Although Elon Musk said Doge didn’t cut Aids programs, global health officials describe widespread and disastrous effects resulting from the White House’s throttling of foreign aid. The disruptions have caused new HIV infections to surge in recent months and threaten to derail plans to eradicate the virus as a public health threat by 2030.
In one stark case, the cuts have cast uncertainty over the rollout of a newly developed injectable that scientists have hailed as “the closest thing to a vaccine that we have ever had in HIV response”.
Musk says his cuts did no defunding
Musk was projected 10ft tall above the stage at the Qatar Economic Forum this week as he gave a sweeping and combative video interview. The creator of the so-called “department of government efficiency”, who once boasted he had fed “USAID into the wood chipper”, found himself defending his cuts to humanitarian aid. Just days before, Bill Gates had accused the world’s richest person of “killing the world’s poorest children”.
In one especially fraught exchange with Bloomberg interviewer Mishal Husain, Musk rebuked a question about whether his cuts to USAID had imperiled HIV/Aids programs and claimed he would “fix it right now” if any services had, in fact, been defunded.
“First of all, the program, the Aids medication program, is continuing. So, your fundamental premise is wrong. It is continuing,” Musk said. “It is false. It’s false. It’s false.”
Rather than Musk’s cuts leaving HIV/Aids programs intact, however, global health officials said that Doge’s efforts have in reality hampered their work worldwide and thrown the protection of large swaths of people from disease into disarray.
Doge’s dismantling of USAID plunges Aids services into chaos
Prior to Doge’s cuts and the Trump administration’s freeze on foreign aid, the US was involved in a wide range of HIV/Aids treatment and prevention programs across dozens of countries. The government implemented the majority of its operations through Pepfar, a USAID-funded program that has contributed more than $110bn to preventing and treating the virus since the initiative began in 2003.
Since Doge dismantled USAID in January, however, the future of Pepfar is uncertain, and many of its services are in jeopardy. A temporary waiver from the state department has allowed funding for some HIV/Aids programs to continue, but only those aimed at treating people who are already living with HIV, as well as pregnant or breastfeeding women.
As a result, many prevention programs involving pre-exposure prophylaxis drugs, or Prep, ground to a halt without US funding. Even services that were allowed, such as testing and treatment, also stopped due to the disruption and confusion caused by Doge’s shutdown of USAID, according to the United Nations. People who showed up to receive testing or medicine often found that no one was there to give it to them, according to a UN health official.
“There were thousands of healthcare workers and community health workers, laboratorians and data clerks, for example, that immediately stopped work,” said Dr Angeli Achrekar, deputy executive director of the programme branch at the Joint United Nations Programme on HIV/AIDS (UNAIDS) and a former Pepfar official. “It’s not like you just turn on the light switch and all of a sudden these services start up again.”
The effects of the cuts have been almost immediate, according to Achrekar, and could roll back years of advancements in combating HIV infections. In Botswana, the number of people receiving Prep has decreased by half since last year. The 30,000 people in Mozambique who were receiving Prep at the end of last year recently went down to 19,000, according to a UN tally. In Zimbabwe, the number of people receiving Prep declined from 4,000 to 1,800 in the same time frame. In Nigeria, 850,000 condoms distributed in December went down to 300,000 by February.
“It’s country after country,” Achrekar said.
A miracle drug cast into uncertainty
The cuts to prevention programs have also caused confusion and uncertainty around the rollout of a highly anticipated new drug called Lenacapivir. The drug, which is under review at the US Food and Drug Administration, protects patients against HIV infection through a single shot given every six months. Two separate large trials across different populations have shown that it almost entirely blocks the risk of contracting the virus.
“It’s nearly 100% effective at stopping new infections,” Achrekar said. “It is the closest thing to a vaccine that we have ever had in the HIV response.” Other researchers have called it a “miracle”.
Pepfar announced at the end of last year that it was partnering with The Global Fund, an international organization that finances global health programs, in an effort to roll out Lenacapivir to at least 2 million people within the next three years. Doge’s cuts have thrown a potential wrench in those plans, however, since the drug would fall under the category of preventative services that the tate department’s waiver says should no longer be funded.
At the Qatar Economic Forum this week, Musk insisted that medication programs were continuing, and, when confronted with the example of Lenacapivir, suggested he would restore its funding.
“Which ones aren’t being funded? I’ll fix it right now,” Musk claimed, later adding: “If in fact this is true, which I doubt it is, then we’ll fix it.”
In response to Musk’s comments, UNAIDS released a statement saying it was encouraged that he would review the crisis caused by halts to US funding. Musk has made similar pledges about restoring health programs that Doge cut in the past, however: in February, Musk said that efforts to prevent the spread of Ebola had been accidentally canceled but were then restored – a claim that USAID officials said was false.
While the Global Fund waits to see what the Trump administration decides to do with Pepfar, it is hoping to carry on with its plans for Lenacapivir whether the US is involved or not. Losing Pepfar’s partnership would mean a huge decrease in funding, however, as well as Pepfar’s extensive connections to organizations that could help in administering the drug.
“We’re not backing off the ambition to deliver Lenacapivir to two million people if we can,” said Peter Sands, the executive director of the Global Fund. “The extent to which we can continue to do that in partnership with Pepfar is uncertain.”
Since the waiver was issued on 1 February there has been no clarity or new policy released on what the Trump administration plans to do with Pepfar. US partners working on prevention services have had their agreements terminated, while UNAIDS projects that if Pepfar’s treatment and prevention services are stopped entirely, it would result in an additional 6.6m HIV infections by 2029.
