US foreign aid freeze wreaks havoc for HIV treatment in Africa

Rev. John Azumah, founder of the Motherly Love Orphanage in Accra, Ghana, which houses children living with HIV, was himself diagnosed with the disease over 20 years ago. 

At the time, he said, he felt hopeless because treatments were largely inaccessible in Ghana.

But in 2003, antiretroviral drugs, or ARVs, came to Ghana through the President’s Emergency Plan for AIDS Relief or PEPFAR, led by then-US President George W. Bush.

“And since then, ARVs have saved thousands of lives, including myself,” he said.

PEPFAR is often regarded as the most successful foreign aid program globally. Over the past two decades, it has saved over 25 million lives, the majority in Africa. 

But recently, President Donald Trump signed an executive order freezing nearly all US foreign aid for 90 days, including for PEPFAR. The move has raised alarm across Africa, where millions depend on US support for health care, including critical HIV treatment.

Azumah said that when the news broke, his phone buzzed with calls.

“A lot of persons living with HIV are calling [me, saying], ‘Rev., what is happening? Rev., are you sure we are safe? Are we not going to die?’ I said, “Let’s keep praying.””

Then, his concern shifted to the children at the orphanage. Like Sandra, 18, who was born with HIV. Her full name and those of others at the orphanage aren’t being used to protect their privacy.  

She said that her future would be bleak without access to regular treatment.

“Without taking our medication, our health will be compromised, our viral load will increase, and we’ll fall sick all the time,” she said.

Desmond, 17, said that he shares similar fears. 

“If you reach the dangerous stage of AIDS, your days are numbered,” he said. “We’re pleading with President Trump to help us, or we’ll suffer.”

The aid freeze is part of Trump’s “America first” policy, which prioritizes domestic concerns over foreign commitments. Although US Secretary of State Marco Rubio recently said that “life-saving” aid, including medicine, health care, food, and shelter, would be temporarily exempt from the aid freeze, the specifics are murky.

“Life-saving means different things for different people, so it’s very unclear. We are not sure what is being cut off and what’s there,” said Yvette Raphael, executive director for the Advocacy for Prevention of HIV and AIDS (APHA), a nongovernmental organization based in Johannesburg, South Africa.

She said Rubio’s temporary waiver was confusing, given that PEPFAR-funded organizations had already received formal stop-work orders. Organizations are legally bound to await clear, specific instructions before resuming operations.

Raphael is not alone in her concerns — health officials and aid organizations across several African countries struggle to interpret these waivers’ scope. Days after the exemptions were announced, many PEPFAR-funded facilities in countries such as Mauritius and South Africa remain closed, leaving millions of people who rely on the program highly vulnerable, according to the United Nations AIDS program.

South Africa has the highest number of people living with HIV in the world, with a high prevalence of HIV among young women.

“Our biggest fear right now is if people are not able to get their treatments where they used to, they are unable to get tested for HIV, we are worried that this will again tick up the number of new infections. And people will struggle with drug resistance,” Raphael said. 

In addition, the USAID, which helps administer PEPFAR, announced last week that its staff worldwide would be placed on administrative leave this month, except for those in mission-critical roles. Analysts say this directive could significantly exacerbate the ongoing crisis.

Elsie Ayeh, president of the Network of People Living with HIV in Ghana, said that the only solution is for PEPFAR to be fully reinstated. 

“Millions around the world are now afraid, with their health hanging in the balance,” she said. 

Ayeh stressed that halting HIV support services, even temporarily, could be fatal.

Dr. Stephen Ayisi Addo, head of the country’s National AIDS and STI Control Programme, said the aid freeze should have been gradual, not abrupt.

“The issue is more about the abruptness of this. There ought to be communication ahead so that people will prepare for it but it’s abrupt, so this is like a force majeure.”

Ayisi Addo said that the current aid situation could reverse years of progress and further weaken Ghana’s ability to respond to current and future epidemics.

“With new pandemics and threats emerging, it’s crucial to control those we can to better manage others,” he said. “So, this then creates a certain complex environment which poses a great challenge in disease control and prevention.”

But some analysts say it is time for Africa to look within and stop waiting for outside help. 

Ben Phiri is a Malawian member of Parliament and chairperson for the Southern and Eastern African Parliamentary Caucus on Sexual and Reproductive Health and Rights.

“This is donor money. It is taxpayers’ money. PEPFAR has been there for some time now. We needed by now to have gone into a stage where locally, we are able to finance our own activities. Now, there is donor fatigue,” he said.

Phiri said that Africa’s health care problems come from weak leadership and a lack of political will.

He pointed to the “Abuja Declaration,” which African nations signed over 20 years ago, urging governments to allocate at least 15% of their annual budgets to health care. Yet, many nations have failed to meet this commitment.

He said that Africa can strengthen its health care by increasing funding, boosting local medicine production, prioritizing prevention and fostering regional collaboration to invest in its workforce and infrastructure.

“Africa is for Africans, and we need to shape the narrative of the sort of Africa we want in the next 10 years, in the next 20 years. It is leadership that we need in Africa. So, I call on African leaders to wake up,” he said.