Trump win: What does it mean for global HIV efforts?

The United States (US) remains one of the leading funders of global health but will this change on president-elect Donald Trump’s watch?

In 2016, the US gave about $6.6 billion in international HIV funding making it one of the largest funders of HIV programmes globally. For some countries like South Africa, this aid is in the form of funding for HIV vaccine research and medical male circumcision to reduce men’s chances of contracting HIV.

In the past, the US also heavily funded antiretrovirals (ARVs). In countries like Angola, assistance still translates into life-saving antiretroviral treatment in patients’ hands through the US President’s Emergency Fund for Aids Relief (Pepfar) programme. South Africa receives about $500 million annually in Pepfar funds.

Many are wondering what a Trump administration will mean for global health. The answer may be far from clear, but activists are likely to keep a close watch on the science guiding policy, HIV funding and generic medicines. But Trump’s xenophobic remarks have many fearful that Pepfar could become an easy target as some Republican politicians have clearly signalled desires to cut budgets.

It is hoped that Pepfar won’t be taken back to the 2006 requirements where at least a third of HIV prevention dollars were targeted at abstinence only and fidelity programmes. Scientific evidence has since shown very little effectiveness of such programming.

In 2004, the Republicans attempted to cut support to the international financing mechanism the Global Fund to Fight Aids, TB and Malaria. Today, the US is the largest contributor to the Global Fund, which supports more than half of all people with HIV globally. In many countries, it is one of the few donors working with marginalised, high-risk populations like men who have sex with men and sex workers.

If Trump’s administration were to set its sights on cutting Global Fund support, it would be disastrous for an international mechanism already underfunded. In the past, US leadership has set the tone for other countries. A US decision to decrease Global Fund support could set a dangerous precedent.

In a 2015 press briefing when Trump was asked whether he would double the number of people on treatment to 30 million people by the year 2020? His response although vague was “I believe so strongly in that. And we are going to lead the way.” However, Trump has backslided on a number of his election promises.

A number of these decisions will not all be made by Trump;  Secretary of State and head of health and human services will also play important roles in deciding US global health policy in months to come.—Additional information from bhekisisa.org

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