The Trump administration has issued formal instructions to the HIV/Aids organisations it funds in SA to immediately stop work, confirming their worst fears.
The directive forces them to cease services and puts pressure on the health department to step into the breach.
On Tuesday the local implementing partners of the US President’s Emergency Plan for Aids Relief (Pepfar) received letters from USAID’s agreement officer for Southern Africa to immediately suspend work.
The letters crystallise the effect of US President Donald Trump’s executive order that all foreign aid be paused pending a review of whether it aligns with his foreign policy agenda.
While successive US administrations have often changed tack on their support for global health policies — most notably on abortion — the abrupt stop ordered by the new Trump administration has left organisations reeling.
Mass harm
“I am 100% supportive of a comprehensive review of foreign aid, however it can be done in a manner that is reasonable and does not cause mass harm,” said a person in a leadership role at a Pepfar implementing partner.
Speaking on condition of anonymity, the person said: “Being asked to put an immediate pause of any duration to the world’s largest HIV and TB treatment programmes will cause irreparable harm.
Government may need to step in both in terms of salaried positions, but also in relation to the care that’s provided by specialised clinics (to ensure) continuity of care.
— Shabir Madhi, Wits health dean
“The provision of life-saving services and medicines will stop and public facilities will immediately face a patient management crisis of unprecedented magnitude — all because they trusted the US government to follow through on its commitments.”
Pepfar is the biggest foreign donor to SA’s HIV/Aids programmes and has provided more than R140bn over the past 20 years. It allocated $448.5m to SA for the current US fiscal year, which ends in September.
Its implementing partners employ thousands of people that provide HIV/Aids services that complement those offered by the state, along with technical support aimed at strengthening the public health system.
Wits University health dean Shabir Madhi confirmed a stop work order had been received for USAID-funded programmes run by the Wits Reproductive Health and HIV Institute, Pepfar’s biggest grant recipient in SA.
Pepfar does not directly finance its implementing partners, but channels funds through US government agencies such as USAID and the Centres for Disease Control.
“A stop work order means that you can’t draw down from the grant (for) any expenditure that may have been approved ... which includes salaries and the procurement of medication or diagnostic tests,” Madhi said.
“Government may need to step in both in terms of salaried positions, but also in relation to the care that’s provided by specialised clinics (to ensure) continuity of care,” he said.
BAFFLED
Health minister Aaron Motsoaledi said the world was baffled by Trump’s announcements.
“We have been fighting the scourge of HIV/Aids, TB and malaria together for more than 20 years as a global community, and depending very much on global funding,” he said.
SA had the world’s biggest HIV testing and counselling campaign, with 5.5-million patients on treatment, he said.
“Total spending on this campaign is R44.4bn, and Pepfar contributes 17% of it,” Motsoaledi said at a media briefing.
Work was under way to determine the impact of the stop work orders, and once this was finalised he intended to meet finance minister Enoch Godongwana, he said.
The government had not received any formal notification of Pepfar’s intention to pause support to SA, he said.
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