduction, now faces mounting pressure to bridge the gap left by funding cuts. She pointed to Namibia, where more than 90% of HIV programmes were donor-funded. Without similar investments or domestic replacements, gains are being reversed. But she also highlighted that sub-Saharan Africa is still outperforming the global average in reducing both infections and deaths—proof, she said, that the continent can still succeed if backed by sustained support. Academic institutions under strain The health crisis has spilled into South Africa's universities and research hubs. Institutions that once hosted major NIH- and PEPFAR-linked studies are now struggling to survive. Without international funding, global research partnerships are suspended, and leading scientists and postgraduate researchers have been laid off. Universities, led by Wits, have asked National Treasury for R2-billion to prevent a collapse of research infrastructure. But that support remains limited—and temporary. The long-term danger? A skills vacuum. Universities are where South Africa trains its future doctors, researchers and epidemiologists. Without strong academic infrastructure, the country risks falling behind on innovation and health leadership for decades to come. Health emergencies meet systemic weakness At the same time, South Africa must brace for new health emergencies. Climate-linked diseases, increased migration, and pandemics demand a robust, self-sufficient health system. If not addressed urgently, the erosion of key services could leave South Africa vulnerable to regional outbreaks, system collapse, and deeper health inequalities. Innovation offers a glimmer of hope UNAIDS is now in talks with global pharmaceutical companies like Gilead Sciences, which has developed lenacapavir, a twice-yearly injectable proven to be 100% effective in preventing HIV transmission. Priced at around R720 a patient per year, the treatment holds massive potential for countries like South Africa—but only if it becomes widely licensed and locally produced. UNAIDS is urging Gilead to open licensing to more manufacturers to reduce costs and accelerate access. Can South Africa keep up? The challenge now is stark: Can South Africa keep pace with the transformation of the global health landscape? As donor funding shrinks and international priorities shift, the country must rapidly build internal capacity—not only to respond to today's emergencies but to future-proof its health system. That means investing in people, protecting academic research, and creating health financing models that are resilient and locally anchored. The window to act is narrowing. Conclusion: Time to lead The global health system is shifting and South Africa must choose how it responds. The loss of US funding has exposed dangerous dependencies, but also an opportunity to build something more sustainable, inclusive, and home-grown. Can the country develop health systems strong enough to endure future crises, empower the next generation of scientists, and deliver care to those who need it most? If so, South Africa could emerge as not just a survivor but as a global leader in health innovation and equity. If not, the nation risks trading its hard-won gains for a long and costly road to recovery. By: Zinhle Dlamini
The Hindu
7 days ago
- Health
- The Hindu
Goal to end AIDS by 2030 ‘more off-track' after Trump cuts, UNAIDS head says
Donald Trump's cuts to HIV/AIDS programmes will further derail an already faltering plan to end the disease as a public health threat by 2030, UNAIDS Executive Director Winnie Byanyima said on Friday, June 13, 2025. With 1.3 million new infections in 2023, according to the latest data, the world was already 'off track,' Ms. Byanyima told journalists in South Africa, a country with the world's largest number of people living with HIV, at 8 million. 'Less funding means we will get more and more off-track,' she said in the main city of Johannesburg, after meeting President Cyril Ramaphosa to discuss Africa's HIV/AIDS strategy in light of the U.S. president slashing billions of dollars in foreign aid in February. 'We don't know yet what that impact will be, but impact there will be: ... already you see in several countries a drop in the number of people going to clinics,' Ms. Byanyima said. Before the cuts, prevention programmes had brought down new infections, she said, but they were "not coming down fast enough to reach our target of 2023." Now, with the shuttering of community prevention clinics across Africa, infections would surely rise, though it wasn't clear yet by how much, she said. The administration's decision to axe swaths of U.S. foreign aid has disrupted the supply of life-saving HIV treatments, with some countries facing potentially running out. In South Africa, about a fifth of whose HIV budget was U.S.-funded, testing and monitoring of HIV patients is already falling. Ms. Byanyima said even poor, indebted countries were managing to plug funding gaps, but called on other rich nations to step in. 'We're saying to the donors: this is one of the diseases ... without a cure, without a vaccine, yet we're seeing progress,' she said. 'If you've got a good success story, why drop it ... before you end it?'
