TALK OF THE TOWN with Mike Aguirre Wed 1pm
Guest Warren Parker–USAID
REPORT ON USAID, THE CRISIS, CONSEQUENCES OF ACTIONS BY THE CURRENT ADMINISTRTION THE LIVES OF TENS OF MILLIONS OF PEOPLE ARE NOW IN JEOPARDY
GUEST WARREN PARKER, PHD. PUBLIC HEALTH & COMMUNICATION SPECIALIST
From Warren Parker:
I’ve worked on the HIV response for more than 30 years with a focus on the sociology of health and related communication. I lived in South Africa through to 2016, before moving to the US.
I led the national Beyond Awareness HIV campaign in South Africa in the 1990s as part of the post-apartheid government. In the 2000s, I established and led a South African non-governmental research organization called the Center for AIDS Development, Research and Evaluation (CADRE) that focused on AIDS response in African countries.
In 2009 I moved on to international consulting. Since 2000, I’ve worked in more than 25 countries, mostly in Africa, on health and development. My focus has been on applying participatory research approaches to bring community insights into disease responses, and issues such as maternal health, nutrition, education and gender-based violence prevention (more than 50 research projects). I’ve also supported the work of UNAIDS with a focus on the global AIDS response.
Nearly all of the work describe above (post-2000) involved projects and activities funded by USAID.
Following the foreign aid cuts in March this year, my work contracts came to a halt. This included work for UNAIDS linked to achieving global AIDS targets and goals, and sustaining the HIV response around the world. Work I was involved in for another international organization on pandemic preparedness (funded by USAID) was also ended.
My insights into the current situation include a strong grounding in African perspectives on HIV, health and development.
The paper I recently wrote with my colleague, Alan Whiteside, an internationally recognized health economist, looks at the implications of the US foreign aid cuts on HIV and AIDS. The key points we make are as follows:
1. The dismantling of USAID, including most of the projects funded under the President’s Emergency Plan for AIDS Relief (PEPFAR – which was established by President Bush in 2003), is unprecedented and catastrophic.
2. The withdrawal of this aid has placed the lives of tens of millions of people in jeopardy. For example, in 2024, 20 million people living with HIV, mostly in Africa, were supported by PEPFAR through life sustaining medications (enabling them to be healthy and productive). HIV transmission to millions of infants was prevented through PEPFAR support for programs giving medications to pregnant women living with HIV. Millions of new HIV infections were prevented through PEPFAR support for prevention programs.
2.1 Despite claims that life-saving funding, including for HIV, would continue, this was not the case in the vast majority of instances. Dismantling USAID by dismissing nearly all domestic and international staff, effectively disrupted payment systems and removed management systems crucial for keeping funding online.
3. The immediate withdrawal of aid resulted in thousands of PEPFAR-funded health facilities and organizations reducing or ending their services, and well over 300 000 health workers immediately losing their jobs. Without continued access to medication, people living with HIV face deteriorating health and increased likelihood of dying. HIV treatment reduces the likelihood of HIV transmission to sexual partners, so without treatment, new infections are likely to increase.
3.1 Many African countries were highly dependent on funding for their health and HIV funding, and are not in a position to immediately support the gaps created by the US funding withdrawal. There are no funders able to fill these gaps at any sustainable level, and the immediate harms are also going to be long-term harms.
4. It is accepted in the foreign aid system that funding will change from time to time, including being reduced and many countries do so. This is done in a measured way over time, to give countries receiving aid an opportunity to adapt and develop new strategies. The way this was done now, though, exerts the most severe possible harm, and places lives in jeopardy – whereas it could have been done more rationally in a measured way over time. The cost is not only in human lives. The US has breached and lost trust of other countries, and removed the advantage of decades of good will – in short the US is now an unreliable partner.
5. President Trump and Elon Musk refuse to acknowledge that people are dying as a result of these actions, yet the results are worse than war.
6. In other parts of the paper, we highlight the global aids goal of ending AIDS by 2030 – which was set in motion by a political agreement by all countries within the UN – including the US. Achieving this goal depended on sustained funding at current levels over the next 5 years. This goal is now unattainable.
7. We also highlight that the way HIV was funded by PEPFAR, and other funding entities, resulted in HIV being treated in a siloed way – differently from other diseases, often with higher and more exclusive funding. Health responses are more efficient if all diseases are integrated into the health system, and when this is done, health delivery is also more sustainable.
8. We recommend that countries and foreign aid support focuses more on building resilient and sustainable approaches to health to avoid eventualities such as imposed by the current US administration.
9. There are some moves to reorganize and continue US support for health, including HIV, but the focus on a very much reduced number of countries, and largely exclude support for the most vulnerable populations affected by HIV (linked to ideological rationale for not supporting DEI). Whatever shape this reorganization takes, it will be slow to implement.
