Latest news with #USAID
The Guardian
2 hours ago
- Politics
- The Guardian
Senator Elizabeth Warren demands answers from Marco Rubio about Gaza aid contract
Elizabeth Warren has confronted the US secretary of state, Marco Rubio, over reports that the state department is considering redirecting $500m from USAID to the controversial Gaza Humanitarian Foundation (GHF). In a letter addressed to Rubio and USAID's acting administrator, Kenneth Jackson, the Massachusetts senator argued that the GHF, a self-proclaimed aid organisation that is backed by the Israeli and US governments, 'marks an alarming departure from the professional humanitarian organizations that have worked on the ground, in Gaza and elsewhere, for decades'. 'The questions surrounding GHF – its funding sources and connection to the Trump Administration, its use of private contractors, its ability to serve and be seen as a neutral entity, its abandonment by its founders, and its basic competence in providing aid – must be answered before the State Department commits any funding to the organization,' Warren wrote in the letter, a copy of which was provided exclusively to the Guardian. The letter from Warren requested answers by 2 July on whether USAID is considering awarding any funds to the GHF, the terms of a possible agreement and the GHF's connections to the Boston Consulting Group, which reportedly helped set up the group's operations. BCG canceled its cooperation with the GHF after the organisation was embroiled in controversy following a series of shootings by Israeli forces at its food distribution sites. Reuters first reported that funds directed to USAID, which is being rolled into the state department, could be rerouted to the GHF in an important boost to a troubled organisation that opened food distribution centres in Gaza last month. The GHF has struggled to partner with major aid organisations, even as Israeli and US officials have put pressure on NGOs to route their humanitarian through the GHF or face having no access to Gaza at all. Major aid organisations have boycotted the GHF, which was forced to temporarily close some of its food distribution centres shortly after its launch last month due to security concerns. Israeli forces have opened fired into crowds near the food distribution sites several times in mass casualty events that Israeli officials have said took place in self-defence. Hundreds of Gazans have been killed. Jake Wood, the former executive director of the GHF, resigned last month shortly before operations began. He said that he could not guarantee the organisation's 'independence' from political influence. Critics have argued that the GHF is a tool for the Israeli and US governments to politicise humanitarian aid and to distribute it in ways that will depopulate sectors of Gaza in apparent violation of international law. The Guardian has approached the state department for comment.
The Hill
4 hours ago
- Politics
- The Hill
Budget reconciliation bill strikes blow against activist judges
Sometimes the most powerful part of a bill isn't a sweeping mandate but a single, strategic sentence. Deep in the House reconciliation package is just such a provision. It bars courts from enforcing injunctions through contempt unless plaintiffs post the required bond. That may look minor, but this clause is the rampart that will repel the courtroom assault on President Trump's agenda. The language needs tightening, but it would save the taxpayers billions, meets Senate budget reconciliation criteria — and must be passed. The provision works not by making new law, but by simply enforcing the current law governing federal courts. Rule 65(c) requires parties seeking a pre-trial injunction to post bond to cover damages if the defendant is later found to have been wrongfully enjoined. The rule is designed both to make defendants whole and to deter frivolous claims. The text and history make clear that bonds are mandatory, but district judges exhibit a disturbing level of defiance. One judge declared himself 'simply unwilling' to impose a 'burdensome' bond on 'public interest' litigants. But invoking the 'public interest' is a purely subjective exercise. Those challenging a government policy have no stronger claim to the public good than the millions who voted to implement that policy in an election. The House finally had enough of activist judges evading the bond requirement, but the provision still must survive the 'Byrd Rule' in the Senate. Because budget reconciliation bills can pass the Senate with only a simple majority, there is a strong incentive to include non-budgetary policy matters. To prevent this, Section 313 of the Budget Act bars any provision that results in budgetary changes that are 'merely incidental' to the provision's non-budgetary goals. For example, in 2021, the Senate parliamentarian blocked a measure to grant amnesty to 8 million illegal immigrants, reasoning that the policy change 'substantially outweighs' its estimated $120 billion budgetary impact. The injunction