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Foreign Aid Freeze Leaves Millions Without H.I.V. Treatment

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Foreign Aid Freeze Leaves Millions Without H.I.V. Treatment

Two weeks into President Trump’s sweeping freeze on foreign aid, H.I.V. groups abroad have not received any funding, jeopardizing the health of more than 20 million people, including 500,000 children. Subsequent waivers from the State Department have clarified that the work can continue, but the funds and legal paperwork to do so are still missing.

With the near closure of the American aid agency known as U.S.A.I.D. and its recall of officers posted abroad, there is little hope that the situation will resolve quickly, experts warned.

H.I.V. treatment and services were funded through the President’s Emergency Plan for AIDS Relief, or PEPFAR, a $7.5 billion program that was frozen along with all foreign aid on Mr. Trump’s first day in office.

Since its start in 2003 during the George W. Bush administration, PEPFAR has delivered lifesaving treatment to as many as 25 million people in 54 countries and had enjoyed bipartisan support. The program was due for a five-year reauthorization in 2023; it survived an effort by some House Republicans to end it and was renewed for one year.

Without treatment, millions of people with H.I.V. would be at risk of severe illness and premature death. The loss of treatment also threatens to reverse the dramatic progress made against H.I.V. in recent years and could spur the emergence of drug-resistant strains of H.I.V.; both outcomes could have a global impact, including in the United States.

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The pause on aid and the stripping down of U.S.A.I.D. have delivered a “system shock,” said Christine Stegling, a deputy executive director at UNAIDS, the United Nations’ H.I.V. division.

“Now you need to see how you can work with the system as it is, to make sure that what is theoretically possible will actually happen,” she said.

On Jan. 28, Secretary of State Marco Rubio issued a waiver for lifesaving medicines and medical services, ostensibly allowing for the distribution of H.I.V. medicines. But the waiver did not name PEPFAR, leaving recipient organizations awaiting clarity.

On Sunday, another State Department waiver said more explicitly that it would cover H.I.V. testing and treatment as well as prevention and treatment of opportunistic infections such as tuberculosis, according to a memo viewed by The New York Times. The memo did not include H.I.V. prevention — except for pregnant and breastfeeding women — or support for orphaned and vulnerable children.

Although PEPFAR is funded by the State Department, roughly two-thirds of its grants are implemented through U.S.A.I.D. and the Centers for Disease Control and Prevention. Neither organization has released funds to grantees since the freeze was initiated.

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In an interview with The Washington Post, Mr. Rubio appeared to blame the recipient organizations for not acting on the waiver, saying he had “real questions about the competence” of the groups. “I wonder whether they’re deliberately sabotaging it for purposes of making a political point,” he said.

But experts familiar with PEPFAR’s requirements said his comments belied the complexity of its system of approvals.

“The messaging and guidance from the State Department expose an ignorance of how these programs function — and an alarming lack of compassion for the millions of lives at risk,” said Jirair Ratevosian, who served as chief of staff for PEPFAR in the Biden administration.

For instance, the stop-work orders compelled each program to cease immediately. The organizations are now legally required to wait for equally explicit instructions and cannot proceed on the basis of a general memo, according to a senior official at a large global health organization that receives PEPFAR funds.

“We have to wait till we get individual letters on each project that tell us not only we can start work, but tell us which work we can start up and with how much money,” the official said. The official asked not to be named for fear of retaliation; 90 percent of the organization’s money comes from PEPFAR.

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The freeze is also disrupting the network of smaller organizations that deliver H.I.V. treatment and services in low-income nations.

In a survey of 275 organizations in 11 sub-Saharan countries conducted over the past week, all reported that their programs or services had shut down or were turning people away, said Dr. Stellah Bosire, executive director of the Africa Center for Health Systems and Gender Justice.

At least 70 organizations reported disruptions in H.I.V. prevention, testing and treatment services, and 41 said that some programs had closed. “Without immediate intervention, these funding suspensions could lead to devastating reversals in public health progress,” Dr. Bosire said in an email.

In Kenya, 40,000 doctors, nurses and other health workers have been affected by the freeze, according to Mackenzie Knowles-Coursin, who was deputy chief of communications at the American mission in Nairobi until Monday. In South Africa, the halt in funding will affect the salaries of more than 15,000 health workers and operations across the country, the nation’s health minister, Aaron Motsoaledi, said during a televised news conference last week.

Some organizations rely on a patchwork of grants, with a stream of funding from one donor applied to purchasing medications and another stream applied to paying staff. Interruption of even one source can hobble the clinics, leaving them without medications to dispense or workers to dispense them.

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The Uganda Key Populations Consortium, an umbrella organization that provides H.I.V. treatment and other services, has lost 70 percent of its funding. It has shuttered 30 of the 54 drop-in centers around the country that dispense medications, and it terminated the contracts of 28 of its 35 staff members.

