- Trump administration shuts down PEPFAR Office fighting the spread of HIV/Aids
- UNAids warns cuts could lead to tenfold increase of global deaths to 6.3 million in 4 years
- Liberian government says it has enough HIV treatment drugs for this year and next
By Anthony Stephens, Senior Correspondent with New Narratives
PELEBO TOWN, Maryland County—Alvin sits under the shade of a mango tree outside a health clinic here coming to terms with the news he has just received. Though he had barely heard of Donald Trump before now, Alvin has just learned that the American president, coming into office for his second term, has ended the supply of life saving medicine that has kept him well since he discovered he was HIV positive more than a year ago.
More than three months since the cuts took effect, Alvin and the estimated 35,000 people with HIV/Aids in Liberia are facing a frightening future.
“With no treatment, I will get sick,” says Alvin, 47. “When somebody sick, when there’s no treatment, won’t they die?”
The Office of Global AIDS and Health Diplomacy was one of dozens of offices that the new Trump administration has shuttered. The Office oversaw the President Emergency Plan for AIDS Relief, or PEPFAR, the widely lauded program instituted by Trump’s fellow Republican, President George W. Bush, in 2003 to tackle the then rapid spread of HIV, the virus that causes Aids. The program is estimated to have saved 25 million lives in the years since.
PEPFAR 2024 results according to the State Department
Human Immunodeficiency Virus or HIV, fights cells in the body needed to battle infections. Victims are vulnerable to contracting other diseases and cancers. Acquired Immunodeficiency Syndrome, or Aids, is the final stage of HIV infection when a person’s immune system is so badly damaged it is difficult to fight off other infections or cancers.
HIV is transmitted through bodily fluids – through unprotected sex, sharing needles, or from mother to child. There was tremendous fear attached to the disease when it became an epidemic in the 1980s but it has since been shown that regular contact with an infected person does not lead to transmission. Still stigma persists in places like Liberia that are less familiar with the disease.
Anti-retroviral drugs do not cure HIV but are critical to keeping the virus at low levels and allowing the infected person to live a healthy life. Alvin is among 25,000 people who are on ART drugs in Liberia, according to DHIS2, a global public information system on health. The site, quoting 2021 data, said, “HIV prevalence in the country has declined steadily and now stands at an all-time low of 1.3%.”
The Ministry of Health assured Front Page Africa there will be no shortages for now. The immediate effect of the cuts was to the medicine supply chain system. USAID supported the storage and distribution to all counties, managed by the World Food Program. The government immediately made funding available to cover the costs of storage and distribution, according to Catherine Cooper, the Chief Medical Officer.
“There is adequate supplies in-country for the entire year and next year,” wrote Cooper in an email.
That reprieve will bring some relief to patients. But after that the picture is less certain. Anti-retroviral drugs were supplied by the US and the Global Fund for Aids, Malaria and TB, a multi-billion global fund to which the US contributes a third of its funding. The US has not withdrawn funding for the Global Fund yet, but health officials are bracing for the possibility.
Alvin has been on the drugs since he was diagnosed with HIV a year ago. (Alvin is not his real name. Front page Africa is withholding the names of all HIV/Aids patients in this story to protect them from stigma.) A health promoter, and a subsistence farmer, Alvin says he does not know how he contracted the virus. After becoming ill and doing tests at a local clinic here the health worker told him his status and prescribed the ART drugs. Alvin says his health has improved.
“Sometimes I used to get small, small sicknesses, but when I started the treatment, it go down,” says Alvin. “The treatment protecting us. I eat normally. I sleep normally. I do anything.”
Sara shows cups of her ARV drugs after receiving them from a nurse here in Yookudi.
Sara, another patient, is a local rice retailer who was devastated by the news. She says she’s been on the drugs for more than 3 years. Her partner left her when she told him that she was HIV positive.
“Without the drugs and treatment, I will not survive,” says Sara. “And plenty of my friends like me, will also face the same problem and die.”