bond provision is not remotely in that situation. It is not a policy change — it merely enforces an existing policy whose express purpose is to protect defendants' wallets. This protection is essential because the Supreme Court has said that a 'party injured by the issuance of an injunction later determined to be erroneous has no action for damages in the absence of a bond.' Right now, because judges are systematically ignoring the bond rule, the federal government is being forced to make outlays of billions of dollars that are irrecoverable. For example, in February, a federal judge issued a temporary restraining order requiring, in the words of Justice Samuel Alito's eventual dissent, the 'United States to pay out (and probably lose forever) 2 billion taxpayer dollars' to reinstate cancelled USAID contracts. There are many such cases. A California district court required the government to reinstate 16,000 fired probationary employees. The government warned the court this would inflict 'massive financial costs that cannot be recouped.' Still, no bond was ordered. A Maryland court issued a similar ruling covering 24,000 employees. Although both were later stayed, the government had to comply for over 3 weeks, at an estimated cost of $41 million. Had these plaintiffs posted the required bond, these multimillion-dollar losses would have been prevented. To the extent the provision's 10-year budgetary impact is hard to estimate precisely, it is not because it lacks direct effect, but because the number of activist judges' injunctions is unpredictable. Each time an injunction is sought, the provision will trigger, thus saving compliance costs. While its frequency is uncertain, its direct budgetary effect will be clear once activated. That said, baseline estimates are possible. Recently, a federal judge blocked planned layoffs of some 180,000 positions at 22 federal agencies. Assuming conservatively that the positions are all paid at the lowest government wage of $22,360, this preliminary injunction is costing the government $350 million each month. But the judge in the case claimed she had no way to determine the financial impact and ordered a bond of $10. The plaintiffs in the case also attest that as many as 700,000 jobs are threatened. If we accept that figure and use the average government salary of $106,000, the bond provision could save taxpayers, in this instance alone, $74 billion if the litigation lasts a year. This House provision makes an injunction without a sufficient bond unenforceable. This would substantially decrease government outlays by ensuring the government always gets its money back when wrongfully enjoined. This is a clear and direct budgetary consequence, and the savings are not 'merely incidental' but are the whole point of the provision. However, the language needs refining before passage. First, explicitly limit it to preliminary injunctions and TROs to address constitutional concerns about curbing courts' remedial powers. Second, it should include temporary administrative stays to prevent circumvention. Third, align with Rule 65(c) in requiring a bond amount 'proper to pay the costs and damages,' to preclude judges from setting trivial bonds. Finally, extend the enforcement ban to executive branch officials, who have far greater incentive to obey than the activist judges whose brazen defiance of Rule 65(c) necessitated this congressional action. Daniel Huff worked as a lawyer in the first Trump White House and is a senior legal fellow at the American Path Initiative.
SBS Australia
10 hours ago
- Politics
- SBS Australia
Report traces impact of US foreign aid cuts on Australian agency programs
At the start of the year, Ciaran O'Toole says Conciliation Resources was just setting out on a five year project. "We work primarily in communities, building or enhancing the capacities in communities to be able to prevent violent conflict. We had just started a program in the in the highlands of Papua New Guinea, and then it was quite quickly stopped as part of U-S AID pulling out." The international peace building group hoped to prevent violence in an area where conflict is increasing. Last year, 49 people were killed in the Highlands in what was considered a major escalation in tribal fighting in the region. "It is what not happens, right? It is the headlines that don't exist. It is around, sort of, working on these complex, long term problems at a community level. So it's not just reacting to when violence occurs." But the plan to station mediators to help communities find non-violent ways to address grievances in PNG's Hela province came to an abrupt halt in January, as the United States Administration paused all USAID funding for 90 days. Since then, only 14 per cent of programs have had their funding reinstated by the U-S government. Conciliation Resources was forced to let go of some staff, and reduce hours for others. "The communities that are affected by violence, and in particular, the women that suffer abuse, the people that are