WEBVTT - How US Aid Cuts Has Left The Fight Against HIV In Crisis 0:00:02.520 --> 0:00:07.040 Bloomberg Audio Studios, podcasts, radio news. 0:00:09.560 --> 0:00:13.000 US cuts to HIV funding has left the global response 0:00:13.039 --> 0:00:16.680 to HIV in crisis. That's the Morning from the UNAIDS 0:00:16.720 --> 0:00:19.400 Agency Executive Director Winni Bianima. 0:00:19.680 --> 0:00:25.360 Clinics have closed, prevention services have halted, people are losing 0:00:25.440 --> 0:00:29.120 access to life saving medicines. People are scared. 0:00:29.640 --> 0:00:33.559 Seventy five percent of people living with HIV are in Africa, 0:00:33.800 --> 0:00:36.120 and many saw twenty twenty five as a chance for 0:00:36.200 --> 0:00:39.880 a breakthrough year in tackling the disease, hopes that now 0:00:39.920 --> 0:00:41.080 seem in tatters. 0:00:41.520 --> 0:00:46.840 A Republican government, President Bush came out at the time 0:00:46.920 --> 0:00:51.240 of the worst crisis pandemic of the century and put 0:00:51.320 --> 0:00:54.800 down a program to save lives right now. There are 0:00:54.920 --> 0:00:58.920 tools that could make us come to the end of 0:00:58.960 --> 0:01:03.480 this pandemic. I say to President Trump, you're a man 0:01:03.520 --> 0:01:05.800 who likes to do a deal. Here's a deal. 0:01:06.240 --> 0:01:08.640 On today's podcast, we're looking at the state of the 0:01:08.680 --> 0:01:12.160 global HIV response in the wake of US funding cuts, 0:01:12.360 --> 0:01:15.479 and whether South Africa's leadership of the Global Fund will 0:01:15.480 --> 0:01:18.280 find the donors needed to get the work moving again. 0:01:21.240 --> 0:01:24.800 I'm Jennifer's Abasajob and this is the next Africa podcast 0:01:25.120 --> 0:01:28.360 bringing you one story each week from the continent driving 0:01:28.400 --> 0:01:31.400 the future of global growth with the context only Bloomberg 0:01:31.440 --> 0:01:37.680 can provide. Well, here to help us break down that 0:01:37.880 --> 0:01:41.880 really fascinating Bloomberg Weekend Interview. I'm joined by our healthcare 0:01:41.920 --> 0:01:45.600 reporter here in Johannesburg, Jennis Q. Jennis, thanks so much 0:01:45.680 --> 0:01:46.479 for being with us. 0:01:46.920 --> 0:01:50.800 Thank you. I wish that we would chat under happier circumstances. 0:01:50.840 --> 0:01:53.640 We seem to always come in with pretty dire stories, 0:01:53.760 --> 0:01:55.160 but they are important. 0:01:55.680 --> 0:01:58.120 Yeah, and it's been actually quite a while since we've 0:01:58.320 --> 0:02:01.120 had you on the podcast to speak about healthcare in 0:02:01.160 --> 0:02:04.040 the region, So you know, let's talk about this latest 0:02:04.040 --> 0:02:07.520 story we heard from Winnie b a Yuma, who painted 0:02:07.840 --> 0:02:10.120 quite a bleak picture of the state of the global 0:02:10.160 --> 0:02:14.079 fight against HIV. Can you give us some context as 0:02:14.120 --> 0:02:17.679 to how serious things have gotten over the past few months. 0:02:19.360 --> 0:02:23.280 In some African countries, it is dire where people aren't 0:02:23.280 --> 0:02:27.080 able to get the anti retrovirals at all. In most cases, 0:02:27.120 --> 0:02:30.040 these medications need to be taken daily, so disruption and 0:02:30.080 --> 0:02:34.600 supply translates into a critical situation, not least because a 0:02:34.639 --> 0:02:38.200 person that's newly infected with HIV is highly infectious, especially 0:02:38.280 --> 0:02:41.720 during the first few weeks off to infection, there's acute phase. 0:02:41.919 --> 0:02:44.120 The viral load or the amount of HIV in the 0:02:44.120 --> 0:02:47.040 blood is very high, and so it significantly increases the 0:02:47.160 --> 0:02:50.880 risk of transmission. For example, if a pregnant woman acquires 0:02:50.919 --> 0:02:54.120 the disease or the virus, especially in your last trimester, 0:02:54.280 --> 0:02:58.440 the chances of the child being born with HIV increases significantly. 