Last month Secretary of State Marco Rubio issued a waiver exempting specific PEPFAR-supported programming from an Executive Order pausing the disbursement of U.S. foreign assistance pending a 90-day review.
However, many PEPFAR partners reported challenges in resuming waived programming. For example, a Christian maternity clinic in Cote D’Ivoire specialized in treating mothers and children living with HIV reported that although programming was approved within the PEPFAR waiver, they are not able to access the network to procure and distribute life-saving antiretroviral medication.
Despite the waiver, the Administration’s subsequent actions have gravely undermined PEPFAR. On Wednesday, February 26, USAID and the Department of State announced that they had completed the review. In the process, a decision was made to terminate nearly 10,000 foreign assistance awards that were distributed across both agencies. Approximately 90% of USAID-funding was terminated in the action – an agency that is responsible for nearly 60% of PEPFAR’s bilateral assistance.
These awards include previously waived PEPFAR-supported projects for ensuring people have access to life-saving treatment, women do not transmit the virus to their babies, and that people who survive HIV don’t succumb to treatable diseases like tuberculosis (TB) and cervical cancer. While PEPFAR programs were already facing challenges, these terminations have made it even more difficult for people living with HIV to access services.
Nearly 20 million people across the globe depend on PEPFAR for antiretroviral medication. Individuals living with HIV must uphold strict treatment regimens to reduce the levels of the virus in their blood – making HIV nontransferable – and to prevent the emergence and spread of drug-resistant HIV that is more difficult and expensive to treat. For pregnant women living with HIV especially – a consistent routine is critical to ensuring babies are born HIV-free. As a result of the freeze and subsequent terminations, Ukraine and Haiti have dangerously low supplies of antiretroviral medication, and other countries are quickly approaching that status.
Many clinics, grassroots organizations, faith-based initiatives, and other programs will not be able to resume work, causing clinics to turn patients away, organizations to lay off critical health care workers, and organizations and clinics to close their doors.
One organization reported that their terminations included awards supporting more than 350,000 people on HIV treatment, including nearly 10,000 children and more than 10,000 pregnant women in Lesotho, Eswatini, and Tanzania. A university reported that programming in Uganda to deliver HIV, TB, and maternal and child services had been terminated. Recent research has shown that terminations may result in 500,000 deaths in South Africa over the next 10 years and around half a million new HIV infections.
This Administration must ensure that PEPFAR’s work continues – whether through USAID, the CDC, the Pentagon, or the State Department. It is a matter of life and death.
Why this matters
In just over 20 years, the President’s Emergency Plan (PEPFAR) has saved over 26 million lives – including over 7.8 million babies – from HIV/AIDS. More than that, PEPFAR has worked alongside local communities, churches, the private sector, and country governments to ensure that people who survive HIV continue to live healthy, prosperous lives.
PEPFAR is a strategic investment in our own national security. In return, PEPFAR engenders goodwill toward the United States at a time when Russia and China are competing for greater influence, in ways that are not beneficial in the long-term for the African continent.
PEPFAR-supported countries are more politically and economically stable than countries where the program is not engaged. Between 2004 and 2018, countries with PEPFAR support had 2.1% greater GDP growth and an 8-9% reduction in boys and girls out of schools. Finally, according to the Bipartisan Policy Center, public opinion of the United States is higher than the global average in PEPFAR-supported countries.
PEPFAR is nearing its goal of ending HIV/AIDS as a public health threat. As it approaches its wind-down phase, it would be a tragic mistake to abruptly end the most successful life-saving global health program. Resuming PEPFAR’s work as soon as possible will determine whether we can reach our goals or fall well short of the finish line, with possibly catastrophic results.
