Counsellors from The AIDS Support Organization (TASO) talk with clients during an HIV clinic day at TASO Mulago service center on Feb. 17 in Kampala, Uganda.Hajarah Nalwadda/Getty Images
Day after day, Jackie Maguvaza travelled to his local health clinic in Zimbabwe’s capital in a futile hunt for the HIV medicine that keeps him alive.
Each time, he was sent away empty-handed. He finally erupted in frustration: “Where are my pills?” he shouted furiously at the clinic staff, stopping occasionally to cough. “Tell me! I want my pills. I want my pills now.”
An apologetic nurse tried to calm him, promising that the clinic in Harare would soon get its allocation of treatment drugs. But by early March, Mr. Maguvaza had only a few of the antiretroviral tablets, or ARVs, left. After 12 years of living with HIV, his fears were rising.
These days, the scene at the clinic in southern Africa is being replicated across the continent, where an estimated 26 million people are living with HIV. The massive cuts to U.S. foreign aid under President Donald Trump are inflicting hardship on millions of people – from refugees in war zones to children enduring famine – and HIV programs are suffering some of the worst damage.
At least 83 per cent of aid programs at the U.S. Agency for International Development have been abruptly cancelled since Mr. Trump came to office, eliminating tens of billions of dollars from African budgets for health, education and other programs. Because USAID was a key funder of HIV programs across Africa, people living with HIV are on the front lines of the new battle.
In South Africa, some clinics are providing only 14 tablets to each patient. That’s enough for just two weeks, instead of the normal three-month supply.
“It’s Trump, it’s Trump,” one clinic explains to its visitors, according to the Treatment Action Campaign, a leading health group in the country.
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A study last month in the Annals of Internal Medicine estimated that as many as 600,000 people could die over the next 10 years in South Africa alone as a result of U.S. funding cuts.
In Uganda, many HIV clinics have been forced to close, forcing their patients to search for new sources of drugs. The government is predicting that new HIV infections could triple.
“Treatment is being disrupted – it’s chaotic on the ground,” said Eric Arts, a professor of microbiology and immunology at Western University in London, Ont., who works closely with an HIV laboratory in Uganda.
Any break in treatment can be deadly. Up to a quarter of Ugandans on ARV treatment could develop resistance to their medicine if supplies are interrupted, he told The Globe and Mail: “It would be a slow march to mortality.”
In Botswana, the abrupt closing of drop-in centres run by independent health groups has “disrupted HIV testing, treatment, care and support services,” says a report this month by UNAIDS, the United Nations agency that fights HIV and AIDS.
Across Africa, thousands of workers in HIV programs have lost their jobs because of the U.S. aid cuts, making HIV services more difficult to obtain.
“There have been reports of panic and hoarding of medication among people living with HIV who fear that their governments and remaining partners may struggle to maintain these services,” the UNAIDS report says.
In Africa, most people living with HIV make regular trips to clinics to collect the antiretrovirals that keep them healthy. The clinics also provide the free testing that is crucial in ensuring that people with HIV learn about their status. And they provide preventive drugs to reduce the transmission of the virus. All are now in jeopardy, although governments are trying to fill the gap.
Denford Magada, a Zimbabwean HIV activist, said he was recently turned away at his local clinic in Harare – for the first time in years – because his regular ARVs were unavailable. Luckily, he still had a few remaining pills at home, but he is worried about the future.
“I’m afraid of defaulting on my treatment if I don’t get the drugs in time,” he told The Globe. “I want to live – I want to take care of my children and my wife.”
Even at clinics where medicine is still available, smaller amounts are being provided. This creates new obstacles for Zimbabweans who often can’t easily reach a clinic.
“It means long queues to get the drugs, because many people will be going back at the same time,” said Sphiwe Chabikwa, a 59-year-old woman with HIV.
The shortages of life-saving medicine are accompanied by another dangerous shortage: a lack of HIV testing. The U.S.-funded New Start centres, which offer free HIV testing and counselling services across Zimbabwe, have suspended their operations.
“I might never know my status until I fall sick,” said Janet Sigauke, a 37-year-old street vendor in Harare who was turned away from a New Start centre. She wanted to get tested because her husband had fallen sick and had refused to be tested.
“I’m worried. And nobody is telling us when they will reopen.”