The organization received about $200,000 per year from the C.D.C. via the Infectious Diseases Institute at Makerere University, as well as an $8 million grant over five years from U.S.A.I.D. The latter provided housing and employment assistance, including to gay and transgender people, and has been shut down to comply with Mr. Trump’s executive order on diversity, equity, inclusion and accessibility.

In 2023, Uganda enacted a sweeping law that criminalized consensual sex between same-sex adults and made same-sex relations while having H.I.V. punishable by death. It has caused scores of Ugandans to be evicted from homes and fired from jobs.

“Cases of human rights violations haven’t really slowed, and now it’s really concerning,” said Richard Lusimbo, director general of the Uganda Key Populations Consortium.

Richard Lusimbo in Kampala, Uganda, last year observing a hearing in Uganda’s constitutional court in which it upheld an anti-L.G.B.T.Q. law.Credit…Abubaker Lubowa/Reuters

“We don’t even have the capacity or even the tools that we need to actually respond to some of these issues,” he said.

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Some organizations dispense medicines to children, which requires more skill than treating adults. Children’s medications are tailored to their age, weight and prior exposure to antiretroviral drugs, and the children must be carefully monitored for drug resistance.

In children who acquired H.I.V. at birth, the infection can progress very quickly to illness, with death occurring as early as eight to 12 weeks after birth — shorter than the 90-day pause on foreign aid.

On Tuesday night, the Trump administration put nearly all of U.S.A.I.D.’s global work force on leave and recalled those posted abroad to return to the United States within 30 days.

“There’s a loss of institutional memory, which may be purposeful, but it’s also creating just a backlog of paperwork, and it’s paralyzing the whole system,” said Elisha Dunn-Georgiou, the president of Global Health Council, a membership organization of health groups.

“Who do you ask questions to?” she said. “How do you move to the next step?”

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Without U.S.A.I.D. staff to process waiver applications, organizations fear they will not see funds anytime soon. Even large global health organizations are struggling to stay afloat; some have already cut programs and staff.

Even if the funds return quickly, it may not be easy to restart programs and return to something resembling normalcy, Ms. Dunn-Georgiou said.

“It costs a lot to restart something, so I don’t think we really know yet if that’s even possible,” she said.

Lynsey Chutel and Stephanie Nolen contributed reporting.

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Scientists pinpoint why COVID vaccine may trigger heart inflammation in certain people

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Scientists pinpoint why COVID vaccine may trigger heart inflammation in certain people

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POST-DOSE PATTERN — New research reveals why the COVID vaccine can trigger heart issues, especially in one group

PREVENTION PAYOFF — Simple lifestyle changes could slash heart attack risk for millions

A new study has identified why mRNA COVID-19 vaccines could trigger heart issues, especially in one demographic. (iStock)

SMOKE SCREEN — A major cannabis study finds little proof for popular medical claims and flags big dangers

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HIDDEN LINK — A common dental health issue may hint at a dangerous cardiovascular condition

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SCREENING DEBATE A new study questions whether annual mammograms are necessary for most women

SUPER SPREAD — An “aggressive” new flu variant sweeps the globe as doctors warn of severe symptoms

The flu season has intensified as the new H3N2 variant causes severe illness worldwide. (iStock)

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DANGEROUS DEFICIT — A nutrient deficiency has been linked to heart disease risk for millions

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CORONARY CHRISTMAS — Holiday heart attacks spike as doctors share hidden triggers and prevention tips

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Aging-related joint disorder increasingly affects people under 40, study finds

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Aging-related joint disorder increasingly affects people under 40, study finds

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Cases of gout are rising in younger individuals, according to a global study.

The condition, which is a type of inflammatory arthritis, steadily increased in people aged 15 to 39 between 1990 and 2021, researchers in China announced.

Although rates vary widely between countries, the total number of young people with the condition is expected to continue rising through 2035.

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The study, published in the journal Joint Bone Spine, investigated 2021 data from the Global Burden of Disease (GBD), spanning 204 countries within the 30-year timeframe.

The data measured gout prevalence, incidence and years lived with disability, tracking global trends over time. The results showed a global increase across all three outcomes.

Gout is expected to continue rising in young people through 2035. (iStock)

Prevalence and disability years increased by 66%, and incidence rose by 62%. In 2021, 15- to 39-year-olds accounted for nearly 14% of new gout cases globally, the study found.

Men from 35 to 39 years old and people in high-income regions had the highest burden, but high-income North America topped the list for highest rates.

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Men were also found to have lived more years with gout due to high BMI, while women tended to have the condition as a link to kidney dysfunction, the study noted.

The total number of cases is expected to increase globally due to population growth, but the study projected that rates per population would decrease.

The researchers noted that data quality, especially in low-income settings, could have posed a limitation to the broad GBD data.

What is gout?

Gout is a common form of arthritis involving sudden and severe attacks of pain, swelling, redness and tenderness in the joints, according to Mayo Clinic. It most often occurs in the big toe.

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The condition occurs when urate crystals accumulate in the joint. These form when there are high levels of uric acid in the blood, which the body produces when it breaks down a natural substance called purines.

