US Success in Fighting AIDS Now Threatened by Funding Cuts

The Impact of US Aid Cuts on HIV Treatment in South Africa

Gugu, a 54-year-old former sex worker from Johannesburg, used to collect her antiretroviral medication (ARVs) from a clinic funded by the United States Agency for International Development (USAID). However, when President Donald Trump announced significant cuts to foreign aid earlier this year, she and thousands of other HIV-positive patients across South Africa faced an uncertain future. Despite the challenges, Gugu was fortunate enough to receive a nine-month supply of ARVs before her clinic closed down.

“I was one of the people who was able to get their medication in bulk. I usually collect a three-month prescription. But before my clinic closed, they gave me nine months’ worth of medication,” she explains. However, Gugu knows that this reprieve is temporary, as she will run out of ARVs in September and plans to seek treatment at a local public hospital.

Her journey with HIV began ten years ago after she quit the sex work industry. Initially, she believed she had tuberculosis due to a persistent cough, but after failing to respond to treatment, she sought an HIV test. “By then I already assumed that I was HIV-positive, and I told the nurse this,” she recalls. She was right, and has been on ARVs ever since.

Today, Gugu works as a project coordinator for an NGO that supports pregnant sex workers in accessing ARVs to ensure their children are born HIV-negative. The organization also conducts home visits to monitor medication adherence and assist with monthly check-ups.

Many HIV-positive sex workers in South Africa relied on private clinics funded by USAID for their treatment. However, most of these facilities have closed following the reduction in US foreign aid. This has raised concerns about the potential reversal of progress made in the global fight against HIV/AIDS.

According to the UNAIDS, the progress in reducing new HIV infections by 40% since 2010 and protecting 4.4 million children from HIV since 2000 could be jeopardized if funding is not restored. The agency warns that without immediate action, there could be an additional six million new HIV infections and four million AIDS-related deaths by 2029.

Gugu believes that many sex workers may be discouraged from seeking care at public hospitals due to long wait times and unhelpful staff. “The problem with going to public hospitals is the time factor. In order to get serviced at these facilities, you have to arrive at 4 or 5am, and they may spend the whole day waiting for their medication. For sex workers, time is money,” she says.

She recently visited a local clinic with friends to register her details and build relationships with staff. However, she encountered a rude nurse who dismissed the importance of sex workers. “She told us there was nothing special about sex workers,” Gugu recalls. This experience highlights the challenges faced by vulnerable populations in accessing quality healthcare.

The impact of US funding cuts extends beyond treatment. It has also affected research aimed at finding an HIV vaccine and cure. Scientists in the UK-based Lancet medical journal estimated that USAID funding directly reduced Aids deaths by 65% over the past two decades.

South Africa, which has the highest number of people living with HIV globally, has benefited significantly from US aid. The President’s Emergency Plan for Aids Relief (Pepfar), launched by George W. Bush in 2003, has contributed to a 66% decrease in AIDS-related deaths since 2010. However, the Trump administration’s cuts have raised concerns about a potential resurgence in infections.

Prof Lynn Morris, Deputy Vice-Chancellor of Wits University, warns that infection rates could spike again. “We’re going to start seeing a reversal of what was essentially a real success story. We were getting on top of some of these things.”

Gugu emphasizes the life-or-death nature of treatment for vulnerable populations like sex workers. “People don’t want to default on their ARVs. They’re scared that they’re going to die if they don’t get access to them.”

Research efforts in South Africa, including the development of a potential HIV vaccine, have also been impacted by the funding cuts. Abdullah Ely, an Associate Professor at Wits University, explains that the Brilliant Consortium, a group of labs working across eight African countries, has faced setbacks due to reduced support.

Universities in South Africa have requested a bailout of 4.6 billion South African rand over the next three years to cover the funding gap. While some alternative funding has been secured, it falls far short of the requested amount.

As Gugu reflects on her future, she expresses concern about the long-term implications for her community. “This isn’t just a problem for right now, we have to think about how it’s going to affect the next generation of women and young people.”