Shuttered clinics and health workers laid off around the world reflect the widespread, negative toll the United States funding freeze is taking on the global AIDS response, according to a new situation report released on Wednesday by the UN agency charged with responding to the disease.
UNAIDS said that at least one status report on the impact of cuts has been received from 55 different countries up to the start of this week.
That includes 42 projects that are supported by the US President's Emergency Plan for AIDS Relief (PEPFAR) and 13 that receive some US support.
Two days after President Trump's executive order in late January declared a 90-day pause to all foreign assistance, the Secretary of State issued an emergency waiver to resume "life-saving" humanitarian assistance, including HIV treatment.
UNAIDS reported just over a week later that there was widespread "confusion" over how the waiver was being implemented on the ground.
The 16 reports received from UNAIDS country offices around the world during the week of 17 to 21 February show that these waivers have led to the resumption of some clinical services, such as HIV treatment and prevention of vertical transmission, in many countries that are highly dependent on US funding.
Many projects ineligible
However, it's unclear how long funding will last amid multiple reports that key US government systems and staff responsible for paying implementing partners are either offline or working at greatly reduced capacity, the UN agency said.
In addition, critical layers of national AIDS responses are ineligible for these waivers, including many HIV prevention and community-led services for key populations and adolescent girls and young women, according to the UN agency.
At the same time, data collection and analysis services have been disrupted in numerous countries, according to reports received last week, which note that the overall quantity and quality of HIV prevention, testing and treatment services has been eroded.
Waiting times increase
Staff working in health facilities are facing increased workloads, and patients are experiencing increased wait times to receive lifesaving services, UNAIDS said.
Other concerns persist, from hobbled health systems to addressing gender-related priorities.
"US Government statements to UN system organizations suggest US-funded programmes focused on gender equality and transgender populations may not resume," according to the UNAIDS situation report.
Fresh data analysis
The situation report covers more granular analysis on the global AIDS response's heavy reliance on US foreign assistance, extracted from the datasets managed by UNAIDS.
For example, more than half of HIV medicines purchased for the Democratic Republic of Congo (DRC), Haiti, Mozambique, Tanzania and Zambia are purchased by the US.
Before the freeze, the US Government provided two thirds of international financing for HIV prevention in low and middle-income countries, according to estimates from the Global HIV Prevention Coalition .
The report also named the 20 countries that rely most heavily on funding from Washington: DRC, Haiti, Mozambique, Tanzania, Zambia, Uganda, Nigeria, Rwanda, Angola, Kenya, Ukraine, Burkina Faso, Burundi, El Salvador, Zimbabwe, Togo, Nepal, Côte d'Ivoire, Eswatini and Benin.
Services at a standstill
Civil society and community-led interventions are central to ending AIDS and to sustaining the gains into the future, according to UN agency.
People living with HIV and key populations at higher risk of infection, play a crucial role in maintaining the local services needed to stay healthy, UNAIDS said.
Yet, many critical services have ground to a halt. Here are some examples:
- Mozambique: Community workers and test counsellors supported by PEPFAR funding are not being paid. As a result, HIV testing is unavailable in most parts of the country, enrolment of new patients is on hold and efforts to support people living with HIV to adhere to their treatment have been compromised
- Tanzania: Young people working as peer educators, community health workers or lay counsellors funded by PEPFAR have been issued temporary job termination notices
- Rwanda: Community-level and facility-based HIV-prevention services targeting populations at high risk of HIV infection, including adolescent girls and young women, gay men and sex workers were not covered by waivers received from the US Government
- South Africa: US-funded facilities that support gay men, such as Engage Men's Health, remain closed
- Ghana: All civil society organizations funded by PEPFAR have halted services to people living with HIV and key populations
Learn more about UNAIDS here .
On the ground in Côte d'Ivoire
Here is an emblematic snapshot of how the UN funding freeze has already affected this West African nation of 27 million, where Washington has supported more than half the total response to assist more than 400,000 adults and children living with AIDS.
- The stop-work order triggered a complete shutdown of services funded by the PEPFAR programme, which covers 516 health facilities in 70 per cent of the country's health districts and 85 per cent of people living with HIV on treatment (about 265,000 people)
- More than 8,600 staff were affected, including 597 clinical workers (doctors, nurses and midwives) and 3,591 community workers
- Distribution of medicines and transport of diagnostic samples ground to halt
- US-funded services partially resumed on 12 February following receipt of waivers, but the majority of US-funded HIV-prevention services for people at high risk of infection, remain shut
- Other national health programmes and systems are affected by the freeze, including the malaria and tuberculosis control programmes and another serving mother and child health alongside the supply chain system for medicines and diagnostics
