PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, has been hailed as “the most important and consequential contribution to public health”, providing HIV treatment to around 20 million people around the world. In January, U.S President Donald Trump froze all programmes supported by PEPFAR. In February, programmes providing life-saving HIV care, including prevention of mother-to-child transmission, were allowed to continue under a limited waiver.

This week, the U.S. Senate made a move that’s given the HIV community some hope: they voted to protect PEPFAR from $400 million cuts proposed in Donald Trump’s rescission package. 

At the International Aids Society (IAS) conference, taking place in Kigali, Rwanda, a panel of experts made up of IAS President-elect Kenneth Ngure, IAS former President Linda-Gail Bekker (Director of Desmond Tutu HIV/TB Centre), and infectious disease fellow at Duke University Global Health Institute, Jirair Ratevosian explained what this means.  

Please give us context of what is happening? 

Jirair Ratevosian:  ​​Earlier this year, the Trump administration proposed a $9.4 billion funding cut that includes $900 million for global health, $400 million for PEPFAR, and other US domestic programming. Congress has 45 days to act on that proposal. That 45-day deadline is this Friday. What happened last night (Tuesday night) was a remarkable achievement for HIV advocacy. The Senate removed the PEPFAR portion from that $9.4 billion rescission package [thus protecting PEPFAR funding from being rescinded]. The [rescission] bill is still moving forward, but now the PEPFAR piece is no longer in there. The Senate will vote on the bill in the next day or two. There could still be new amendments added to this bill, but the bipartisan effort to remove the PEPFAR language is a big deal that should be celebrated.

Does this mean programmes for key populations will continue? 

Linda-Gail Bekker: My understanding, at this point, is that this is just about the amount of money. I don’t think there are any details on what aspects [or programmes] will go forward in the future. It’s important to note that, within the State Department, there is a scientific advisory group that advises on PEPFAR. So there is external input to the PEPFAR plan. And I would imagine that there are still some steps to go through, and there will be plans around how and where this money will be used.

What are the next steps?

Kenneth Ngure: PEPFAR is a lifeline for communities across Africa. Restoring this funding would mean hope for people living with and affected by HIV. What has happened in the U.S Senate is a positive signal. But the advocacy must continue from all sectors, including the media, service providers and the community. Let’s keep advocating so that the money is allocated properly. 

Which areas should be prioritised?

Linda-Gail Bekker: We have to safeguard the “last mile” activities of finding people who are not yet in healthcare services, and we have to ensure that people who are already in treatment programmes are able to access their treatment uninterruptedly. Primary prevention is key; this includes prevention of vertical transmission (mother-to-child). Primary prevention must include pre-exposure prophylaxis. And it’s very important not to leave behind key and vulnerable populations, because these are the components of this epidemic that will continue to undo our goal to end the epidemic as a public health threat.  – Health-e News