affected directly by violence who struggle to see a light at the end of the tunnel sometimes. Yeah. I would feel more for them." The program is one of more than 120 run by Australian agencies impacted by the cuts, according to a report by the Australian Council for International Development. Director of Policy and Advocacy Jessica McKenzie says the cost is in the hundreds of millions. "400 million ((AUD)) worth of programming has been cut. 20 country offices have closed, and we've seen a number of staff laid off. Just one agency had to let go of 200 local staff, not even their own staff, and they would have been single income families. And so you can imagine the flow on effects of this." The council expects the actual effect of the cuts to be greater, with less than half of its members responding to the survey. Australian-run programs in Indo-Pacific region were hardest hit, with $113 million AUD worth of funding lost in the Pacific closely followed by $111 million AUD in Southeast Asia. But the impact for Australian agencies extends throughout Africa, the Middle East, and Asia. Ms McKenzie says a program assisting 765,000 people in Yemen was cut. "It was providing life saving medicine. It was providing life saving food, and it was providing malnutrition help for 26,000 children under the age of five." In Nepal, a program supporting over 300 girls to go to school has been axed. "That means that they're more exposed to modern slavery, to human trafficking, to force child marriage. The flow on effects of these projects and their ability to break the cycle of poverty are really quite compounding." The council found that child-related programs encompassing, education, health, nutrition, and anti-child trafficking took the greatest financial hit, closely followed by projects focused on climate change. The U-S Administration undertook a review during the initial pause to ensure only programs that aligned with the foreign policy of the President were funded by the government. Whilst aid organisations say they have been given little clarity as to why programs were cut, there's a belief that those focused on climate change and gender did not meet the expectations of the administration. Mr O'Toole says there was some themes within the cuts. "I don't think there was much thinking gone into it, to be quite honest. I think it was anything that included elements of gender, which our program obviously did. Possibly even the words peace building was eliminated, we believe, pretty quickly. There's a lot of talk around peace from the administration. A desire to sign peace agreements to Nobel Prizes, but at the end of the day, peace starts in communities. It starts with people. It starts on the ground." Australia's International Development Minister Anne Aly says the government is still working to understand the full extent of the U-S cuts. "We are concerned that the cuts will have an impact, particularly on the poorer nations within our region, which is why we continue to say and to demonstrate that we are a trusted partner in the region. It's why we have not cut our a budget. In fact, we've increased our aid budget." ACFID is calling for the budget to be increased from 0.65% to 1% of total federal spending to help fill the gap left by the United States. "In the past, between 2005 and 2015, it was at 1% of Australian federal expenditure. So this isn't a really big change." Labor reallocated $120 million of foreign aid from global health and education programs to the Indo-Pacific region in its pre-election budget in response to the USAID pause. Overall, Labor committed to spend an additional $135 million on aid in the next financial year, an increase in line with inflation. That's below Labor's Party Platform to increase the aid each budget as a percent of gross national income, with a final target of 0.5 per cent of GNI. It's remained stagnant at 0.19 per cent since 2022. Dr Aly says the overall spend will continue to be gradually increased. "That's what's in our platform. What I'm saying is what we have done is increase our overseas development assistance budget, and that we have made a commitment to increase it by indexation." Since coming into power, Labor has increased its diplomatic and humanitarian efforts in the Pacific with concerns about China's influence in the region driving increased investment and aid programs. Ms McKenzie says the government should priorities the programs with the greatest impact. "We can rebalance it towards more of those health, education, nutrition programs, rather than some of the more geostrategic imperatives." Dr Aly says Australia will continue to prioritise the Indo-Pacific. "We're focused on ensuring that the countries in our region have economic resilience. We're focused on the health needs of the countries in our region. We're focused on ensuring that our aid goes to where it's most needed and where it can have most impact. I don't think it should be a point of contention that Australia should be focused on the region in which we operate."
