Q&A: To fight HIV, the U.S. needs to listen to Africa

BERLIN - Lawmakers in the deeply divided U.S. Congress face a contentious battle over a lauded global HIV programme that has saved 25 million lives but is slated for severe funding cuts by President Donald Trump.

The President's Emergency Plan for AIDS Relief (PEPFAR), launched in 2003, has provided $120 billion in funding and delivered life-saving treatments in more than 50 countries, particularly in sub-Saharan Africa.

But since January, PEPFAR has been working at half steam after the Trump administration dismantled USAID, cut funding for HIV programmes and ended prevention services for people at high risk, such as the LGBTQ+ community and sex workers.

In March, Congress failed to reauthorize PEPFAR, and the programme has been functioning with previously appropriated funds. Now the Trump administration is withholding funds that were approved by Congress but will disappear if not released by Sept. 30.

Context sat down with Dr. Jirair Ratevosian, a senior advisor to the United States Global AIDS Coordinator under former president Joe Biden, to discuss the future of the global HIV response and America's role.

How would you describe the current situation of PEPFAR?

PEPFAR is now finding itself in a state of shock, or recovering from a state of shock that was initiated by the Trump administration on the first day of his administration on January 20th.

What's at stake for the future of PEPFAR by September 30?

The Trump administration has requested a foreign aid and global health portfolio that is much smaller than in previous years - proposing over 40% in cuts to global health programming.

But Congress wants a higher spending in global health funding. And then Congress is also having discussions around the future of PEPFAR and the global health initiatives that the State Department will be leading.

What we're seeing is Congress finally pushing back against the Trump administration, wanting to protect the bipartisan history of these programmes that are very effective - that are saving taxpayer dollars, ultimately.

Programmes that are promoting American ingenuity, like lenacapavir, a twice-yearly injection to prevent HIV infections.

Congress sees how shortsighted it is to cut foreign aid because, at the end of the day, it's a very small percentage of the US federal budget.

Last month, African leaders launched the Accra Initiative, which seeks to break free from donor cycles and help Africa govern its own health finance. What's your assessment?

The Accra Initiative is a very important step. It's African voices saying that Africa is ready to lead. It's African voices saying that they are prioritising health care and they're thinking about health care as an economic issue, an economic well-being issue.

And it's also a message to donors and to other governments, like the United States, to say: we want to partner with you, we want to work with you.

But I don't know if there's anybody listening to or reading the Accra Initiative. I think that's the challenge. The other challenge is that these African governments now have to put resources where they're making promises.

Advocates say one of the reasons behind PEPFAR’s success was its inclusive nature regarding the groups most at risk of an HIV infection, including LGBTQ+ people. Yet we’re seeing a growing crackdown on sexual minorities in Ghana and several other African countries.

I wish there was stronger language in the Accra Initiative. We haven't seen the language to protect the human rights of all people, of all citizens.

That is why I think diplomacy is so important when it comes to partnerships. We have to work with governments to make sure that they understand, first of all, that human rights are human rights for everyone.

But then also understand that, as it relates to fighting HIV, there are certain needs that certain populations have that have to be met in order to keep them healthy.

We all have to be more strategic and creative in reaching these populations and ensuring that they feel safe to access health care.

(Reporting by Enrique Anarte in Berlin; Editing by Anastasia Moloney and Ellen Wulfhorst)