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As we mark World AIDS Day, the new president of EGPAF — or the Elizabeth Glaser Pediatric AIDS Foundation — talks about steering the organization through the “chaos” of the U.S. foreign aid freeze.
Also in today’s edition: UNAIDS chief Winnie Byanyima discusses the backsliding caused by funding cuts to HIV/AIDS work, and we dissect internal U.N. documents detailing how the U.S. wants to handle gang violence in Haiti.
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When Dr. Doris Macharia became president of the Elizabeth Glaser Pediatric AIDS Foundation in March, she walked straight into the maelstrom of U.S. President Donald Trump’s foreign aid freeze. “We had to shut down a lot of activities,” she says, noting cuts that hit more than 350,000 people on HIV treatment, including nearly 10,000 children, and that forced “tough decisions” on staff.
But the shock gave her focus, writes Devex contributing reporter Andrew Green. “This particular disruption had to make us think, ‘What do we need to prioritize?’” For her, that meant protecting EGPAF’s core focus: “on children, on mothers, on eliminating mother-to-child transmission [of HIV], on ending pediatric AIDS.”
Eight months in, she says she’s “doubling down on our mission” of helping mothers with HIV not pass it onto their children and pushing deeper work with governments. The funding climate remains tricky. “We are learning to read the tea leaves,” she says, though she’s encouraged that stopping mother-to-child transmission is explicitly named in the “America First Global Health Strategy” — a sign “there’s going to be support for moms … for kids.” But governments will “still need support,” and EGPAF wants to cocreate solutions and provide expertise.
She worries about integrating maternal and child health without losing focus on pediatric AIDS. “We don’t want stigma to start going up again,” she says.
Looking ahead, EGPAF’s new 2024-2028 plan stays tightly focused on ending pediatric AIDS, eliminating mother-to-child transmission, using data, and strengthening health systems. “It calls for precision and prioritization,” Macharia says. And after learning how fast funding can disappear, she’s calling on donors to help close the gaps for women and children. “At the moment, right now, we have work to do.”
Read: Despite ‘chaos,’ EGPAF maintains focus on ending pediatric AIDS
Related: Where is the political demand to eliminate pediatric HIV/AIDS? (Pro)
When it comes to funding the AIDS response, donor money has been particularly important for prevention services — and now that donors are pulling out, it’s causing huge disruption. UNAIDS warns of an additional 3.9 million infections projected just over the next five years. The number of people receiving PrEP, or preexposure prophylaxis, in Burundi is down 64%, condom distribution in Nigeria fell by 55%, and male circumcision decreased by 65% in Uganda and 88% in Botswana. Across sub-Saharan Africa, 450,000 women have lost mentors and services that help ensure the prevention of HIV transmission to their children, and clinics for key populations are closing, writes Devex Senior Reporter Jenny Lei Ravelo.
The crisis is unfolding amid a “deteriorating human rights environment globally,” UNAIDS Executive Director Winnie Byanyima says, noting rising criminalization of sex work, same-sex relations, gender expression, and drug possession. She urged governments to protect rights — and funders to invest in prevention, especially lenacapavir, the long-acting injectable she says could avert 50,000 infections but “is still a drop in the ocean.”
The United States, Gilead, and the Global Fund aim to reach 2 million people in two years, while China is ramping up support in countries where it has “strong relationships.” But Byanyima warns the real impact of funding cuts will take time to surface: Once treatment stops, “the virus that has been suppressed becomes live.” Governments “are not going to see the negative impact, the deaths now,” she says — but without action, “some people will die in some years to come, and that’s not good.”
