Abandoned by the U.S., African HIV fighters must revise their strategies
How can countries in the Global South ensure their health sovereignty?
By Steeves Winner
The Trump administration’s freeze on American foreign aid has forced people who work to take care of Africans’ health to rethink their anti-AIDS, anti-malaria and other health programs — in particular how to pay for them.
Among the programs at risk because of the freeze is Pepfar (the U.S. President’s Emergency Plan for AIDS Relief), which was established in 2003 under the presidency of George W. Bush, which has saved more than 25 million lives in 55 countries over the last 20 years.
The abrupt withdrawal of American funds from the Pepfar program, interrupting HIV/AIDS treatment and prevention, threatens millions of lives, several NGOs warn.
According to the UN, stopping this program could lead to the death of more than 6 million people in the next four years.
While new HIV infections worldwide have fallen by 60% since 1995 to reach 1.3 million in 2023 according to Ugandan Winnie Byanyima, the executive director of UNAIDS, she says this figure could soar to 7.8 million by 2029 if the funding freeze continues.
The suspension of American aid also has consequences for health workers involved in the prevention and fight against the HIV virus. In the wake of this announcement, thousands of contracts were terminated in the space of a few days across the African continent, seriously disrupting the work of community health services.
What’s to be done?
Ideas for positive steps to remedy the problem are discussed in the following article published by AIDES, a French community-based non-profit organisation that is also a member of the Coalition Plus anti-AIDS network. The following excerpt from the article has been modestly edited and translated into English.
Beyond the temporary suspension, this situation raises fundamental questions:
How can countries in the Global South ensure their health sovereignty?
How can they no longer depend on the political fluctuations of major powers?
“The lifting, overnight and without alternative, of resources on which the survival of millions of people depends is neither a step towards the resilience of health systems, nor a strengthening of health sovereignty, quite the contrary,” warns Professor Mehdi Karkouri, president of Coalition PLUS.
Even if aid were to resume in the coming months, the consequences of this decision are likely to be felt for years, compromising the public health objectives set by nations and international organizations.
The OUT Engage men’s health center in Johannesburg, which diagnoses at least five HIV cases a day and provides medication, has a sign on its door explaining its temporary closure.
“In the short term, I hope there will be some money coming in, so that in the medium and long term we can do other projects,” says Dawie Nel, director of the LGBTQ+ health NGO.
In South Africa, where AIDS killed an entire generation in the mid-2000s, creating an army of orphans, U.S. aid is particularly valuable. “The United States is a completely unreliable partner,” Nel laments.
South Africa is one of the main beneficiaries of the President’s Emergency Plan for AIDS Relief (Pepfar), a major U.S. program to fight HIV/AIDS that has now been suspended. The country still has nearly 14% of HIV-positive people, one of the highest rates in the world.
Towards health autonomy for countries in the South?
The freeze on American funding comes at a time when foreign aid in health is increasingly criticized, both in the North and the South. While the need for international funding remains, dependence on these funds exposes African countries to unilateral decisions that could jeopardize millions of lives.
It is therefore essential to rethink health financing models in Africa and accelerate national investments. Since the Abuja Declaration, which recommended allocating 15% of national budgets to health, few countries have achieved this objective.
For Coalition PLUS, several alternatives must be explored. On the one hand, removing intellectual property barriers to allow the local production of essential medicines at a lower cost. On the other hand, reducing the pressure exerted by debt, which limits the investment capacities of States in their own health systems.
Today, it is estimated that the extraction of resources and labor from the South to the North exceeds Official Development Assistance (ODA) by 30 times.
This reality highlights a structural inequality that perpetuates the dependence of low- and middle-income countries.
Faced with these challenges, Coalition PLUS calls for increased international solidarity and a profound transformation of health financing mechanisms.
“25 years ago, we advocated for an increase in national budgets dedicated to health. Today, we must go even further and guarantee countries in the South the means to ensure their own health sovereignty,” the organization concludes.
The freeze on American foreign aid has revealed the vulnerability of the health systems of the countries benefiting from the Pepfar program. It’s a situation that could force them to rethink completely and urgently their financing strategies.
Steeves Winner, the author of this article, is a Cameroonian journalist who writes under a pseudonym. Contact him at steeves.w@yahoo.com.
Source: African Human Rights Media Network member RightsAfrica.com.
