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Before the PepFar program, millions in Africa were deprived of life -saving treatment. Experts now fear for its future
- HIV —Idiagnosis was ‘death sentence’ in Africa in the 1990s
- Pepfar helped reduce medicine prices dramatically
- Activists worry the funding for the AIDS plan may fall under Trump
Nairobi – At the height of the HIV/AIDS crisis in the 1990s, it meant to be diagnosed with the virus in Kenya stiffening for the worst.
“We pretty much gave people a death sentence,” recalls Lilian Otiso, a doctor who was a medical trainee at the time at Kenyatta National Hospital, Kenya’s largest referral hospital.
Very effective antiretroviral therapies (ARGs) had Reduced AIDS -death by 47% in the US in the year after they became available in 1996. But they cost more than $ 10,000 per Patient Annually – Father out of reach for most patients in Africa.
Even in 2002, only 50,000 people in Africa received ARGs, only 0.1% of the nearly 30 million HIV-positive people on the continent. The average life expectancy had fallen to 47 years compared to an expected 62 year without AIDS.
This meant that medical staff like Otiso could only help people who were diagnosed with the disease to deal with the inevitable.
“We went through them how to break the news to the family and get their affairs in order. Support groups and Nutrition Council were all we could offer,” said Otiso, now CEO of LVCT, a Kenyan non -state -state organization that Provides testing, advice and support to HIV/AIDS patients.
The launch of the President’s Emergency Plan for AIDS -Fless (PepFar) in 2003 Changed everything. The world’s largest health program, aimed at a single disease, has pepared pepared $ 120 billion in financing over 20 years and provided life -saving treatment to millions in over 50 countries.
But the future of the program is in danger. President Donald Trump ordered a 90-day break in foreign development assistance on January 20, the day he took the Oath of Office.
This included stopping the supply of life -saving drugs for HIV, malaria and tuberculosis as well as medical supplies to newborn babies, in countries supported by USAID across the globe, showed a memo that was reviewed by Reuters.
This follows a rocky period in which Pepfar failed to secure a five-year financing permit in 2023 for the first time in the beginning, as the US Congress only awarded one year’s extension.
The road to Pepfar
When AIDS occurred in the mid -1980s, the public health sector in Uganda was already strained by war. In the 1990s, the government established a joint clinical research center to study the disease that had spread within military ranks.
“Uganda imported these very expensive ARGs, deciding who received them was essentially a military decision,” Ugandan journalist Daniel Kalinaki told context/Thomson Reuters Foundation in an interview. Kalinaki is co -author of “Open Secret: People Facing Up to HIV and AIDS in Uganda.”
In 2000, South Africa was facing a trial From 39 pharmaceutical companies seeking to block legislation that would provide the import of low cost generic drugs to treat HIV and AIDS. Companies claimed that this violated international patents.
Standoff centered around intellectual property rights. In the late 1990s, Western companies continued to protect their patents so that only they could produce the medicine.
However, some countries began to produce generic versions by the reverse engineering of the active ingredients of antiretroviral drugs that help suppress levels of the virus and prevent its transmission.
“The West built a medical Vollgrav around itself at the time,” says Kalinaki. “When India and Cuba began to produce generic?”
Pharmaceutical companies also claimed that Africa lacked the infrastructure to control heritage effectively.
“Western pharmaceutical companies presented all kinds of arguments – some based on real challenges, but did not aim to solve the problem,” says Kalinaki.
“The quoted lack of cooling, inadequate knowledge, and even claiming African patients couldn’t take pills properly because they were too poor and hungry.”
Andrew Natsios, the then head of the US Agency of International Development went on, witnesses before Congress In 2001, Africans were unable to comply with treatment regimes because “they do not know what clocks and watches are” and marked with the sun, and it would also struggle to take medication on a schedule.
A box of HIV medicine is seen before it is given to an HIV -positive patient in the IOM Treatment Center in Eastleigh, Nairobi, Kenya, November 29, 2018. Image taken November 29, 2018 Reuters/Baz Ratner
A box of HIV medicine is seen before it is given to an HIV -positive patient in the IOM Treatment Center in Eastleigh, Nairobi, Kenya, November 29, 2018. Image taken November 29, 2018 Reuters/Baz Ratner
Security threat
The United States slowly began to see HIV/AIDS as a danger of political stability in new democracies. Former President Bill Clinton declared AIDS a “National security threat“And after September 11, 2001, attacks on the United States, the efforts became even higher.
According to records of former President George W. Bush’s archives in the White House, he launched Pepfar as a Corner stone in American foreign policy “To help relieve despair that allows extremism to grab.”
At that time, Africa had not only the highest HIV spread, but also The largest number of orphaned children who were seen as a potential Pool for recruiting to militants and criminal groups.
But Bush also framed Pepfar as a humanitarian reaction to the HIV/AIDS crisis in Africa, driven by the US moral obligation to relieve suffering and save lives in poor nations destroyed by the epidemic.
During the program, ARGs were widely available, gives hope For millions of people who would have previously been doomed to die.
While Pepfar originally depended on proprietary medicine from US producers, it began to approve generation in 2005 after accelerated reviews from the US Food and Drug Administration.
In 2008, Generika made up 90% of PepFar-Finded ARGswhich significantly reduced costs.
“Pepfar came because of a mix of players – activated pushing hard, people working behind the scenes and a lot of pressure to bring down prices,” says Otiso.
As for compliance, African patients defied the stereotypes by demonstrating better compliance with treatment regimes than their North American colleagues.
“What shocked (critics) was that observance here was better than in the West,” says Otiso. “We had radios. We had at 7am.
An HIV -adhesion advisor speaks to a woman tested for HIV in the IOM Treatment Center in Eastleigh, Nairobi, Kenya, November 29, 2018. Reuters/Baz Ratner
An HIV -adhesion advisor speaks to a woman tested for HIV in the IOM Treatment Center in Eastleigh, Nairobi, Kenya, November 29, 2018. Reuters/Baz Ratner
‘Foreign Policy Victory’
Since launching, Pepfar has provided antiretroviral therapy to more than 20 million people with HIV and saved 26 million livesAccording to US government data.
Pepfar’s influence expanded beyond HIV, strengthening health care systems to tackle other diseases and improve the health of mother and children.
This dramatic shift not only emphasized the effectiveness of the treatment, but also Pepfar’s geopolitical significance.
“I’m not naive enough to believe that Pepfar was purely altruistic,” says Kalinaki. “It was a defensive mechanism that turned into something good – no doubt America’s greatest foreign policy victory in a long time.”
Today, the program is facing growing uncertainty. Anti-aborte groups in the United States have claimed that pepar is used to promote abortion.
A review of service providers funded by Pepfar in Mozambique found that four nurses performed a total of 21 abortions since January 2021, said three US officials who briefed members of the congress on the case on January 23 in an attempt to show transparency and demonstrate that measures to ensure that compliance with the ban on abortions worked.
The officials said it was the first time it was found that a pepar-funded provider has provided an abortion in the program’s 20-year history.
However, US laws already explicitly prohibit the use of foreign aid for abortion services.
“Given the already existing challenge and standoff with pepar in terms of renewal, we are likely to be in a difficult place where the impending threat that Pepar is not being renewed will be real,” said Catherine Nyambura, director of programs On Athena Network, a global feminist organization that works with women and girls to lead and shape the response of HIV and AIDS.
This story is part of a series supported by HIVOS’s Free to be me -Program.
(Reporting Christine Mungai; Editing Sadiya Ansari and Ayla Jean Yackley.)
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