Nearly 3,000 people have been infected with HIV since late January because of the U.S. government suspending funding for HIV prevention services, the UN’s HIV/AIDS program estimates. “The thing that concerns us: death when people are not on life-saving treatment, or if they’re off treatment there’s the risk of drug resistance, for example, and there’s the risk of new infections increasing,” said Angeli Achrekar, the deputy executive director for programs at UNAIDS. She also led the U.S. President’s Emergency Plan for AIDS Relief for 18 months as an acting U.S. global AIDS coordinator during the Biden administration. Carmen recently spoke with Achrekar, who made the case for continuing the program as the Trump administration assesses whether it aligns with its “America First” priorities. This interview has been edited for length and clarity. Rep. Brian Mast (R-Fla.), chair of the House Foreign Affairs Committee, questions why the U.S. is still paying for HIV drugs for millions of people 20 years after PEPFAR started. Does he have a point? The point that Brian Mast raises is an important one. We’re no longer in an emergency state. We are in a state of needing to work together with countries in a very methodical way to ensure that the gains are sustained over time by countries themselves. Over the past many years, we’ve been methodically working to ensure that the HIV response is sustained at the country level, with country resources, which would mean that U.S. government resources should decrease. And he’s right; they should decrease over time. It’s just that it can’t happen abruptly because it really shocks the system. People can’t fall off of treatment. We have to do this in a way where we’re sustaining the incredible gains that have been made. You’ve been reaching out to members of Congress about the freeze. What’s your message to them, and what reactions are you getting? I think what’s not clear is that, while the intention is really … important that this waiver exists for lifesaving HIV services; it’s not just like a light that turns on and off. The implementation is really challenged right now. What we’re also trying to convey is that prevention is really important in the HIV response. The minute we take our eyes off of prevention, preventing new infections, we’re never going to get to that place of countries being able to sustain that HIV response, because we’re just not turning the tap off. And that’s also in a moment where we have some amazing U.S.-led innovations like long-acting [preventive drugs]. The end game is in sight, but we’re dropping the ball on where we need to focus. How are governments in the most affected countries reacting to this? Are they able to step in? We’re working with governments, with communities, with others at the country level to try and mitigate those risks, like, for example, talk about how communities can go to other pickup sites where the governments are so that they can continue with their services. But there’s still so much confusion. We are hoping that other countries, other foundations, other private sector partners start coming in a meaningful way. In some countries, like Malawi, for example, we’re seeing governments just saying: "This is an emergency situation; we’re going to find a way to tap into our reserves and mobilize our health care workers and community health workers so that essential services can continue.”
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