Disruptions in US funding could threaten HIV care for children in Africa
Key takeaways:
- An estimated 700,000 children receive HIV treatment each year through PEPFAR.
- The State Department issued a limited waiver to resume HIV services, but many clinics already let staff go.
Millions of children in Africa rely on funding from the United States for HIV care or testing — support that was threatened last month when President Donald J. Trump froze foreign aid spending after taking office.
Trump ordered a 90-day pause on U.S. foreign aid spending, including for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), “to ensure they are efficient and consistent with U.S. foreign policy under the America First agenda,” the State Department said.
On Jan. 28, Secretary of State Marco Rubio issued a waiver for programs that provide lifesaving services. PEPFAR then received a limited waiver on Feb. 1 to resume HIV testing and treatment, according to a copy of a State Department memo posted online by UNAIDS.
Since President George W. Bush launched PEPFAR in 2003, it has prevented nearly 8 million children from being born with HIV. Eighteen countries have eliminated mother-to-child transmission of HIV since 2015, according to WHO. Two others, Namibia and Botswana, are on the path to elimination.
In 2022, an estimated 700,000 children received ART and more than 5 million children received HIV testing services through PEPFAR, according to Jennifer Kates, PhD, senior vice president and director of global health and HIV policy at KFF, a health policy nonprofit.
U.S. State Department data from 2024 showed that the program provided medical care and social support for 6.6 million orphans, vulnerable children and their caregivers who have been affected by HIV.
“Based on our analyses, PEPFAR has had a number of other positive health impacts among children,” Kates told Healio.
According to a 2023 analysis that Kates co-authored, 5.1% of the 4 million child deaths in sub-Saharan Africa in 2003 were associated with HIV, compared with 1.6% of the 2.8 million child deaths in 2018. Additionally, countries that participated in PEPFAR saw faster declines in mortality among children aged 5 years and younger, compared with non-PEPFAR countries, Kates and colleagues reported. The benefits were not all HIV-related.
“PEPFAR funding is associated with significant declines in overall child mortality, increased childhood immunization rates, and greater retention in school,” Kates said.
According to Kates, services for orphans and vulnerable children and HIV PrEP for people other than pregnant and breastfeeding women were not reinstated under the waiver issued by the State Department.
“This information (about the waiver) is still being communicated to the field, and some of its implementers have already had to let go of health care workers or shut their doors,” Kates said.
Sten Vermund, MD, PhD, Dean of the University of South Florida College of Public Health and Chief Medical Officer of the Global Virus Network, said any disruption in ART can be detrimental to people living with HIV.
“When you interrupt antiretroviral therapy, or you interrupt anti-tuberculosis therapy, you run the risk of stimulating the growth of resistant organisms,” Vermund told Healio. “For both public health purposes to reduce transmission ... and for clinical medical purposes to avoid the emergence of resistant organisms, we do not want to have gaps in care.”
The fate of other global health programs is up in the air, according to Kates. Rubio’s waiver excluded programs related to abortions, family planning and non-lifesaving assistance.
References:
- Gaumer G, et al. BMJ Open. 2023;doi:10.1136/bmjopen-2022-070221.
- KFF. The status of President Trump’s pause of foreign aid and implications for PEPFAR and other Global Health programs. https://www.kff.org/policy-watch/the-status-of-president-trumps-pause-of-foreign-aid-and-implications-for-pepfar-and-other-global-health-programs/. Published Feb. 3, 2025. Accessed Feb. 5, 2025.
- U.S. Department of State. Emergency humanitarian waiver to foreign assistance pause. https://www.state.gov/emergency-humanitarian-waiver-to-foreign-assistance-pause/. Published Jan. 28, 2025. Accessed Feb. 5, 2025.
- U.S. Department of State. PEPFAR latest global results and projects factsheet (2024). https://www.state.gov/pepfar-latest-global-results-factsheet-dec-2024/. Published Dec. 1, 2024. Accessed Feb. 11, 2025.
- WHO. Triple Elimination Initiative. https://www.who.int/initiatives/triple-elimination-initiative-of-mother-to-child-transmission-of-hiv-syphilis-and-hepatitis-b/validation. Accessed Feb. 5, 2025.