Guyana prepared to counter U.S. nixing of HIV funding – Dr Cummings

The United States (US) has announced that it would cease pumping money into the fight against HIV/AIDS in Caribbean countries, less than a month after pulling funding from the Inter-American Development Bank’s (IDB) Multilateral Investment Fund (MIF).

Guyana is one country which benefited from the US President’s Emergency Fund for AIDS Relief (PEPFAR), the US $15 billion initiative to combat global HIV/AIDS, tuberculosis (TB), and malaria primarily in 15 HIV Caribbean countries hard hit by these scourges. This fund has been in existence since 2003, but now directors of America’s global fund to fight AIDS around the world say they can no longer justify supporting the upper middle-income countries of the Caribbean, and have ordered fund terminations from as early as this year.

Guyana’s status

However, junior Minister in the Ministry of Public Health (MoPH), Dr Karen Cummings, told this newspaper that Guyana is safe in this regard, as Government has been putting contingencies in place for such an occurrence, because it has been expected.

“We have been putting systems in place to phase it in gradually as we strive to embark on our universal coverage in terms of our 90/90 plan — that of seeking to ensure that 90 per cent of the persons who are HIV positive are tested, and those who are tested are treated, and those treated have the viral suppression as well.”

She said the MoPH is still in the program, and is “trying to scale up”. “I would say that we have it under control in the sense that there is funding. We are phasing it in, and we continue to have retroviral to meet the demands of those who are HIV positive,” she explained. “We are still working with the Pan American Health Organisation (PAHO), and the National AIDS Program Secretariat (NAPS) to assist us in this regard. So we have it under control. We also have global funds for HIV, TB and malaria,” she told Guyana Times International.

The Bahamas, which at just over 3% has the highest population prevalence of HIV in the English-speaking Caribbean, will have its funding cut entirely in September 2017, followed by Barbados in 2018. Meanwhile, Guyana, Suriname and Trinidad & Tobago will have their funding slashed to historic lows for two years, before their allocations end in 2019.

Of the middle-income Caribbean countries, only Jamaica will be spared from cuts, but under strict conditions. Far fewer people living with HIV in Jamaica receive treatment than in the other upper-middle income Caribbean countries, and estimates are that more than 3 in 10 Jamaican men who have sex with men are HIV positive. To address this, PEPFAR says, it will move 67-75 per cent of its Caribbean regional budget to the island between 2017 and 2019. In exchange, Jamaica will have to meet ambitious targets to curb its epidemic, or PEPFAR will leave the English-speaking Caribbean region entirely, including the member countries of the Organisation of Eastern Caribbean States.

In the Caribbean, PEPFAR contributes to the cost of HIV prevention programmes; drug procurement; and the treatment, care and psychosocial support of people living with HIV and AIDS. The Fund also works with community organisations to target HIV prevention and care for LGBT people and commercial sex workers who are on the periphery of direct government programmes.

PEPFAR’s interventions are further supported by health experts at US diplomatic missions, where some vacant posts have already been frozen as a result of the claw back.

PEPFAR’s moves now increase the burden on regional governments to bring their HIV/AIDS epidemics under control, even as public finances in several of the affected countries have already been stretched. With the exception of Haiti, which will retain its PEPFAR funding entirely, a complete regional pullout would leave a US$9 million gap in financing for the Caribbean’s response to HIV and AIDS, based on PEPFAR’s 2014/15 expenditure levels.

Despite some progress, the picture of the Caribbean’s HIV/AIDS response is mixed. Prevention messages that focus on abstinence and condom use are mainstays of national health campaigns, and costly interventions such as drug prophylaxis to prevent HIV infection are off the radar for most. Moralistic views and discrimination against the LGBT community are effective barriers to healthcare, and the prevalence of HIV among these marginalised groups can often run times higher than in the general population.

Strong progress and adoption of international best practices — such as the Barbados decision to treat all people living with HIV, regardless of the stage of their disease — have been largely supported by PEPFAR funds. Central governments will now have limited time to ensure sustainability of these gains, and to finance gaps after the departure of US aid.

While PEPFAR’s directors made no explicit link between their decisions and President Trump’s dictates to cut America’s levels of foreign aid, the repeal of PEPFAR’s reach in the Caribbean follows the administration’s decision to cut funding to the United Nations Food and Population Fund, as well as its removal of federal dollars from Planned Parenthood and other international development programmes.