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In 2003, George W. Bush launched PEPFAR, the President’s Emergency Plan for AIDS Relief, to fund HIV prevention and treatment in Africa. Created to battle an escalating AIDS epidemic in the 2000s, PEPFAR has now become a cornerstone of the United States’ global health efforts. Since its inception, PEPFAR has provided antiretroviral treatment for 11.5 million people and HIV counseling and testing for more than 55 million people. In 2014, the United Nations released new data on the HIV status of the three African countries with the highest HIV infection rates in 2003: Zimbabwe, Malawi, and Zambia. The data showed that 70 percent of adults with HIV have been diagnosed, 87 percent of those diagnosed are receiving treatment, and 89 percent of those on treatment have lower virus levels in their system than before getting treatment.

While higher than those a decade earlier, these numbers are not high enough. UNAIDS (United Nations Programme on HIV/AIDS) has set a new goal: to have zero new infections by 2030. Reaching this goal depends on funding PEPFAR, but the Trump administration holds conflicting viewpoints on the program.

Some officials within the Trump administration, such as Secretary of State Rex Tillerson, have voiced support for PEPFAR. During his confirmation hearing, Secretary Tillerson complimented the program, calling it “one of the most extraordinarily successful programs in Africa.” Vice President Mike Pence voted to approve George W. Bush’s PEPFAR initiative and Obama’s 2008 renewal of the same program. But other moves from within the administration indicate a decrease in funding for global aid programs. A questionnaire from the Trump transition team asks if “PEPFAR is worth the massive investment when there are so many security concerns in Africa?”

However, policy shifts from the new administration are already affecting HIV prevention and treatment abroad. Trump’s reinstatement and expansion of the “Mexico City policy,” also known as the “global gag rule,” ends U.S funding for international health organizations that mention or otherwise promote abortion services. Typically, this would have no effect on HIV prevention and care, but most health care centers in Africa are “one-stop shops.” where people access everything from Tylenol to antiretroviral drugs for HIV treatment.

HIV counseling center in Nairobi, Kenya

Image Source: Brent Stirton / Staff

Global health organizations that establish these “one-stop” health care centers, such as Maria Stopes International and the Planned Parenthood Association of Ghana, have refused to sign the “Mexico City policy” and will no longer receive U.S funding. These organizations will be forced to reduce staff and community services. Defunding health care centers in rural communities prevents not only legal abortions, but also life-saving HIV diagnoses, counseling, and treatment.

Health care workers in Malawi, Zimbabwe, and Zambia are at the cusp of achieving UNAID’s goal of zero new infections by 2030. Eradicating HIV in Africa would be a remarkable breakthrough in global health, but funding this dream requires funding PEPFAR. 

Featured Image Source: Marco Di Lauro / Stringer

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