“It will be a death sentence. Patients will be without quality care as clinics will close, and doctors, nurses and health care personnel will be stopped from working.”
That is how Stellenbosch University Health Professor Emeritus, Usuf Chikte described the implications of US President Donald Trump’s decision to cut aid to HIV and Aids related programmes in South Africa.
In his order, Trump said: “All executive departments and agencies, including the United States Agency for International Development (USAID), shall, to the maximum extent allowed by law, halt foreign aid or assistance delivered or provided to South Africa, and shall promptly exercise all available authorities and discretion to halt such aid or assistance.”
His decision was linked to what he called the seizure of land from minority groups following the signing of the Expropriation Bill into law. The South African government seeks to use the law as a framework to expropriate land without compensation.
South Africa does not receive direct funding from the US, except the US President’s Emergency Plan for AIDS Relief or PEPFAR which contributes about 17% to the South African HIV/AIDS programme budget.
The US embassy in South Africa has since confirmed that PEPFAR was exempt from Trump’s executive order, saying: “We have full permission to restart PEPFAR under the conditions of the limited waiver PEPFAR was granted under the January humanitarian waiver from Secretary (Marco) Rubio.”
Chikte said while this may offer some respite, it was unclear how it will be implemented given Rubio had announced that the waiver is for life-saving humanitarian assistance which may affect organisations’ ability to continue to operate though its implementation is restricted in terms of scope and uncertain whether it will be timeous.
“President Donald Trump’s decision to cut USAID funding to nonprofit organisations is having a savage effect especially to health and environmental initiatives in South Africa which receive almost $320 million annually for essential services, research and projects. This amounts to approximately 20% of the country’s HIV/AIDS funding, which is critical, as most is expended in the areas with high levels of HIV. If not remedied, this amounts to a death sentence as patients will be without quality care as clinics will close, and doctors, nurses and health care personnel will be stopped from working.
“The financial support has been critical for the country to provide essential medication for treatment of these diseases to tens of thousands of patients. In addition, the financial support contributes significantly for South African scientists to conduct fundamental research on these diseases. This research is continuing and adds to the pool of knowledge that can lead to the eventual eradication of these diseases all over the world,” said Chikte.
Unless new sources of funding are found, South Africa has limited choices in how it has to deal with the prevention and treatment of HIV/AIDS and TB treatment, said Chikte.
“Its priority has to be the treatment of current patients by provision of the required medication to the patients. Millions of South Africans, and indeed on the continent, are dependent on the necessary treatment, but not enough funds will be available to treat everyone. Life-saving humanitarian assistance, according to the waiver, is for core lifesaving medicine, medical services, food, shelter and subsistence assistance, as well as supplies and reasonable administrative costs as necessary to deliver such assistance. The problem is once supplies and services are disrupted, and jobs of health care workers are threatened it is difficult to restore confidence and trust in the system and get back on track,” he added.
The African-led HIV Control Working Group (AHCWG) said while the most recent communication on the limited PEPFAR waiver provides more information, it has done little to quell the anxiety among stakeholders.
“The impact of the Executive Order on PEPFAR-supported programs is like dropping a bombshell. This one event 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 programs is intolerable, with long-lasting consequences.”
UCT public health professor Leslie London said while it was not clear where the money would now come from, “it will surely be replaced by other sources (Chinese, European, etc) which will reduce Trump’s influence.”
Cape Times