Africa
ON 20 January 2025, the US President issued an Executive Order to pause all
foreign aid funding for 90 days, which was immediately applied to the United States
Government (USG) funded President’s Emergency Plan for AIDS Relief (PEPFAR).
Launched in 2004, PEPFAR has been critical in global health efforts, saving over 26
million lives and providing life-saving HIV treatment for over 20 million people around
the world, particularly in African countries.
The statement by the African-led HIV Control Working Group stated that halting funding to such a successful public health programme, without notice risks the lives of millions of people, who depend on resources to manage HIV infections or prevent new transmissions, particularly amongst high-risk populations.
According to the statement, the decision overlooks the interconnectedness of our global community, where solidarity is essential to reduce the global disease burden.
“While we recognize the power and rights of Governments to make decisions
regarding their foreign policies, decisions that impact the health of millions of people
around the world must be made in the context of a clearly defined plan that fully
considers all the life-threatening implications.
“Instead, the Executive Order has created confusion, panic, and uncertainty among
the USG funding agencies, country implementing partners, and most critically, the
millions of people living with HIV. PLHIV, who depend on the USG funded health
services to survive.
“Although the most recent communication on the limited PEPFAR waiver provides more information, it has done little to quell the anxiety among stakeholders.
“Furthermore, the waiver does not include pre-exposure prophylaxis, PrEP, for those at high risk of new HIV acquisition, such as adolescent girls, young women, men who have sex with men, sex workers, and other priority populations,” the statement said.
The impact of the Executive Order on PEPFAR-supported programmes is like dropping
a bombshell. This one event that has destroyed decades of trust and security among
PLHIV and threatened fragile health systems built by PEPFAR that supported the
response to COVID-19, Ebola, and recently the Mpox outbreak.
The 90-day limbo for the future of HIV care and treatment programmes is intolerable, with long-lasting consequences.
“While we unreservedly oppose the Executive Order, its cascading effects, including
the ensuing stop-work orders, this also demonstrates the inherent risks of African
countries’ over-reliance on donor support for HIV programmes.
“African governments need to reevaluate the sustainability of their HIV programmes and make bold decisions to sustain their HIV response. Now is the time, in the midst of an emergency, for African leaders to look inward for domestic solutions and funding to address this challenge. Increasing health investments through domestic resources and local solutions is imperative to securing the long-term health and wellbeing of millions of
people across Africa.
“The African-led HIV Control Working Group, AHCWG, 1 is a think tank of African HIV
and policy experts, established to project an African voice on the efficiency and
sustainability of the HIV response. The group is actively addressing the
consequences of the Executive order and the actions required to respond to the
unprecedented challenges,” ur added.
In response to the Executive Order, the group calls for four immediate actions:
1. Immediate and full reinstatement of all PEPFAR and other USG-funded
programmes that provide life-saving HIV programs globally from the 90-day
pause for re-evaluation and realignment of foreign policy, and a more
systematic and appropriately considered approach adopted for determining
future funding.
2. Clear communication on the future of funding for the HIV programme after the
conclusion of the re-evaluation and realignment of foreign policy.
3. African governments to recognize that there are no secure commitments from
external funders regarding healthcare services and take immediate action to
ensure health security for their people. This includes defining what capacity is
needed,and at what costs, to support testing, prevention, care, and treatment
for PLHIV and those at risk. It further includes sourcing domestic funding to
the largest extent possible to ensure health security.
4. Strategic collaboration between global stakeholders and African governments
committed to building the necessary capacity for Africa’s health care independence.
6th February, 2925.
C.E.
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