The US administration’s freeze on funding to USAID is not just about allocation of resources, but also signals loss of leadership in health — the fight against AIDS and support for biomedical research — with wide-reaching implications for global public health.
In 1995, the AIDS death rate in the US was a high 16.2 per 100,000 people. By 1999, AIDS-related deaths globally numbered an alarming 18.8 million, and over 13 million children were orphaned due to the epidemic.
Driven by HIV activists and treatment advocates, the US leadership played a pivotal role in mitigating the devastating impact of AIDS in low- and middle-income countries. Over the past three decades, research funded by the National Institutes of Health has been integral to uncovering the biology of HIV and driving drug development to transform HIV into a manageable chronic condition.
Lowered cost
US leadership and India’s manufacturing played a key role in scaling up access to HIV treatment for millions. At the turn of the century, activists challenged patent barriers to unlock generic competition from India, cutting treatment cost to less than $100 per person per year from $10,000.
The creation of the Global Fund to Fight AIDS, Tuberculosis, and Malaria in 2002 and the US President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 helped procure and distribute generic antiretroviral therapy (ART) to millions living with HIV in limited-resource settings.
While governments in South and Southeast Asia increasingly procure HIV treatment through domestic funding, USAID, along with PEPFAR, has supported community organisations that provide testing, counselling, and referrals for treatment to high-risk populations. The agency also connected children affected by HIV/AIDS to essential services.
In India, USAID’s financial and technical support was vital, given the country’s seven million children who have at least one parent living with HIV and 1.5 million children orphaned due to the virus. Additionally, USAID initiated the first large-scale pilot project to diagnose tuberculosis (TB) in people living with HIV in five states, helping integrate daily treatment regimens for individuals co-infected with TB and HIV.
Setting the clock back
The US administration’s decision to freeze foreign aid for major health programmes undermines the efforts underway to strengthen the health system in several states in India. The HIV community is in shock.
A waiver from the US State Department allowed the resumption of certain PEPFAR treatment and prevention of mother-to-child transmission programmes. However, primary HIV prevention programmes — particularly those offering access to pre-exposure prophylaxis (PrEP) — have been explicitly blocked.
At risk is the access to newer tools needed to end AIDS by 2030. New HIV drugs like lenacapavir help achieve a significant reduction in new infections among individuals at high risk of acquiring HIV. But the freeze on funding will undermine PEPFAR’s and the Global Fund’s coordinated attempt to provide affordable and equitable access to twice-yearly injectable lenacapavir for HIV PrEP.
Advocates are legally challenging the decision, seeking immediate reversal. Without continued investment and aid for HIV prevention services and vulnerable populations, the hard-won gains risk being undone.
(The writer is a lawyer working on HIV, public health, and access to medicines. Views are personal)
