US Exempts ‘Life-Saving’ Projects from Global Health Services Stop-Work Order
Many PEPFAR-funded projects are confused about whether they can continue to offer all HIV services to clients.

The Trump Administration exempted “life-saving humanitarian assistance” from the “stop-work order” issued to all foreign aid recipients late Tuesday – but widespread confusion remained about which programmes could continue to operate unimpeded. Meanwhile, US Senate confirmation hearings for Robert F Kennedy Jr, Trump’s pick for Secretary of Health and Human Services (HHS), began Wednesday with a tense stand-off between the HHS nominee and Senate Democrats. 

US Secretary of State Marcus Rubio issued the memo announcing the foreign aid waiver, defining humanitarian assistance as “core to life-saving medicine, medical services, food, shelter, and subsistence assistance, as well as supplies and reasonable administrative costs as necessary to deliver such assistance”. 

However, he warned that the “resumption is temporary in nature”.

It does not apply to programmes that involve “abortions, family planning conferences, gender or DEl [diversity, equity and inclusion] ideology programs, transgender surgeries, or other non-life-saving assistance”, he added – many of which have never been covered by US foreign aid.

The waiver follows a global outcry over HIV clinics providing antiretroviral (ARV) medicine and other services being told to immediately cease operations over the past few weeks. Any interruption of ARVs threatens the wellbeing of people with HIV, weakening their immune systems and possibly leading to drug-resistant HIV.

UNAIDS Executive Director Winnie Byanyima welcomed the waiver, saying that it “ensures that millions of people living with HIV can continue to receive life-saving HIV medication during the assessment of US foreign development assistance.”

“This urgent decision recognises PEPFAR’s critical role in the AIDS response and restores hope to people living with HIV,” she added.

Despite the partial reversal, many projects funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) said they remained unclear about whether they could resume providing ARV medicine and other services to people with HIV.

Health Minister is ‘baffled’

South African Health Minister Aaron Motsoaledi

South African Health Minister Aaron Motsoaledi told a media briefing that he had not received any official notice of the stop work order from the US government, adding that “the world is baffled by the decisions”.

“We have been fighting the scourge of HIV, TB and malaria together for more than 20 years as a global community, depending very much also on global funding,” Motsoaledi told the  briefing on Tuesday evening.

South Africa has the world’s biggest HIV programme, with 5.5 million people on ARVs, he added. PEPFAR funds have covered around 17% the country’s HIV work, assisting the government in the 27 most affected districts (out of 52), he added. South Africa’s Cabinet will discuss the issue this week, according to the health ministry.

However, most other African countries are heavily dependent on PEPFAR to fund their ARV programmes. PEPFAR funding covers the ARV medication of around two-thirds of those on treatment, according to Byanyima.

HIV testing essential to save babies

However, it is not just HIV treatment that is urgent, according to amFAR, the Foundation for AIDS Research.

HIV testing is also urgency, particularly of pregnant women to ensure that, if they’re HIV positive, they can be given treatment to prevent them from transmitting the virus to their babies.

PEPFAR also cover the salaries of over 270,000 health care workers who deliver health services, including over 12,500 doctors or clinical officers, and these may be the only health workers in their category at a health facility.

In Mozambique, for example, an impoverished country in south-western Africa, PEPFAR funds over 1,000 doctors and over 800 nurses and midwives, according to amFAR.

Commenting on Tuesday, the World Health Organization (WHO) called on the US government “to enable additional exemptions to ensure the delivery of lifesaving HIV treatment and care”.

 “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,” the WHO added..

‘Does it make America safer?’

Commenting on the Trump Administration’s new approach to foreign aid, State Department spokesperson Tammy Bruce stated: “American taxpayer dollars spent overseas should be spent wisely, and for the benefit of Americans.The pause in foreign assistance has allowed the State Department to prevent unjustified and non-emergency spending.

“Our test is simple: Does it make America safer, stronger, and more prosperous? Some aid programs fail this test. Others may have merit, but are not emergency spending and can be reviewed during the 90-day pause.”

 

Image Credits: International AIDS Society.

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