Immediate Risks and Disruptions

The U.S. decision to freeze all funding for foreign assistance has impacted HIV prevention services in several countries in Latin America, including Peru. This has led to significant disruptions in HIV treatment and PrEP programs for groups of migrants with HIV and migrant key populations. It also reduced community-led HIV prevention efforts, and decreased treatment adherence, counseling, and social support activities for migrants with HIV or at risk. Consequently, in a country that already has an increasing number of new HIV infections, there are increased risks of more new HIV infections, higher mortality rates, and a deterioration in the quality of care for migrants living with HIV.

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Immediate Risks and Disruptions

The US decision to freeze all funding for foreign assistance has impacted HIV prevention services in several countries in Latin America, including Peru. This has led to significant disruptions in HIV treatment and PrEP programmes for groups of migrants with HIV and migrant key populations. It also reduced community-led HIV prevention efforts, and decreased treatment adherence, counseling, and social support activities for migrants with HIV or at risk. Consequently, in a country that already has an increasing number of new HIV infections, there are increased risks of more new HIV infections, higher mortality rates, and a deterioration in the quality of care for migrants living with HIV.

Current Situation:

• ICAP: This NGO, serving 2,300 migrants with HIV, has resumed antiretroviral therapy (ART) activities after receiving a letter two weeks ago. However, community-based services supporting recruitment and adherence have not resumed and are seeking alternative funding sources.
• IMPACVIH: This community-based organization (CBO) was negotiating US Government grants for Indigenous people living with HIV before the funding freeze. They are now seeking new donors.
• Community-led and peer-led facilities: These have been most impacted, with reduced ability to participate in policy discussions and collect/report data.

Disruptions:

• Distribution of condoms and other prevention commodities: There is sufficient stock for 6-12 months, but access to PrEP services for adolescent girls and young women (AGYW), sex workers, men who have sex with men (MSM), and transgender (TG) people has been disrupted.
• Reduced HIV prevention capacity: Availability of counseling and testing for sex workers, MSM, people who inject drugs (PWID), TG people, and prisoners has been affected.
• Migrants with HIV: Migrant key populations are the most affected.

Government Commitment & Advocacy

• President Joseph Nyumah Boakai reaffirmed his administration's commitment to supporting people living with HIV, emphasizing the importance of implementing the Safeguard Policy Exit Roadmap recommendations to the Global Fund by December 2024 to regain confidence and support and pledged timely and necessary assistance to combat HIV.

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Government Commitment & Advocacy

• President Joseph Nyumah Boakai reaffirmed his administration's commitment to supporting people living with HIV, emphasizing the importance of implementing the Safeguard Policy Exit Roadmap recommendations to the Global Fund by December 2024 to regain confidence and support and pledged timely and necessary assistance to combat HIV.

Impact of Foreign Aid Withdrawal & Mitigation Efforts

• The Ministry of Finance and Development Planning (MFDP) assessed the impact of foreign aid withdrawal and is working on an impact mitigation plan, including prioritization strategies.
• The Ministry of Health (MOH) allocated $300,000 for commodity distribution to minimize disruptions after support from the World Food Programme was suspended. MOH utilized its own resources to prevent service interruptions, assigning staff under its payroll for HIV services to ensure integration and sustainability.

Documented Impact on Services

• FHI360 (USAID-funded): Experienced a suspension but later received a waiver, allowing 26 facilities across four counties to resume case finding, PrEP for key pregnant and breastfeeding mothers, prevention, and referral services. However, prevention services for key populations remain excluded from the waiver.
• JHIEPGO & Global Fund-Supported KP Programmes: Community PrEP and above-site support, previously suspended, resumed two weeks ago. Human rights, key and vulnerable populations US-funded (FHI) key populations programmes remain ceased, with seven implementing partners canceled, causing significant gaps in HIV prevention services and case finding for key populations.

LGBTIQ+ Context & Rising Tensions

• The introduction of an anti-LGBTIQ+ bill on July 17, 2024, proposing life imprisonment for homosexuality, has created an environment in which it is difficult to deliver HIV testing, prevention and treatment services. The bill, sponsored by Hon. Johnson S. N. Williams, has fueled public hostility and increased risks for LGBTIQ+ individuals.
• A crisis within the Liberia Annual Conference of the United Methodist Church has further exacerbated anti-LGBTIQ+ sentiments. LGBTIQ+ communities have been sharing PrEP amongst themselves as they await the resumption of services.

Immediate Risks and Disruptions

• Termination of CSO Funding: Civil Society Organizations (CSOs) received termination letters on 27 February, leading to significant disruptions in HIV services.
• Service Disruptions: The closure of drop-in centers for key populations has disrupted HIV testing, treatment, care, and support services. There are challenges in referring clients to government facilities, as service providers are no longer working, and there has been no proper handover of client files.

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