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Aids funding under threat

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There are fears that the United States of America (US)’s current proposed cuts on HIV treatment, health development programmes and research could have a disastrous and deadly impact on the fight against HIV and Aids in Malawi.

The US Embassy in Malawi confirmed yesterday that President Donald Trump’s administration has made a US federal budget (fiscal year 2018) request to the Congress for its review and action. But the embassy said the US remains firmly committed to partnering with the Government of Malawi to continue the joint fight against HIV.

Last month, the Trump administration released a proposed budget which indicates that there will be a 15 percent cut in the President’s Emergency Plan for Aids Relief (Pepfar) programme and the Global Fund to Fight Aids, Tuberculosis and Malaria— to which the US is a major contributor. These interventions cumulatively provide the bulk of funding for HIV prevention, treatment and care programmes in sub-Saharan Africa and other parts of the developing world.

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The proposed budget also indicates that there shall be a 50 percent cut in USAID’s global health programmes, which could have an effect on long-term investments in critical vaccine and microbicide research. There is also a proposed $7 billion cut to the National Institutes of Health budget which includes a $1.1 billion cut to National Institute of Allergy and Infectious diseases.

This is likely have a devastating impact on overall HIV research, research and development of vaccines and other new prevention options and scientific innovations. There are also cuts in the budget of the Centres for Disease Control and Prevention, among other centres, that would have an impact on developing nations such as Malawi.

Malawi Health Equity Network Executive Director, George Jobe, said in an interview that Malawi is a role model in the fight against HIV and Aids and that, if the cuts were to be implemented it would be terrible.

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“Any slight move in the negative direction in the health sector means that someone somewhere will die. Such deaths may not be officially documented, but that is what is happening. We very much appreciate the financial support that Malawi has received from the US. We cannot even point fingers at them should they decide otherwise, but all we can do is plead with them to continue supporting us,” Jobe said.

Reacting to the funding cuts, Chief Executive Officer for Global Aids Interfaith Alliance, Todd Scafer, said the challenge would be to ensure that people with new infections or newly detected infections get access to treatment.

He said Pepfar is providing support to 63 countries. “…Almost 90 percent of funding for HIV treatment and programmes in Malawi comes from international donors, with Pepfar providing a significant portion of that. If these proposed cuts are implemented, they will impact Malawi’s ability to find new cases of HIV and ensure treatment is available to all who test positive,” he said.

Executive Director for US based Aids Vaccine Advocacy Coalition (Avac), Mitchell Warren, said the proposed budget will thwart health development and research programmes that are hallmarks of America’s profound commitment to advancing knowledge and saving lives at home and abroad.

“No HIV treatment, prevention or research programme supported by the US government is left untouched in the proposed budget. Critical global and domestic health, development and poverty programmes also face devastating cuts,” Warren said in a statement in reaction to the proposed budget.

Director of Health Services in the Ministry of Health, Dr Charles Mwansambo, said the ministry got an assurance that there would be no cuts in HIV treatment even though there are some proposals to cut funding.

“On funding cuts in health blanket programmes, let us keep our fingers crossed as these are just proposals; there are no formal approvals yet. Let us be optimistic and ignore the dark side of it,” Mwansambo said.

Public Affairs Officer for the US Embassy in Malawi, Edward Monster, said the federal budget request was submitted to the Congress for its review and action.

“The Congress, with final approval from the President, ultimately determines the budget of the US Government. We do not yet know what the results of that ongoing process will be,” Monster said.

He, however, highlighted that Trump’s request includes a $5 billion (globally) for Pepfar to maintain all current patient levels on HIV/Aids Anti-retroviral treatment (ART), and to expand HIV prevention and treatment services, where possible, through increased performance and efficiency gains.

“Within this total, $1.1 billion is for the US contribution to the Global Fund to Fight Aids, Tuberculosis and Malaria to remain on track to meet the US one to two matching commitment. The $5 billion requested for Pepfar represents 20 percent of all of the funds requested in fiscal year 2018 for US foreign assistance programmes. It supports our close collaboration with Pepfar partners, including the Government of Malawi and the Global Fund to Fight Aids, TB and Malaria, to work toward sustainable control,” Monster said.

Some of the notable US funded projects

* Roll out of Option B+ (providing ART to all pregnant women)

* Roll out of Test and Start (the initiation of same day treatment to people diagnosed with HIV)

* Malawi Population-based HIV Impact Assessment (MPHIA) research, which affirmed Malawi’s exceptional progress towards the globally endorsed targets leading to epidemic control by 2020.

* The US government’s efforts have contributed to a decline in HIV prevalence from 11.8 percent in 2004 to 8.8 percent (in 2015- 2016) among Malawian men and women aged 15-49-US embassy

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