0:02:59.080 --> 0:03:03.360 And while made can be taken to keep it under control, 0:03:03.639 --> 0:03:07.040 it is an incurable disease, so you can live long 0:03:07.080 --> 0:03:10.480 with HIV if you've got the medication. But the point 0:03:10.680 --> 0:03:13.040 is that a child who's born HIV positive has to 0:03:13.080 --> 0:03:16.560 be on meds for life, and that has both physical 0:03:16.600 --> 0:03:17.919 and financial costs. 0:03:18.400 --> 0:03:21.400 And when we think about the cuts and the cuts 0:03:21.400 --> 0:03:24.760 to some of these services, how has that affected what 0:03:24.919 --> 0:03:27.680 is already a dire situation in the region. 0:03:28.440 --> 0:03:31.320 In many places, it's meant that clinic doors have been closed. 0:03:31.440 --> 0:03:34.480 In South Africa, though, which is unlike many other countries 0:03:34.480 --> 0:03:38.240 on the continents, the government provides the ravs, so in 0:03:38.280 --> 0:03:40.760 some ways the impact has been a little less harsh here. 0:03:41.600 --> 0:03:44.520 That's still not to say it isn't significance In South Africa. 0:03:44.720 --> 0:03:48.440 Many of the NGOs have had to severely scale back. 0:03:48.600 --> 0:03:52.120 I spoke with the national chairwoman of the Treatment Action Campaign, 0:03:52.360 --> 0:03:55.800 a South African nonprofit that lost eighty eight percent of 0:03:55.800 --> 0:03:58.080 its staff after the US funding was halted at the 0:03:58.160 --> 0:04:01.480 end of February. She described how are their mobile clinics 0:04:01.520 --> 0:04:03.960 and the work that they were doing specifically with sex 0:04:04.040 --> 0:04:08.040 workers has effectively ended, and how with our regular drugs 0:04:08.080 --> 0:04:12.119 everything gets bad pretty quickly. Even in South Africa, it's 0:04:12.160 --> 0:04:14.920 hard to cater for what we call key populations. These 0:04:14.960 --> 0:04:18.520 are migrants, men who have sex with men, sex workers, 0:04:18.520 --> 0:04:22.640 and drug users. And as Mitchell Warren, who is the 0:04:22.680 --> 0:04:27.680 executive director of the New York based Global HIV Prevention 0:04:27.760 --> 0:04:31.440 Advocacy Group AVAC, he says, you know, governments are not 0:04:31.600 --> 0:04:34.320 great at dealing with some of these issues of sexuality 0:04:35.000 --> 0:04:38.280 and HIV AIDS programs don't have on off switches. They 0:04:38.320 --> 0:04:42.800 take time, and those relationships take time, and it's easy 0:04:42.839 --> 0:04:45.200 to break something down, but it's really hard to build 0:04:45.240 --> 0:04:45.840 something up. 0:04:46.560 --> 0:04:50.320 And even prior to these cuts there, I mean, this 0:04:50.480 --> 0:04:54.320 has been something that many health advocates for years had 0:04:54.360 --> 0:04:58.560 tried to bring down at least the statistics for decades, 0:04:58.600 --> 0:05:01.839 and you know, so that there had been plans to 0:05:01.880 --> 0:05:05.080 hold HIV as a public health crisis by twenty thirty. 0:05:05.520 --> 0:05:08.520 Was that within reach prior to these cuts? And I 0:05:08.560 --> 0:05:11.400 wonder with some of the other advocates that you speak to, 0:05:12.080 --> 0:05:16.080 do they think potentially we've pushed out the goalposts essentially 0:05:16.120 --> 0:05:17.800 on achieving that even further. 0:05:18.400 --> 0:05:22.760 Absolutely, a small amount of foreign aid means that plan 0:05:23.480 --> 0:05:25.440 in the disease is a public cult threat by twenty 0:05:25.560 --> 0:05:28.680 thirty is only going to get more off track, Willdn't 0:05:28.680 --> 0:05:30.960 it be? A NEMO said as much in a recent 0:05:30.960 --> 0:05:34.320 press conference here in South Africa, and it was going 0:05:34.360 --> 0:05:37.080 to be a challenge twenty thirties only five years away, 0:05:37.400 --> 0:05:41.800 but it definitely makes it a whole lot more challenging. 