News24
11 hours ago
- Health
- News24
These are the children the United States left to die in Mozambique
In Mozambique, the health system is overwhelmingly built on US money. When the Trump administration instantly pulled much of this funding without warning, disease and death spread. Spotlight and GroundUp visited one of the worst affected regions to describe the human toll. Hospitals run short of life-saving drugs. Doctors and nurses are laid off en masse. Hospital lines get longer and longer. Some patients are given the wrong medication, likely because the data capturers (who manage patient files) have lost their jobs. Community case workers who deliver HIV medication to orphaned children stop coming. Without their antiretrovirals (ARVs), some of these children die, GroundUp reports. Following US President Donald Trump's executive order to suspend US global aid funding on 20 January, the health system in parts of Mozambique fell into a state of chaos. US aid agencies had financed much of the country's healthcare workforce, along with the transportation of drugs and diagnostic tests to government hospitals. In some provinces, this money came from the US Centres for Disease Control and Prevention (CDC), which restored much of its funding shortly after the executive order. But in the central provinces of Sofala and Manica the money came from the US Agency for International Development (USAID), which permanently pulled most of its grants. For a week in June, I travelled to nine rural villages and towns across the two provinces. Interviews with grieving caregivers, health workers and government officials across these settlements all converged on one clear and near-universal conclusion: the funding cuts have led to the deaths of children. One of the clearest reasons is this. After USAID-backed community health workers were dismissed, thousands of HIV-positive children under their care were abandoned. Panic at all levels In 2020, a Sofala-based organisation called ComuSanas received a large USAID grant to employ hundreds of community workers throughout rural parts of the province. 'The project aimed to reduce mortality among children living with HIV,' says Joaquim Issufo, a former community worker with the project. He spoke to me from a street market in the impoverished district of Buzi, where he now runs a stall selling fish. 'We worked with children aged 0 to 17, especially orphans and vulnerable children.' These children live in remote villages, far away from public amenities. Some were found living in homes without any adults. Many others live with an elderly grandparent who can barely afford to feed them. Jesse Copelyn/GroundUp In the midst of poverty and isolation, the case workers, known locally as activists, functioned as a bridge between these children and the country's hospitals. They shuttled diagnostic tests between communities and health facilities. They brought children their medicines and ensured they took the correct doses at the right times. And they accompanied them to health facilities, and helped them weave through bureaucracy. Issufo notes that their role also extended far beyond health: they organised birth certificates, enrolled children in schools and referred them for housing. When drought and famine ripped through villages, they brought food baskets and provided nutritional education. In the villages that I went to, children and their caregivers referred to the activists as 'mother', 'father' or 'sister', and said that they were like family members. But after USAID issued stop-work orders to ComuSanas in January, those 'mothers and fathers' abruptly stopped visiting, and suddenly the region's most desperate children were left to fend for themselves. Issufo says that after this, there was 'panic at all levels, both for us as activists and also for our beneficiaries'. Children hospitalised and left for dead About 80km from Issufo's fish stall is the village of Tica, in the Nhamatanda district. Amid homes of mud brick and thatch, a group of former ComuSanas activists sit on logs, buckets and reed mats and explain the consequences of the programme's termination. '[Before the USAID cuts], I was taking care of a boy because [he] lives with an elderly woman, and she had to work,' says Marta Jofulande, 'I had to go to the health facility and give the child his [ARV] medication. I also helped to do things like preparing food. But with this suspension, I couldn't go anymore.' Jesse Copelyn/GroundUp Shortly after, Jofulande was told by the child's elderly caregiver that he had fallen ill, and was in critical care at a central hospital. 'I was the one bringing the [ARVs] to him,' says Jofulande, 'As soon as the programme stopped, he no longer took the medication, and that's when he relapsed. He is in a very critical condition and is breathing through a tube.' 'His name is Cleiton,' she adds. 'He's eight years old.' Jesse Copelyn/GroundUp Many other children have already perished. A 20-minute drive from Tica is the settlement of Mutua, in the Dondo district. There, activist Carlota Francisco says, 'During this pause, we had cases [of children] that were really critical that ended up losing their lives.' One of them had been a 2-year-old girl under her care. 'That child depended on me,' says Francisco, who explains that she would fetch and provide the girl's ARVs. After she stopped, she says the girl's caregivers failed to give her the correct dosages. The 2-year-old died shortly thereafter. Stories such as this were repeated in almost every village that we visited. Often, children or their caregivers attempted to get the medication without the activists. But many of the hospitals were in a state of chaos because USAID-funded health workers and data capturers had been laid off. The linkage officers that knew these children and had previously assisted them were gone too. (The procurement of the country's ARVs is financed by The Global Fund to Fight AIDS, Tuberculosis and Malaria. This money continues to flow, but the distribution of these drugs to hospitals relies on US money.) Endless queues, drug shortages and the loss of patient files meant some didn't get their medication. Rates of ARV treatment fall throughout the province The director of health for the Buzi district, Roque Junior Gemo, explains that a key role of the community workers had been to extend health services to remote areas that they had long struggled to reach. 