STOPAIDS and its members, in solidarity with people living with and affected by HIV globally, welcome the news that the temporary freeze on US funding for ‘lifesaving’ HIV medicines has been lifted. However, it remains unclear whether funding for HIV testing, prevention and other critical services, and the community systems that are so essential to delivering these, will be reinstated alongside this. *

We urge President Trump to grant an exemption for the entire PEPFAR budget, this great demonstration of positive US impact in the world, so it can continue to deliver its life saving services.

We are deeply concerned about the broader question mark over the future of US funding for the HIV response, the loss of which would have catastrophic implications for the global goal of ending AIDS, and would almost certainly undermine the HIV response here in the UK.

The US President’s Emergency Plan for AIDS Relief (PEPFAR) – established in 2003,  provides antiretroviral medication as well as crucial prevention, testing, support and educational services in 54 countries.  To date, its critical work has saved nearly 26 million lives.

The scale of interventions that PEPFAR supports cannot be understated. According to amfAR, the Foundation for AIDS research, on a daily basis around the world, PEPFAR is responsible for supporting: 

• More than 222,000 people living with HIV to have access to treatment
• More than 224,000 HIV tests;
• Services for 17,695 orphans and vulnerable children impacted by HIV;
• 7,163 cervical cancer screenings, newly diagnosing 363 women with cervical cancer or precancerous lesions, and treating 324 women with positive cervical cancer results (a critical intervention as women living with HIV are 6 times more likely to develop cervical cancer).
• Care and support for 3,618 women experiencing gender-based violence, including 779 women who experienced sexual violence. This includes HIV testing and pre-exposure prophylaxis to prevent HIV acquisition. 

In addition, PEPFAR is currently providing ARV treatment to 679,936 pregnant women living with HIV both for their own health and to prevent vertical transmission.    

These services are delivered by 190,000 clinical and ancillary care providers worldwide. Stop work orders are already affecting this workforce, with organisations that receive PEPFAR funding reporting that they have been instructed to terminate staff contracts, a move that has already seen services shut.  If this continues, it will leave hundreds of thousands of people unable to access life-saving HIV services.

Without these services, rates of HIV acquisitions and AIDS-related deaths in the 54 countries that rely on PEPFAR funding will dramatically increase. The countries most affected by this policy include key strategic partners for the UK such as Kenya, South Africa, Malawi, and Nigeria among many others. An under-resourced HIV response globally will also have a detrimental impact on the UK in terms of growing resistance to HIV treatments, which will not respect borders. These abrupt cuts will also put additional pressure on health systems globally, decreasing their pandemic preparedness and resistance which will cause further economic strain, negatively affecting us all. 

Stepping-up to support communities living with and affected by HIV globally is therefore not just the right thing to do, it is clearly in the UK’s national interest. 

We call on the UK Government to:

• Raise the concerns about the impact of funding cuts to PEPFAR at the highest possible level with the US administration. 
• Identify ways to advance UK funds both to address the urgent funding crisis, working with other countries and with civil society and community partners to coordinate a rapid response to save lives, and to plan ways to fill the long-term funding gap that will likely be left if the US withdraws funding to the communities that are most affected by HIV. 
• Issue a ministerial statement setting out the FCDO’s analysis on the impact of this policy on UK aid programmes and the communities they support.

Signed:

• STOPAIDS
• 4M Mentor Mothers
• ACT UP London
• Aunty Lous House
• AVERT
• Black Health Activists Mentoring & Empowering Network (BHAMEN)
• Bloomsbury Network
• Blue Sky Trust
• BHIVA
• Body Positive Dorset
• Body and Soul
• Brigstowe
• Brighton and Sussex Centre for Global Health Research
• British Association for Sexual Health and HIV (BASHH)
• Catholics for AIDS Prevention & Support (CAPS) C.I.O.
• Chasing Zero
• Church of Scotland HIV Programme
• CHIVA
• Fast-Track Cities LondonFrontline AIDS
• Harm Reduction International
• HIV i-Base
• HIV Justice Network
• International Drug Policy Consortium (IDPC)
• IPPF
• Just Treatment
• MESMAC
• National AIDS Trust (NAT)
• Naz
• One Voice Network
• Plushealth
• Positive Faith Peer Support (CAPS)
• Positively UK
• Queen Mary University of London
• Salamander Trust
• Sophia Forum
• Spectra
• Tackle
• Terrence Higgins Trust
• Thames Valley Positive Support
• The Sussex Beacon
• UK CAB
• Universities Allied for Essential Medicines Europe (UAEM)
• Individuals:
  • Tristan Barber, Consultant in HIV medicine
  • Brian Baker, Person living with HIV
  • Jane Shepherd, HIV Peer Supporter

* On Tuesday 28 January the US administration communicated that there would be a waiver for certain life-saving interventions across USAID and PEPFAR but there was a lack of specificity of exactly what would be included and excluded. Over the weekend, a leaked document suggested that the waiver would be applied to PEPFAR on limited terms, enabling the resumption of “life-saving HIV care and treatment services” as well as HIV testing and prevention and treatment of opportunistic infections, alongside prevention of vertical transmission services and “reasonable implementing agency and implementing partner administrative costs”. 

If this document can be relied on, then funds for the following services will remain frozen: all other prevention tools and approaches, support including post-exposure prophylaxis for people who have experienced sexual and gender-based violence, cervical cancer screening and treatment and support for orphans and vulnerable children impacted by HIV.  At present however, organisations implementing US-funded programmes have received no communication regarding a waiver, and remain unclear about whether they can reopen any services, with many now forced to proceed with terminating staff contracts. We are deeply unsettled about the catastrophic implications that this uncertainty is having on the HIV response, and what the current dire situation could mean for the future of funding for PEPFAR.