African HIV services face double blow of cuts from both Trump and UK
Groups fighting to prevent HIV in Senegal are facing a double blow of aid cuts: Britain announced a £150 million cut to its biggest donor, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Donald Trump will cut US aid funding.
Senegal already had the ability to stop the spread of the virus, which was thwarted by cuts Trump announced at the beginning of the year that hit services reaching some of the most vulnerable groups.
Aid from the United States Agency for International Development (USAID) accounts for a quarter of funding for HIV services in Senegal, with a third coming from the Global Fund. On November 21, the Global Fund will host a summit aiming to raise $18bn (£13.3bn) for its work over the next three years. The UK announced an aid pledge of £850 million; It is estimated that a 15 percent decline could cost 255,000 lives.
After USAID closed following Trump’s announcement earlier this year, about 25 facilities — about a fifth of those in Senegal that offer pre-exposure prophylaxis (PrEP) to prevent new infections — were left in disarray.
“Does this mean that some people have had to stop PrEP? Yes, of course,” said Ousseynou Badio, project leader for the Alliance Nationale des Communautés pour la Santé (ANCS), a Senegalese national health alliance.
After learning about the program through a friend two years ago, Ibrahim* began taking a daily medication known as pre-exposure prophylaxis (PrEP), which prevents life-shortening HIV infection.
“I was pretty hesitant to start this at first because I didn’t know what I would find there,” he said. “I was pretty scared”. To avoid discrimination, Ibrahim was not open about his sexuality. “I would have to hide and be very careful,” he said, so he avoided an HIV test because he was afraid of the outcome and of the “eyes of society” being turned towards him.
However, with the support of the National Network of Key Populations of Senegal (RENAPOC), he was tested and his HIV negative status was confirmed. He was later offered PrEP to help prevent him from becoming one of up to 30 per cent of gay men in the country with the virus. This compares with the relatively low national infection rate of about 0.3 percent. “I think my self-confidence has increased since I started taking the drug,” he said Independent. Ibrahim is one of the lucky ones, his access and support for PrEP was not affected.
But while the United States has been more protective of its HIV programs than many other regions, it has rescinded almost all measures. The National Council Against AIDs (CNLS) found a decline in access to PrEP, testing, and condoms, as well as a decline in people living with the virus and continuing their antiretroviral treatments, based on a survey of 128 healthcare professionals and 18 community organization leaders following Trump’s cuts. But the council said the true impact of the budget cuts across the country would not be known until at least the end of this year.
The US has already cut money from the Global Fund this year, forcing them to make sudden cuts to their programs. The consequences, including deaths, were rapid.
‘We see Trump’s decisions’
The outpatient clinic at Fann Hospital, south of Dakar, Senegal’s capital, is a sweltering rabbit hole of offices and laboratories filled with humming equipment. In its corners are shelves filled with color-coded cardboard folders containing records of anonymous patients. For privacy reasons they are marked only with a number rather than a name. The internet is still not reliable enough to fully digitize the hospital’s records.
There, in addition to providing drug therapy to HIV patients, they were also distributing food kits to deal with the country’s ongoing malnutrition problems.
“We are no longer providing food kits that will help them recover,” said Dr Ndeye Fatou Ngom, head of the centre. “Treatment will not work if you do not eat enough. If you cannot find enough food, naturally you cannot go to the hospital and take your medicines.”
For vulnerable groups, the impact is more than physical: “They lose hope, and that can trigger depression. Many are depressed. When Trump makes his statement, people say: ‘What are we going to do’?”
A few steps further away in the same complex is a cheerful youth center with colorful graffiti-style murals on the walls, seating made from old tires and a growing garden on the roof. It also receives most of its support from the Global Fund. Even though the decisions were made four thousand miles across the Atlantic from the westernmost tip of Africa, the news mostly reaches members of the center who were born with HIV.
“Mamadou*, who attended the center, said, “We know what is happening at the international level. We see Trump’s decisions,” referring to the decrease in funds.
The project, called Tagg Bi, which means bird’s nest in Wolof, the country’s native language, had to end after the United States withdrew money from the Global Fund. “We were able to share the problems we were experiencing at home. At the same time, we were teaching young people how to explain their situation and how to protect themselves,” he said. Mamadou added that the renewal was ready around the time Trump was elected for a second term, “and that’s why we lost the funding. So that’s something we can feel and see.”
A US State Department spokesperson said: “Over the past year, the United States has provided more than $60 million in health assistance programs to Senegal to address its most urgent health needs, including HIV prevention and treatment.
“As we work with countries to responsibly transition to self-sufficiency, the United States continues to fund life-saving HIV care and treatment services in Senegal. This life-saving assistance supports seven health districts in Senegal with HIV testing, provision of anti-retroviral therapy, viral load monitoring, and peer support.”
“If we don’t meet our target in November… we can’t do what we’re doing,” said Mark Taylor, portfolio manager at the Global Fund. “I’m talking about scope. So things will have to be narrowed down.”
Dr. from CNLS Awa Diagne said that when the first cuts were made, the US “chose a life-saving package of services that they allowed” but “they forgot about prevention, which is the key.”
“What was interrupted was much more significant than they acknowledged,” he added.
This article was produced as part of The Independent. Rethinking Global Aid project
* Names have been changed to protect identities
