The United States’ suspension of foreign aid assistance, announced by the Trump administration on January 20, 2025, has raised global concerns about the potential ramifications for the fight against HIV/AIDS, particularly in countries where millions of lives depend on international aid. The order, which mandates a halt in the disbursement of foreign assistance funding for at least 90 days, threatens the continuity of vital health programs worldwide. There is no certainty that the funding will resume after the suspension period, leaving many vulnerable populations at risk, especially those living with HIV.
A critical area of concern is the President’s Emergency Plan for AIDS Relief (PEPFAR), a program launched in 2003 to combat the HIV/AIDS epidemic globally. PEPFAR operates in 54 countries, with a significant focus on Sub-Saharan Africa, where HIV prevalence is high. The program has provided life-saving antiretroviral therapy (ARVs) to millions of people living with HIV and has been instrumental in the global fight against the disease. With the US suspending aid, these efforts could face severe setbacks, endangering the lives of more than 20 million people who rely on this support.
Lesotho’s Response to the Threat of ARV Shortages
Among the countries at risk is Lesotho, a small landlocked nation in Southern Africa that faces one of the highest HIV prevalence rates in the world. In Lesotho, the provision of ARVs, which are essential for managing HIV and preventing the spread of the virus, has been supported largely by international assistance, including from the US.
However, Lesotho’s Parliamentary Chair of Chairs, Mr. Mokhothu Makhalanyane, has attempted to reassure the public that there will not be an immediate impact on the availability of ARVs. According to Mr. Makhalanyane, since last year, Lesotho has been able to procure 88 percent of its ARV supply domestically, with the remaining 12 percent being funded by the Global Fund. While he acknowledged that the US contributes to the funding of the Global Fund, he emphasized that Lesotho’s current ARV stock is secure for now.
The Global Fund’s Role and the US Contribution
The Global Fund to Fight AIDS, Tuberculosis, and Malaria is an international financing institution that supports programs to fight these diseases in low- and middle-income countries. While the United States is one of the largest contributors to the Global Fund, it is important to note that the Fund also receives support from other countries, private sector donors, and foundations. This diversified funding base has allowed the Global Fund to continue its operations in the face of potential disruptions, even if US assistance is temporarily paused.
Nevertheless, the US plays a pivotal role in the Global Fund’s operations. If the suspension of foreign aid is extended beyond 90 days or becomes permanent, the funding of programs like PEPFAR and the Global Fund would undoubtedly face challenges, putting millions of lives at risk. Although Lesotho has made strides in securing its ARV supply, many other countries may not be in a similar position and could face critical shortages.
The Broader Global Impact
The potential consequences of the US aid suspension go beyond just Lesotho. In countries across Sub-Saharan Africa, where the HIV/AIDS epidemic has been most devastating, the disruption of foreign aid could result in the loss of vital services, including HIV testing, treatment, and prevention programs. The US is the largest donor to PEPFAR, and any interruption in funding could reverse years of progress made in reducing HIV transmission and improving the quality of life for those living with the virus.
Experts warn that the suspension of foreign assistance could also harm broader public health initiatives. For instance, the fight against tuberculosis and malaria, diseases that often co-exist with HIV, could be set back significantly, exacerbating existing health crises.
The US suspension of foreign aid presents a serious threat to global health, particularly for the 20 million people living with HIV in the countries supported by programs like PEPFAR. While Lesotho has managed to secure a substantial portion of its ARV supply domestically, many nations lack the infrastructure or resources to do the same. The situation underscores the critical importance of international cooperation in tackling global health crises. The continuation of US foreign aid, particularly in the fight against HIV/AIDS, remains vital to sustaining global health efforts and ensuring that millions of people continue to receive the care they need.
