Brussels, January 30, 2025
In support of communities, civil society organisations, international and regional organisations and individuals living with and affected by HIV/AIDS globally, the European AIDS Treatment Group (EATG) and its members echo that the US administration should in all cases uphold the rights, dignity and freedom of vulnerable populations including migrants, transgender people, people living with HIV and those belonging to key populations.
These past few days, the new US administration signed a series of Executive Orders that have a considerable impact on global health policies and the HIV/AIDS response. Prominently:
Collectively, these executive actions have introduced significant uncertainties in global health initiatives. This policy shift in the USA sets the scene for the rest of the world, as well as highlights shortcomings in the uptake of initiatives and funding from other countries. Specifically, the EU and European bilateral funding for HIV aid has been diminishing – with exceptions like the Global Fund, French Expertise, and German GIZ funding. EATG, even more now, reiterates the need for the EU and European countries to upscale their contributions to and support for the global HIV/AIDS response.
In addition, the US funding freeze will have devastating effects on Ukraine which has the second largest HIV epidemic among WHO Europe countries. It is our view that in the present circumstances the EU needs to come forward regarding solutions to meet the situation in Ukraine, not least if some aspects of PEPFAR funding remain outside the Emergency Humanitarian Waiver of 29th January 2025. The EU and countries in Europe and Central Asia are called for to provide the necessary support to cover these imminent gaps.
With President Donald Trump’s transition back into the White House, the current US administration is positioned to implement a US-focused economic agenda that aims to recalibrate international relationships to meet the “Make America Great Again” pledge. After his inauguration on January 20th, President Trump signed a series of Executive Orders to implement this vision that, however, threaten the health and wellbeing of communities worldwide.
In his declaration, President Trump stated that US foreign policy will now prioritise core American interests and citizens and directed the Secretary of State to bring the Department of State’s “policies, programmes personnel, and operations in line with an America First foreign policy”.
In recent days, the administration undertook a review process, freezing all US foreign aid funding for 90 days. EATG is deeply concerned by the terms and implications of the Executive Order “REEVALUATING AND REALIGNING UNITED STATES FOREIGN AID” of 20th January 2025. Sections 1 to 3 of this Order undermine and/or negate US contributions to the maintenance of global health. We are particularly concerned at the imposition of the freeze on a range of programmes including PEPFAR (President’s Emergency Plan for Aids Relief).
Even if a temporary Emergency Humanitarian Waiver has been put in place to allow people in 55 countries worldwide to continue accessing life-saving HIV treatment, confusion and uncertainty prevail as the waiver excludes activities about abortion, gender, diversity, transgender and non-life saving work as well as administrative costs for the distribution of medicines. EATG remains adamant on the critical role and legacy of President’s Emergency Plan for AIDS Relief (PEPFAR) in the HIV/AIDS response.
Until now, PEPFAR has saved more than 26 million lives in more than 50 countries, prevented millions of HIV infections, and transformed the HIV/AIDS pandemic from a health emergency to a controlled epidemic, allowing several countries to reach and even exceed the UNAIDS 95-95-95 target. PEPFAR helps HIV treatment reach some 20 million people globally, including more than 550,000 children. Cutting down essential funding will put community-based organisations, networks, and lifesaving health and developmental programmes at critical risk, dismantling decades of progress in the HIV/AIDS response.
In addition to the aid freeze, President Trump has announced the withdrawal of the US from the World Health Organization (WHO), asserted by failure to handle the COVID-19 pandemic. This decision, formalised through an Executive Order, means that the US will not be a member of the WHO after the withdrawal is complete. This excepted one-year process is anticipated to weaken global health coordination and undermine the organisation’s capacity to operate effectively, leaving many countries vulnerable to health emergencies, disease outbreaks and future pandemics. The US is the top donor and partner to WHO, and contributed US$1.284bn in 2022-23.
In a more worrisome turn of events, President Trump has also signed an Executive Order that reinstates the Global Gag Rule that prohibits foreign organisations that receive US health aid from providing, referring to or advocating for abortion services, irrespective of whether non-US funding is used for such activities. The EATG and its members reiterate that reimposing this rule will have dire consequences on HIV responses globally; the International AIDS Society estimates that this has led to an approximate 90.000 new HIV acquisitions and almost 30.000 maternal and child deaths each year it has been in place, due to disruptions in HIV services.
Alarmingly, another Executive Order was signed to dismantle diversity, equity and inclusion (DEI) initiatives across Federal agencies including the US Food and Drug Administration (FDA). EATG is deeply concerned at the terms of the Executive Order “ENDING RADICAL AND WASTEFUL GOVERNMENT DEI PROGRAMS AND PREFERENCING”. We believe that diversity, equity and inclusion are central issues in health care, clinical treatment, and in scientific research leading to advances in medicine. This Executive Order has the potential to jeopardise the effectiveness of care, treatment, and research. It further threatens the health and wellbeing of transgender people by excluding them from health-related programmes that have hitherto been supportive of them.
This raises significant concerns around the inclusion of underserved and underrepresented communities in clinical research as this approach would impede and threaten the FDA’s mandate of ensuring quality care for all patients. This approach would not only contribute to the exclusion of key populations from research but also limit our understanding of drug effectiveness and safety across different populations, potentially compromising patient care and global health security.
In support of communities, civil society organisations, international and regional organisations and individuals living with and affected by HIV/AIDS globally, the European AIDS Treatment Group (EATG) and its members echo that the US administration should in all cases uphold the rights, dignity and freedom of vulnerable populations including migrants, transgender people, people living with HIV and those belonging to key populations.
Collectively, these executive actions have introduced significant uncertainties in global health initiatives. In these coming months, the scope and scale of the US policy shift on global health will keep on increasing, affecting and influencing other governments. Nonetheless, this situation calls for unity and leadership which governments and countries from around the globe can embed by shifting their focus and resources to the health sector.
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