Alvin and Sara are some of hundreds of people living with HIV/Aids in Maryland County. Together with the central region the southeast has one of the country’s highest prevalence of HIV positive people at 2.7 percent, according to a 2021 report by the US based National Library of Medicine, a scientific research group. It’s low compared with infection rates in Africa’s east and southern areas which have run above 25 percent of the population.
The outlook is grim.
Data shows the plummeting death rate once ARTs were introduced
“If they stop taking treatment, they will die,” says Kumba, a senior nurse and counselor of a clinic here in Yookudi, Harper District, which borders neighboring Ivory Coast. She has 15 HIV/Aids patients in her care, some of whom come from Ivory Coast. She agreed to speak on the condition of anonymity because the Trump administration threatened to retaliate against anyone speaking to the media.
Kumba says most of her patients, are older people and are in critical need and can’t go without the drugs. “It will be a great, great, problem and many deaths.”
A big worry for medical experts is that viral loads, suppressed by the drugs, will see a resurgence making it easier for patients to transmit the disease. A resurgence across the continent would likely make its way to Liberia. That could end Liberia’s success in keeping numbers low.
“So these medications are important,” says a medical doctor who said clinics in Maryland have supplies for 6-8 months. “If the person is not taking their medication, the person can easily transfer the virus.”
50 Jobs Cut as Funding for Key HIV Mentors Ends
The US also funded jobs for 50 staff of the Network of People Living with HIV, the umbrella body of HIV/Aids groups in the country. So called “peer navigators” were tasked with finding newly diagnosed patients and helping them overcome fear and depression. Peer navigators took patients to clinics. They sometimes took patients’ drugs to them. The US government funded nearly all the organization’s operations including the peer navigators. The network is still funded by the Global Fund for Aids, Malaria and TB, for outreach but the cuts have been devastating
“It’s a great trauma,” says Madam Josephine Godoe, president of the network, in an interview in her Monrovia office. Madam Godoe says she has been flooded with calls from members who were laid off. Some found their work so meaningful they are continuing without pay. “Some will even sneak and go to the facility and spend the whole day there.”
People around the world are reeling from the effects of Trump’s aid cuts. Here in Liberia the US Agency for International Development (USAID) alone spent $US167 million in 2023 – equivalent to 15 percent of the government’s budget. Liberia is one of ten countries most reliant on USAID, according to the Center for Global Development, a UK based think tank.
Some ART drugs stored in the ART clinic at the J.J. Dossen Hospital in Maryland County. Authorities at the hosptial and the county health team say they still have enough drugs. Credit: Anthony Stephens/New Narratives.
At the Home of Dignity Health Center, a clinic that treats HIV/AIDs patients in Brewerville, on the outskirts of Monrovia, the administrator says she has enough medicine and supplies now.
Madam Chinnie Sieh says The Global Fund, through Plan Liberia, funds much of their operations. But still the US aid cuts have affected the clinic badly because the peer navigators have been laid off. They “have not received more than five patients since the announcement,” she says. She fears that the issue “poses a great risk to the population,” warning that Liberia has had limited experience of HIV and a resurgence could really test the broken health care system.
The stigma attached to HIV/Aids, overcome in other parts of the world, is still strong here. Five of the patients have been abandoned by their families. One is Victor Bryant, 48, who has been at the clinic for two months where he is fed and supported by the staff.
Mr. Bryant is bravely agreeing to share his identity in an effort to break the stigma.
Mrs. Chinnie Sieh looks after Victor Bryant, 48, a patient, who consented to be photographed. Credit: Anthony Stephens/New Narratives.
Some African countries, including South Africa have responded to the US aid cuts by readjusting national budgets to fund their HIV/AIDs programs. Madam Godoe urges the Liberian government to do the same.
“We are requesting the national government to take ownership of her citizens,” says Madam Godoe. “If this donor pulls away, what become of us Liberians? We pay huge taxes to government. So, they should have a sustainable plan for citizens.”
For now Sara, Alvin and Victor are living day by day, waiting for decisions by leaders they will never meet but who will, in effect, decide if they live or die.
This story is a collaboration with New Narratives as part of the West Africa Justice Reporting Project. Funding was provided by the Swedish embassy in Liberia. The donor had no say in the story’s content.