A gout flare-up can happen at any time, often at night, causing the affected joint to feel hot, swollen, tender and sensitive to the touch.

Urate crystals, described as sharp and needle-like, build up in the joint, causing intense pain and swelling. (iStock)

Purines can also be found in certain foods, like red meat or organ meats like liver and some seafood, including anchovies, sardines, mussels, scallops, trout and tuna, according to the Mayo Clinic. Alcoholic drinks, especially beer, and drinks sweetened with fruit sugar can also lead to higher uric acid levels.

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Uric acid will typically dissolve in the blood and pass through the kidneys into urine, but when the body produces too much or too little uric acid, it can cause a build-up of urate crystals. These are described by the Mayo Clinic as sharp and needle-like, causing pain, inflammation and swelling in the joint or surrounding tissue.

Risk factors for gout include a diet rich in high-purine foods and being overweight, which causes the body to produce more uric acid and the kidneys to have trouble eliminating it.

Experts urge patients to seek medical attention for gout flare-ups. (iStock)

Certain conditions like untreated high blood pressure, diabetes, obesity, metabolic syndrome and heart and kidney diseases can increase the risk of gout, as well as certain medications.

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A family history of gout can also increase risk. Men are more likely to develop the condition, as women tend to have lower uric acid levels, although symptoms generally develop after menopause.

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Untreated gout can cause worsening pain and joint damage, experts caution. It may also lead to more severe conditions, such as recurrent gout, advanced gout and kidney stones.

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The Mayo Clinic advises patients to seek immediate medical care if a fever occurs or if a joint becomes hot and inflamed, which is a sign of infection. Certain anti-inflammatory medications can help treat gout flares and complications.

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Fox News Digital reached out to the researchers for comment.

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New study questions whether annual mammograms are necessary for most women

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New study questions whether annual mammograms are necessary for most women

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A new study suggests that annual mammograms may not be the only effective approach for preventing breast cancer.

The research, published in the Journal of the American Medical Association (JAMA), tested a risk-based breast cancer screening approach against standard annual mammography.

The WISDOM randomized clinical trial, led by study authors from universities and healthcare systems across the U.S., considered more than 28,000 women aged 40 to 74 years old, splitting them into a risk-based screening group and an annual mammography group.

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Researchers calculated each woman’s individual risk based on genetics (sequencing of nine breast cancer genes) and other health factors. 

A new study suggests that annual mammograms may not be the only effective approach for preventing breast cancer. (iStock)

Those who were at the highest risk were advised to alternate between a mammogram and an MRI scan every six months. Patients with elevated risk were told to get an annual mammography and counseling.

Average-risk women were guided to get mammograms every two years, while low-risk individuals were advised to have no screening until they became higher risk or reached age 50.

HIDDEN TYPE OF BREAST CANCER COULD BE EXPOSED BY NEW BREAKTHROUGH TECH

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The researchers found that risk-based screening did not lead to more advanced cancer diagnoses (stage 2B or higher) compared with annual screening, indicating that it is just as safe as traditional methods. The risk-based approach, however, did not reduce the number of biopsies overall, as researchers had hoped.

Among the risk-based group of women, those with higher risk had more screening, biopsies and detected cancers. Women at lower risk had fewer procedures.

The research, published in the Journal of the American Medical Association (JAMA), tested a risk-based breast cancer screening approach against standard annual mammography. (iStock)

“[The] findings suggest that risk-based breast cancer screening is a safe alternative to annual screening for women aged 40 to 74 years,” the researchers noted in the research summary. “Screening intensity matched individual risk, potentially reducing unnecessary imaging.”

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Fox News medical contributor Dr. Nicole Saphier, associate professor of radiology at Memorial Sloan Kettering Cancer Center in New Jersey, commented that while these findings are important, the study “completely sidelines” what screenings are designed to do — detect cancer early.

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“If you don’t measure stage 0, stage 1 or stage 2A cancers, you can’t tell whether personalized screening delays diagnosis in a way that matters for survival and treatment intensity,” Saphier, who was not involved in the study, told Fox News Digital in an interview.

Those who were at the highest risk were advised to alternate between a mammogram and an MRI scan every six months. (iStock)

More than 60% of breast cancers in the U.S. are diagnosed at stage 1 or 2A, where cure rates exceed 90%, the doctor noted.

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The trial doesn’t “fully evaluate” whether risk-based screening changes detection at the earliest and most treatable stages, where screening “delivers its greatest benefit,” according to Saphier.

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“Mammography is not without risk — radiation exposure, false positives, anxiety and potential over-diagnosis are real and should be acknowledged,” she said. “But it remains the most effective, evidence-based tool for detecting breast cancer early, when treatment is most successful.”

The expert added that labeling women under 50 as “low risk” is “outdated,” as breast cancer diagnoses are on the rise in younger females.

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“Until long-term mortality data support alternative approaches, annual screening beginning at 40 for average risk women should continue,” Saphier added. “Women should be assessed for breast cancer risk by 25 years old to determine if screening should begin earlier.”

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