Swazi Observer

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US MOVE A BIG BLOW – MINISTER

By SITHEMBILE HLATSHWAYO | 2025-01-31

Government is projecting that new HIV and TB infections may increase following the suspension of the HIV/AIDS funding by the United States of America (USA).

The ongoing activities targeting the strengthening of the supply chain management of medical commodities would also be impacted negatively by the interruption of experts who have been assisting in this initiative.

This was revealed by Minister of Health, Mduduzi Matsebula, through a statement issued yesterday afternoon.

Matsebula stated that the executive order by US President Donald Trump was set to negatively impact the government in the HIV and TB response, particularly the assistance that is received through the President's Emergency Plan for AIDS Relief (PEPFAR), which is solely funded by the US Government.

PEPFAR is a bilateral commitment by the US Government to support HIV/AIDS prevention, care, and treatment in developing countries.

Matsebula said the increase in new HIV and TB infections would result in a long-term negative effect in controlling the co-epidemics in the population.

He stated that, overall, the consequences of a halt in the PEPFAR funding could include struggles to maintain HIV viral suppression and reduce HIV-related mortality; a reversal of the 95-95-95 gains made in HIV prevention, treatment, and care; increased HIV transmission rates, morbidity, and mortality; and overburdened healthcare systems due to higher demand and limited support.

Losses
He noted that there could also be greater social and economic impacts on communities, especially vulnerable groups like women, youth, and key populations, particularly in the event of job losses.

The minister stated that prevention initiatives such as pre-exposure prophylaxis, post-exposure prophylaxis, and behaviour change communication targeting key populations, including adolescent girls and young women, would be slowed down.

This, he said, would further contribute to the potential increase in new HIV infections among these groups, which would eventually spillover to the general population.

Counselling
Matsebula highlighted that HIV testing and counselling would also be affected, through a reduction in the number of counsellors who offer this service.

Furthermore, he added that outreach programmes targeting testing of men and young people, including the distribution of self-test kits, would reduce.

The quality of HIV treatment would also be negatively impacted due to interruptions in clinical mentorship and training of health workers providing the service, reduced access to optimised treatment regimens, multi-month dispensing, and decentralised service delivery models.

Matsebula mentioned that another area which would be affected was the health laboratory systems, through a disruption in the availability of viral load reagents and a weakened capacity of the national laboratory to respond to broader public health challenges.

On another note, he stated that gender-based violence (GBV) programmes, which have been supported by PEPFAR to address vulnerabilities of women and girls to HIV and GBV, would be negatively impacted by the loss of funding, leading to a potential increase in HIV among these groups.

Support
The minister also mentioned that support for data-driven decision-making would be interrupted due to disrupted funding to support digital systems for health information at central and peripheral levels.

The executive order by Trump was effective on Tuesday at 5pm.
PEPFAR also implements programmes through other entities and non-governmental organisations (NGOs) including the National Emergency Response Council on HIV/AIDS (NERCHA), Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), Georgetown University, PSI, The Luke Commission, and ICAP.

Others are PACT, Young Heroes, World Vision, DataFi, PSM, Project Last Mile, Right to Care, URC, CANGO, CERA, Kwakha Indvodza, Bible Society, and AMICAALL.

These organisations work with the ministry in the HIV and TB response, bridging certain gaps and alleviating some of the burden that could befall the ministry and government.

Projected negative impact of reduced PEPFAR funding

Reversal of progress in controlling HIV/AIDS and TB: Increased new infections could lead to long-term challenges in managing these co-epidemics.

g Slowed prevention initiatives: Programmes like pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and behaviour change communication targeting key populations.
(e.g., adolescent girls and young women) may be hindered, increasing infections in these groups and the general population.

Reduced HIV testing and counselling: Fewer counsellors will be available, impacting access to these services.
g Decreased outreach programmes: Testing initiatives for men and young people, including self-test kit distribution, will decline.

g Lower quality of HIV treatment: Interruptions in clinical mentorship, health worker training, access to optimised treatment regimens, multi-month dispensing, and decentralised service delivery models will negatively affect care.

g Impact on gender-based violence (GBV) programmes: Reduced support for GBV initiatives could increase HIV vulnerability among women and girls.

g Disruption in data-driven decision-making: Funding cuts will affect digital health information systems at central and peripheral levels.

g Weakened health laboratory systems: Reduced availability of viral load reagents and diminished capacity of national laboratories to address public health challenges.

g Supply chain management challenges: Ongoing efforts to strengthen medical commodity supply chains will be disrupted due to the loss of expert support.

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