Read: HIV prevention services hit hardest by funding cuts, UNAIDS warns
A tenfold surge in HIV cases in Fiji — driven by “a new wave of injecting methamphetamine use” — is emerging as one of the fastest-rising epidemics in the world, and it could be a preview of what the rest of Asia-Pacific could face, according to an opinion piece for Devex by Dr. Saia Ma’u Piukala, regional director for the western Pacific at the World Health Organization, and Eamonn Murphy, director of regional support teams for Asia-Pacific, Eastern Europe, and Central Asia regions at UNAIDS. Fiji’s outbreak is spilling into the general population — more babies are being infected — and the region is now seeing that “when one nation is vulnerable, so too are its neighbors and the region as a whole.”
Piukala and Murphy point to rising infections from the Philippines to Papua New Guinea and warn that epidemics behave predictably: “If we fail to invest in the systems that hold them at bay, they mushroom.” And with an average of one new HIV infection in Asia-Pacific every two minutes, the financial and human cost is mounting quickly because “the cost of inaction compounds fast,” they write.
What makes this moment urgent, they argue, is that the tools to stop the spread already exist — long-acting PrEP that prevents infection with “just two injections a year,” rapid and self-testing, and treatment that ensures sexual transmission is impossible under certain circumstances.
Their five-point call to action urges governments to keep HIV high on national agendas, scale up prevention and harm reduction, embed HIV services into primary health care, fund community-led responses, and tackle stigma and discriminatory laws that keep people from care. Fiji may be small, they argue, but it’s showing exactly where the region is headed unless leaders act now.
Opinion: HIV is not over in Asia-Pacific — a wake-up call from Fiji
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The early plan by the U.S. to tackle violence in Haiti was startlingly blunt — the force would search, seize, and “kill” gang members. Canada and other potential partners pushed back, and the language shifted to “neutralize, isolate, and deter armed gangs.”
That word swap — featured in documents obtained by Devex — reveals the real fight: Is the U.N.-mandated suppression force engaged in policing or war? It shapes everything from rules of engagement to whether countries will send troops.
Human rights groups insist it’s largely a law enforcement mission. “We wouldn’t characterize the situation in Haiti as an armed conflict,” says Louis Charbonneau of Human Rights Watch; he says international authorities must adhere to international law when tackling the issue.
But others Colum spoke to said Haiti’s most powerful gangs have military-grade equipment and a military-style culture, saying the reality is obvious. “I don’t see how you can do combat with soldiers without calling it an armed conflict,” says Walter Dorn of the Royal Military College of Canada.
Meanwhile, the U.S. is designating gangs such as Viv Ansanm as “terrorist organizations,” which makes other countries that might send troops nervous. “There’s no way other nations would want to go into Haiti with their kinds of rules of engagement,” Dorn says. Recent U.S. strikes against boats in Venezuela have shown a willingness to dismiss legal arguments against their conduct, even from lawyers in its own government.
On top of that, Haiti’s legal and judicial infrastructure is shaky, civilian casualties are possible, and some children have been recruited to fight for gangs, further complicating the fight against them.
The new 5,500-strong Gang Suppression Force — “five times the size of its predecessor,” says U.S. Ambassador to the U.N. Mike Waltz — was approved by the U.N. Security Council in December. It’ll have sweeping authority for “offensive operations to neutralize gang leadership and disrupt resource flows.”
Veteran U.N. peacekeeping official Jack Christofides is in place as a special representative, but no force commander or lead battalion has been secured. While the final concept of operations isn’t settled yet, the goal is reportedly to have it ready for a Dec. 9 meeting at which they hope to secure partners.
Exclusive: US-backed Haiti anti-gang force in search of lead battalion
More than 900 people have died across Sri Lanka, Indonesia, and Thailand as Cyclone Ditwah brought heavy rains that caused severe flooding and landslides in parts of South and Southeast Asia. [The Guardian]
The International Committee of the Red Cross has been awarded Germany’s Marion Dönhoff Prize for upholding international humanitarian law. [dpa via Yahoo]
A Kenyan high court has struck down parts of the nation’s 2012 seed law, ruling that it is unconstitutional to criminalize the sharing and selling of indigenous seeds among farmers. [AP]
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