Picture: ISTOCK
Picture: ISTOCK

The Department of Health is anxiously waiting to see if the US Congress approves President Donald Trump’s proposed cuts to global health programmes, as its decision could reduce donor support for HIV/AIDS in SA.

The US is the world’s biggest contributor to the global fight against HIV/AIDS and in 2016 contributed $4.9bn through bilateral programmes and international efforts such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, according to the Kaiser Family Foundation.

Trump’s proposed 2018 budget would shave almost $1bn off this figure, including a $222m cut to its contribution to the Global Fund.

"We should all be concerned," said the department’s deputy director-general for HIV/AIDS, tuberculosis and maternal and child health, Yogan Pillay.

SA has the world’s biggest HIV/AIDS burden, with more than 7-million people living with the disease. Unlike many other countries in sub-Saharan Africa, SA funds the lion’s share of its HIV/AIDS programmes itself.

Nevertheless, the scale of the country’s epidemic means donor funding accounts for 18.5% of the HIV/AIDS funds available to SA for the 2017-18 fiscal year, said Pillay.

The US is the biggest international donor to SA’s HIV/AIDS efforts, via the President’s Emergency Programme for AIDS Relief (Pepfar). It has provided more than $5.6bn to SA since 2004 and has gradually shifted its emphasis from providing treatment to technical support.

While Pepfar has committed to providing $483m to SA for the 2017-18 US fiscal year, which begins on October 1, it is unclear what lies in store for the following year, said Pillay.

US embassy spokeswoman Cynthia Harvey said no funding determinations had been made beyond 2017 as discussions for 2018 had not yet begun.

Citing recent remarks by Pepfar ambassador Deborah Birx, she said: "The Trump administration remains committed to Pepfar to not only save lives, but to also change the very course of the HIV pandemic."

Pillay warned that if Trump’s proposed 2018 budget was given the go-ahead, it would not only threaten the funding it received via Pepfar but also the support it got from the Global Fund. It was unclear how the fund might manage a cut in its available funds and how grant recipients such as SA would be affected, said Pillay.

The Foundation for AIDS Research and HIV-prevention advocacy group Avac have forecast that the proposed cuts would disrupt treatment for more than 1-million people and were likely to lead to nearly 150,000 AIDS-related deaths.

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