Scientists and NGOs working on HIV/Aids programmes across SA are in limbo as they wait for the US government to clarify whether their funding is secure.
Anxiety is running high as the US President’s Emergency Plan for Aids Relief (Pepfar) is the biggest foreign donor to SA’s HIV/Aids programmes, while the US National Institutes of Health (NIH) is the largest funder of HIV/Aids research in SA.
Pepfar supports programmes in the 27 districts worst affected by the epidemic, paying the salaries of thousands of staff working alongside state employees in public health facilities, while the NIH has enabled SA to be at the forefront of HIV/Aids research.
US President Donald Trump signed an executive order after his inauguration on January 20, pausing all foreign direct assistance pending a 90-day review. This directive was swiftly followed by a “stop work order” that the International Aids Society said froze funding for Pepfar, including existing grants and contracts.
The society warned that the move placed millions of lives in jeopardy, as many recipient countries are heavily dependent on Pepfar support.
Pepfar is the world’s biggest HIV/Aids donor and has provided $110bn over the past 20 years to the countries hardest hit by the disease, including SA.
The programme has invested R140bn in SA since 2004, with $448.5m allocated to SA for the US fiscal year, which ends on September 30. That funding is now in question, along with the future of Pepfar’s “implementing partners” and the fate of the communities they work with.
While the Treasury has consistently said it is committed to funding HIV treatment, this fiscal environment will leave it hard-pressed to fill the gap should Pepfar support to SA dry up.
Our Pepfar grant is about 85% of the Health Systems Trust budget. Without it about 85% of our staff will be laid off.
— Ronel Visser, Health Systems Trust's director for health system strengthening
Pepfar does not fund the SA government directly but provides grants to nongovernmental organisations such as the Health Systems Trust, the Aurum Institute, and the Wits Reproductive Health and HIV Research Institute. These organisations not only help with service delivery but also provide technical assistance.
The Health Systems Trust for example, played an instrumental role in developing the health departments’ chronic medicine dispensing system, which enables patients to collect their prescriptions at pickup points such as churches and community halls, lessening the load on hospitals and clinics. It employs 1,700 people on its Pepfar-funded programmes.
“Our Pepfar grant is about 85% of the Health Systems Trust budget. Without it about 85% of our staff will be laid off,” said the trust’s director for health system strengthening Ronel Visser.
If Pepfar stopped funding organisations such as the Health Systems Trust, it would have a “huge impact” on SA’s ability to control its HIV/Aids epidemic, she said. “There is (insufficient) funding in the provinces and very high staff vacancy rates in facilities. We can’t see how (the country) will be able to maintain the gains that have been made.”
We don’t have alternative funds: this potentially puts jobs and programmes on the line.
— Dave Clark, Aurum Institute CEO
The Aurum Institute, which provides HIV and tuberculosis testing and treatment as well as technical support, has more than 500 staff funded by the US government.
“It’s an unsettling time. We are uncertain whether the pause extends to funds already committed,” said Aurum Institute CEO Dave Clark. “We don’t have alternative funds: this potentially puts jobs and programmes on the line,” he said.
Health department spokesperson Foster Mohale said the government had yet to receive formal communication from Pepfar on the implications of Trump’s announcement. “The department will communicate the implications of such a decision once we receive a formal correspondence,” he said.
Desmond Tutu Health Foundation CEO Linda-Gail Bekker said South Africans had for decades successfully competed for NIH research funding. “With this very valuable resource we have contributed significant research ... to progress public health, particularly in HIV, TB and other infectious diseases which impact people all over the world, including Americans”.
Pepfar and other funds to support the HIV response had saved millions of lives, families, and communities, she said. “This has been a huge investment. Stopping funding will cost lives, reverse the progress that has been made and hugely impact the dividends from this important and critical investment. This will be even more devastating if the funds stop abruptly.”
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