Q&A: Exclusion of trans people from US HIV funds risks gains

BERLIN - U.S. President Donald Trump's administration has made access to HIV treatment for men who have sex with men and trans people uniquely difficult, despite a waiver for parts of the flagship President's Emergency Plan for AIDS Relief, or PEPFAR.

Both groups are among those most at risk of HIV infection and face multiple legal and social obstacles in many of the 55 countries, including Kenya, Nigeria and Zimbabwe, that benefit from PEPFAR since it was launched in 2003.

But when life-saving PEPFAR services were exempted from Trump's foreign aid freeze in February, the waiver said only pregnant and breastfeeding women could receive preventive medicine, also known as PrEP.

Now PEPFAR's future is even more uncertain after the progamme's congressional authorisation expired this week, even though funding has been earmarked through the end of September.

Context spoke to Beirne Roose-Snyder, a senior policy fellow at the Council for Global Equality, which works on U.S. foreign policy and LGBTQ+ rights, to find out what the funding freeze means for PEPFAR and the people it helps.

PEPFAR has been in place for more than 20 years. What is happening now?

In the last year, a new, surging far-right in American politics decided to politicise PEPFAR - and pull it away from the ways that it's been successful, which is working with the best partners for every context and meeting the needs of the people most at risk of HIV.

It's hard for people to remember how catastrophic HIV was in sub-Saharan Africa in the early 2000s. It was a national security threat to lose the teachers, healthcare providers, soldiers of a whole generation.

That's why PEPFAR has been seen as one of our greatest diplomatic successes. But the recent attack on it is a very specific weaponised attack that mirrors the type of scapegoating of trans people that we're also seeing in domestic U.S. politics.

How has PEPFAR helped LGBTQ+ people, particularly trans people, access HIV care?

Being able to go into a typical hospital and get safe care in which the doctors don't mock, blame, harass or even, in some countries, try to have you arrested is huge.

There may only be one clinic that is the safe space for you to talk openly about your HIV risk, get the prevention you need or your antiretrovirals if you are HIV-positive.

There may only be one clinic that has nurses who don't make you cry, who respect your identity, who you're comfortable talking about your risks with.

And PEPFAR has been the primary support for those type of clinics where governments have not stepped in.

What do recent foreign aid disruptions mean for trans people?

Erasing those clinics and drop-in centres means there's a huge number of people who don't know how they're going to get care right now. We don't know how many of them will simply drop out of care.

What's true for everybody who is HIV positive is that staying on your meds is one of the most important things you can do, not just for your own health, but for community health.

If you're on antiretrovirals and the HIV viral load in your system is undetectable, you also can't transmit HIV. So keeping people on steady care, able to go and get their meds from places that are physically and emotionally safe for them, where they can present as themselves, is unbelievably important for all of our HIV goals globally.

What happens now?

The unilateral actions of the White House don't end PEPFAR. We are still fighting for PEPFAR to move the money that Congress has said it should be moving to the local clinics and health services projects that are vital to the success of PEPFAR.

No matter what the White House is trying to say, there's a lot of fight that is still going to be happening to make sure that we keep our promises to keep these clinics open.

This interview has been edited for clarity and brevity.

This story is part of a series supported by Hivos's Free To Be Me programme.

(Reporting by Enrique Anarte; editing by Ayla Jean Yackley)