'They are like our tree branches to bring services to the people,' says Gemo, 'Our villages are very remote, and we have a large population that needs information [and] basic services.' 'Especially in the HIV area, we have terminal patients who were once followed up by activists. They used to get medications at home. Without that help, their condition worsened, and some died.' This forms part of an issue that extends far beyond the district of Buzi. In the Sofala capital of Beira, I sat down with some of the province's senior health officials. The HIV supervisor for the province, Manuel Seco, provided data on the HIV response in Sofala, before and after the cuts. Between May and December of 2024, the total number of people on ARVs in the province had risen by over 20 /000 people, the data shows. This increase occurred steadily, rising by 500 to 5 000 people each month. But as soon as the cuts were made, this progress was halted and the trend reversed. Since January, the number of people on ARV treatment has been falling by hundreds of people each month. The reason, according to Seco, is that many people who were on ARVs have stopped their treatment, while new ARV initiations have dropped sharply. And the impact extends far beyond just the HIV response. Jesse Copelyn/GroundUp TB left untreated Buried within a compound owned by Tongaat Hulett is a government hospital that services the rural population of Mafambisse, in Dondo district. Joaquim Mupanguiua, who deals with TB at the hospital, says that after the activists were laid off, the hospital saw a steep decline in the number of TB patients coming to the facility. 'Only when they are already very ill do they come to the health unit,' he says. 'But with the activists they would easily go to the communities and find the sick.' Indeed the number of patients coming to the hospital is roughly a third of what it once was: 'We used to get around 28 to 30 [TB] patients per month, but now we're down to fewer than 10,' Mupanguiua notes. Because patients come to the hospital when they're already severely ill, there's significantly less that health facilities can do for them. It's thus no surprise that Mupanguiua believes that there has been an uptick in needless TB deaths. Finding other ways Back in the Buzi district office, Gemo says that efforts have been made to assist terminal patients that had previously been supported by activists, but there are so many people in need that they aren't able to help everyone. Activists often said something similar – they continue to visit their beneficiaries when they can, they say, but without ComuSanas sponsoring their transport costs, many struggle to visit children in remote areas. And the loss of their income with the programme means that they now need to spend their days finding other ways to survive – subsistence farming and street markets are the usual routes. But this work rarely offers the kind of regular income that ComuSanas had been providing. 'Honestly, buying notebooks, pens and clothes for my children [has become] very difficult,' says Dondo-based activist, Brito Balao. Meanwhile, in Tica, activists asked how they could provide food to their former beneficiaries when they are themselves going hungry. Despite this, the activists still live within the same villages as their beneficiaries. And so unlike those in Washington, they cannot withdraw their support without facing the resentment or desperation of their communities. 'We work with love, and we get really sad not being able to be there for those kids,' says one Mutua-based activist. 'There's even another family that cried today [when they saw me]. 'You've been away for a while,' they said. Gosh, we feel bad.' Among former beneficiaries of the programme the sense of abandonment was palpable, and their anger was often directed at the former activists. This was often compounded by the fact that no one had explained to them why the programme had stopped. Jesse Copelyn/GroundUp In the village of Nharuchonga, Joana, explains that in the past her activist, Fatima, would always come and ensure that her daughter took her ARVs. Now that Fatima has stopped coming, her daughter doesn't always take the medication, she says. (Fatima is present during this conversation.) 'We've been abandoned by Fatima,' she states, looking directly away from the former activist. 'Until now we have been too shy to ask why she has abandoned us.' In many other cases, the tone was simply one of sadness. Back in Tica, inside an outdoor kitchen made of corrugated iron sheets, Maria holds her five-year-old granddaughter Teresa. Despite facing hunger at various points over recent years, she cooks sweet potatoes above a small fire, and insists that everyone eats. Both of Teresa's parents died of AIDS, says Maria. It has been left to her to raise the child, all the while trying to grow rice and maize for subsistence – an effort hampered by frequent drought. For a long time Maria has had help with this parental role, she says. Activist Marta Jofulande had been assisting her family and acting like a mother to the child. But since the programme was terminated, they don't see much of Jofulande anymore. Instead, five-year-old Teresa has been forced to deal with the exit of yet another parental figure./ A note on quotes: Most of our interviews were in Portuguese and were mediated by a local translator. We subsequently transcribed and translated the recordings of these interviews using AI-based software, including Descript and ChatGPT. Where there was a significant mismatch between the interpretations of the translator and the software, we contacted the interviewee or got third parties to help translate the recordings. The cost of travel, accommodation and the journalist's remuneration was shared between GroundUp and Spotlight.
Reuters
12 hours ago
- Health
- Reuters
Insight: Trump aid cuts deal a blow to HIV prevention in Africa
June 20 (Reuters) - 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, opens new tab, 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, opens new tab 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, opens new tab. "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." 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, opens new tab. 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. 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.
