Kampala, Uganda — As US President Donald Trump ends nearly all foreign aid funding, access to medicines that have suppressed an epidemic for decades will disappear.
Clinics that provide medicine to people with HIV/AIDS, as well as drugs that prevent transmission of the virus, closed here this week as the United States stopped nearly all foreign development assistance.
“These services are no more. All staff at the clinic were terminated,” says Macklean Kyomya, executive director of the Alliance of Women Advocating for Change, which ran a drop-in center that provided HIV/AIDS testing, counseling, antiretroviral treatments and other critical services.
Kyomya says her organization received a letter Feb. 4 from its funder, the Uganda-based Infectious Diseases Institute, that all money was gone. The institute received its funding from the US Agency for International Development, known as USAID.
US President Donald Trump issued an executive order on Jan. 20, his first day in office, that suspended nearly all international aid for a 90-day review period. That includes USAID and US State Department work, which together administer life-saving health services around the world. This includes the massive US President’s Emergency Plan for AIDS Relief program (PEPFAR), which since its inception in 2003 has supplied life-saving drugs and services to prevent the spread of HIV/AIDS and to treat infected people.
On Jan. 28, US Secretary of State Marco Rubio issued a waiver to allow some “existing life-saving humanitarian assistance programs” to continue, but it’s unclear which, if any, HIV/AIDS relief services will continue under that waiver. It’s also unclear whether funding for the programs will resume after the 90-day review period. Questions sent by Global Press Journal to the US State Department did not receive a response.
About 1.5 million Ugandans live with HIV/AIDS, according to the United Nations, and about 1.2 million of those people take antiretroviral drugs — many of which are provided thanks to US funding.
It’s the same across the world: More than 20 million people, including more than half a million children, receive antiretroviral treatment in 55 countries through PEPFAR. The situation in Uganda is just a snapshot of the emerging crisis that is only bound to get worse as people lose access to the medicine they need to suppress or resist contracting the virus.
Flavia Kyomukama, executive director of the National Forum of People Living with HIV Networks in Uganda, circulated a message on WhatsApp this week to urge health workers to tell patients to get their antiretroviral medicine prescriptions immediately refilled.
The message warned that all patients should get to the health clinics “before they get closed because health workers in these facilities have started packing their bags.”
US-provided supplies and human resources have already been cut, says Robert Kiwanuka, program manager at Muvubuka Agunjuse in Kampala, which has provided free treatment to youth, as well as commercial sex workers and people living with HIV-positive partners.
“Some have started coming, approaching us, telling us, ‘What’s next?”‘ Kiwanuka says.
People have told him that while they might have some medicine supply, they don’t know what they’ll do in the coming months.
The impact will be disastrous, Kyomya says.
“Key populations will go underground,” she says. “We are likely to have new cases of HIV and those who are on [antiretroviral therapy] will develop resistance if they don’t get treatment in time.”
Any pause in the distribution of antiretroviral drugs could be catastrophic, says Julie Fischer, an associate research professor at Georgetown University’s Center for Global Health Science and Security.
There is often a very narrow window of time during which the medicine is most effective at preventing HIV infection, she says. For infants in particular, she adds, treatment to ensure they don’t get HIV from parents with the virus must happen quickly – usually within hours.
According to UNAIDS, nearly all pregnant women in Uganda who have HIV/AIDS receive treatment that prevents transmission of the virus to their babies.
If that number goes down, Fischer says, there will be vast, long-term damage.
“Those consequences can ripple for years, not just for the individuals exposed who don’t have a chance to be treated, but also for their families and communities.”
The stories from people who seek clinic services tell of the desperation that leads adults and teens into situations where they’re at risk of contracting HIV.
Hadijja Nalubega was just 15 years old when her mother fell ill and was no longer able to work. She says she tried to find a job to support her family, but couldn’t, so she settled for a last resort: She exchanged sex for money. She used the money to buy food and pay for her sisters’ school fees.
Now 20 years old, she’s received free reproductive health services for years at Muvubuka Agunjuse. Once, she says, she had sex with a man who looked unwell.
“He gave me a lot of money,” she says. “In the morning, I rushed to the clinic.”
There, she adds, health workers gave her PEP medication — postexposure prophylaxis — that she believes kept her from contracting the virus.
With the abrupt end of services, she says, “we shall suffer.”
