The world could relive the worst days of the AIDS pandemic without a resumption of US financial support for international aid, the head of UNAIDS warned on Monday.
"US budget cuts mean that today 27 African countries are experiencing staff shortages and disruptions in diagnostic and treatment systems, as well as collapsing surveillance systems," UNAIDS Director General Winnie Byanyima said at a press conference in Geneva.
"In the longer term, we see the AIDS pandemic resurging globally, not only in low-income countries (...) in Africa, but also among key populations in Eastern Europe and Latin America," and "we will see people dying, just as we saw in the 1990s and 2000s," she said.
"We are going to see a real resurgence of this disease," she insisted, making a direct appeal to President Donald Trump to "make a deal" on disease prevention that brings in far more money than it costs.
The months-long suspension of US aid has caused confusion and disruption in the global AIDS response network, despite the Trump administration's exemption for certain programs, UNAIDS, which is itself funded 50% by the United States, warned in early February.
According to the UN agency, without a resumption of US aid, and while no other country has announced plans to replace them, there will be an additional 6.3 million deaths from AIDS over the next four years. "In 2023, there were 600,000 deaths (...). So we're talking about ten times more," said Ms. Byanyima.
Ms. Byanyima explained that "the United States has been an incredible partner" and UNAIDS has worked in "close collaboration" with the Pepfar program, launched by former President George W. Bush to fight AIDS, which has also been affected by budget cuts.
But "the suddenness of the withdrawal of US funding led to the closure of many clinics and the layoff of thousands of health workers," she noted.
While she considers it "reasonable that the United States wants to reduce its funding," the senior UN official points out that "the suddenness of the withdrawal (...) has a devastating impact on all countries, particularly in Africa, Asia and Latin America."
– “a new revolution” –
In some African countries, the AIDS response is heavily dependent on external aid, such as in Tanzania, where it accounts for 94% of funding and comes largely from the United States. Uganda is also dependent on 90%, Ms. Byanyima said.
Some countries, such as Kenya (63%), South Africa (76%), and Botswana (66%), have managed to reduce their dependency, she said. But "it is wrong to believe" that others "are sitting back and doing nothing."
"We urge a review and urgent restoration of services, services that save lives," she said.
The UN's call is all the more urgent as experts believe that an antiretroviral drug, developed by the American giant Gilead based on the molecule lenacapavir, could be a game-changer in the fight against AIDS.
According to Ms. Byanyima, "we are at the dawn of a new revolution in preventive treatment" and "we could see the end of AIDS" thanks to an ambitious deployment of the treatment, which she describes as a "miracle tool."
"Gilead is an American company that has every chance of profiting from this innovation, provided that the President of the United States and his administration understand the deal" around disease prevention, she insisted.
Like many other organizations, UNAIDS is affected by the US decisions. But for now, the agency has not made any layoffs, she said.
"We continue to examine scenarios for the future," Byanyima said.
So far, no other country has announced plans to fill the American void, she noted, adding: "The worst-case scenario would be further cuts from Europe and zero support from the United States."
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