Overview

Fifteen new reports on the impact of the freeze of US foreign assistance on the global AIDS response were received from UNAIDS’ Country Offices during the week of 24-28 February. As of 28 February, at least one status report had been received from 59 countries, including 79% of all PEPFAR-funded countries and an additional 15 countries that receive US support for their AIDS responses.

Last week, the U.S. Government issued termination letters for many agreements held by USAID. For example in South Africa, 44 USAID-funded health projects in South Africa received termination letters on 26 February. These decisions will directly affect approximately 7,500 PEPFAR-funded staff working on the national HIV response in South Africa. Managers of critical programmes have said they have been given too little time to transition from U.S. funding to other sources of funding.

Most reports received from UNAIDS’ Country Offices over the past week paint a similar picture to the previous week: the combination of the U.S. Government’s waiver for life-saving services and emergency funding provided by national governments and partners are keeping HIV testing, treatment and vertical transmission services running, but often at reduced capacity. However, critical HIV prevention services funded by the U.S. Government , such as pre-exposure prophylaxis (PrEP), and community-led support services for adolescent girls, young women and key populations remain stopped.

In Haiti, where foreign aid accounts for 97% of the funding for the AIDS response, the latest report from the UNAIDS Country Office in Port au Prince reported that 128 sites, previously funded by PEPFAR, had completely halted services, out of 181 total sites nationally. Patients have flooded the remaining sites, which are unable to meet the increased demand. Providers of sexual and reproductive health services and support services for key populations and adolescent girls and young women have been severely impacted. For example, a foundation that provides 55% of PrEP services for key populations in Haiti has halted these services. A rapid assessment has estimated that more than 750,000 people are affected by the U.S. freeze of foreign assistance in Haiti. Confusion regarding the waiver has delayed the resumption of services by providers.

Other serious impacts of the U.S. funding freeze and terminations are being reported by UNAIDS Country Offices. For example, the stoppage of U.S. funding for data systems and surveys is compromising  quality control of data, which in turn impacts the efficiency and effectiveness of HIV prevention, testing and treatment service delivery. In Ghana, a Demographic and Health Survey, the best measure of HIV prevalence in the general population, may be postponed.

Systems for the management of clinical data, survey data and other critical strategic information for planning and programme management have been hit hard by the U.S. funding freeze. In Tajikistan, for example, the U.S. had been supporting HIV data collection and analysis. The freeze is exposing the HIV response to reductions in data quality and data loss, which is likely to affect the efficiency of HIV service delivery. 

In Zambia, limited access to the databases of closed projects is hampering efforts to sustain the delivery of priority HIV services.

Another emerging issue is the sudden absence of technical assistance, typically expert consultants who guide critical national HIV planning, service delivery and monitoring processes in low-income countries that have a shortage of technical capacity.

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