US secretary of state Marco Rubio has issued a waiver partially lifting the Trump administration’s freeze on foreign aid, potentially offering a reprieve for US-funded HIV/Aids programmes that provide life-saving treatment.
The “life-saving humanitarian assistance” waiver includes “core life-saving medicine, medical services, food, shelter and subsistence assistance, as well as supplies and reasonable administrative costs” and directs organisations implementing life-saving humanitarian assistance to resume work if they have stopped, US media reports say.
For SA, the development means nongovernmental organisations funded by the US President’s Emergency Plan for Aids Relief (Pepfar) are likely to resume some of their activities. However, the details have yet to be communicated to Pepfar’s implementing partners, which earlier this week received letters from the Trump administration directing them to stop work.
Similar instructions were sent to US-funded staff working in the public health sector. On Wednesday they were still in the dark about which services they would be permitted to resume while the review is under way.
Rubio’s waiver excludes activities that involve abortions, family-planning conferences, gender or diversity, equity and inclusivity ideology programmes, transgender surgeries and nonlife-saving assistance.
“A funding halt for HIV programmes can put people living with HIV at immediate increased risk of illness and death and undermine efforts to prevent transmission in communities and countries.
— World Health Organisation
US President Donald Trump signed an executive order within hours of his inauguration on January 20 pausing almost all foreign aid for 90 days, pending a review to determine whether it was aligned with his policy agenda. It was followed by a “stop work” order from the US state department on January 24, pausing all committed foreign aid. As the US is the biggest aid donor, the freeze on foreign aid sent shock waves through the organisations it supports.
The World Health Organisation (WHO), scientists and activists have warned that suspending the HIV services provided by Pepfar places lives in jeopardy and risks an increase in transmission.
Pepfar was founded in 2003 by former US president George W Bush and has since then disbursed more than $110bn to the countries worst affected by HIV/Aids, including SA.
The WHO said it was deeply concerned about implications of the funding pause for HIV programmes in low- and middle-income countries, as they provided access to HIV treatment to more than 30-million people.
“A funding halt for HIV programmes can put people living with HIV at immediate increased risk of illness and death and undermine efforts to prevent transmission in communities and countries. Such measures, if prolonged, could lead to rises in new infections and deaths, reversing decades of progress and potentially taking the world back to the 1980s and 1990s when millions died of HIV every year globally, including many in the US,” it said.
Pepfar operates in 54 countries, supporting more than 190,000 full-time equivalent staff to dispense HIV medication to 220,000 people each day, according to the Foundation for Aids Research (Amfar). In SA, it supports 13,800 healthcare staff, including almost 180 doctors, almost 2,000 nurses and midwives, 53 laboratory staff, almost 200 pharmacists and pharmacy assistants and more than 8,200 community health workers, it estimated.
“A stop work order immediately removes these individuals from providing daily services. Hundreds of thousands of people will immediately be unable to access effective and life-saving HIV treatment and other services,” Amfar said on Tuesday.
“Even short cessations of these programmes cause unnecessary suffering, loss to follow-up, and risk onward transmission that cannot simply be ‘turned back on’ when the suspension is lifted,” it said.
Western Cape Health and Wellness MEC Mireille Wenger said the provincial government was working with its delivery partners to assess the situation and minimise disruption.
“While the way some services are delivered may change, essential healthcare — including the procurement and distribution of medication such as ART (antiretroviral therapy) — will continue. There may, however, be adjustments in how and where clients access certain support services,” Wenger said, urging patients to seek care at their nearest clinic.
“Our partnership with the US, through programmes such as Pepfar and USAID, has always been a positive one, with substantial gains in healthcare outcomes for the province. We are doing everything we can to support this important partnership continuing,” she said.
Update: January 29 2205
This story has been updated with new information.
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