0:05:42.880 --> 0:05:45.160 And Jennie, what does that look like on a day 0:05:45.200 --> 0:05:47.520 to day basis You're somebody who's been covering this for 0:05:47.600 --> 0:05:53.119 quite some time. What is the current situation on the ground. 0:05:53.400 --> 0:05:57.599 So certainly here in South Africa we've got the government's 0:05:57.640 --> 0:06:00.560 being resolute that it's not going to know these cuts, 0:06:00.560 --> 0:06:04.520 aren't going to sync their HIV programs, and they are 0:06:04.560 --> 0:06:09.000 taking steps to move files from that were at you know, 0:06:09.080 --> 0:06:11.760 various clinics run by NGO's move them into the public 0:06:11.800 --> 0:06:15.640 sector hospitals. But it's not an easy thing to do. 0:06:15.760 --> 0:06:18.800 It's not a smooth transition. And then, as I was 0:06:18.839 --> 0:06:22.120 talking about those key populations a little earlier, many of 0:06:22.160 --> 0:06:25.599 them are not likely to be able to go to 0:06:25.720 --> 0:06:30.000 public clinics. They migrants need the correct paperwork to be 0:06:30.040 --> 0:06:32.800 attended to. Sex workers. You know, if you've worked the 0:06:32.800 --> 0:06:35.000 whole night and now you've got to line up and 0:06:35.000 --> 0:06:37.840 a queue at a public hospital before seven o'clock in 0:06:37.880 --> 0:06:41.200 the morning, and you know that that's going to be challenging. 0:06:41.240 --> 0:06:43.280 But then there's also going to be a lot of 0:06:43.440 --> 0:06:47.720 staff training and how to treat people more sensitively. On 0:06:47.760 --> 0:06:51.640 top of that, if you feel that you're going to 0:06:51.680 --> 0:06:54.839 be questioned, your life choices are going to be questioned, 0:06:54.839 --> 0:06:57.880 you're probably not going to be open and honest with 0:06:58.120 --> 0:07:02.240 a healthcare provider, and that means that you're probably not 0:07:02.320 --> 0:07:08.080 going to get targeted treatments and the correct kind of interventions. 0:07:08.920 --> 0:07:11.800 In the rest of Africa, we've seen even worse situations 0:07:11.880 --> 0:07:16.080 where because the Arabs are simply not available. We've even 0:07:16.200 --> 0:07:20.680 had some impact in South Africa because of neighboring countries 0:07:20.760 --> 0:07:26.040 that have shortages of the Arabs. Where a lot of 0:07:26.080 --> 0:07:30.160 the action campaigns had spent years making sure that people 0:07:30.240 --> 0:07:33.960 could gets six or more months supply of arabs at 0:07:33.960 --> 0:07:37.600 a time. This was important because for many people to 0:07:37.640 --> 0:07:40.680 not just the time out of their job or their 0:07:40.760 --> 0:07:43.520 day to get the arabs, but it's the transport costs, etc. 0:07:44.000 --> 0:07:47.040 And so we'd moved in South Africa to a situation 0:07:47.080 --> 0:07:50.360 where people were able to get six months or more medication, 0:07:50.680 --> 0:07:52.920 and that has been rolled back in South Africa because 0:07:52.920 --> 0:07:56.320 of concerns that people will get the medication and then 0:07:56.520 --> 0:07:59.640 set it over the border to people who desperate because 0:07:59.640 --> 0:08:01.320 they just have no access at all. 0:08:02.000 --> 0:08:04.120 And Janna is stick with us. When we come back, 0:08:04.160 --> 0:08:06.200 we'll look at the efforts to try and find new 0:08:06.320 --> 0:08:09.400 sources of funding, including the role that the South African 0:08:09.440 --> 0:08:18.320 government will potentially be playing. We'll be right back. Welcome back. Today. 0:08:18.360 --> 0:08:20.720 We're looking at the state of global efforts to tackle 0:08:20.920 --> 0:08:24.760 HIV after the executive director of unaid's declared that it 0:08:24.880 --> 0:08:28.320 was in crisis. Our healthcare reporter Janis q is still 0:08:28.400 --> 0:08:32.240 with us now. Jana, so South African Presidents Zoo Ramaposa 0:08:32.320 --> 0:08:35.800 has decided to take on the responsibility to try and 0:08:35.880 --> 0:08:39.560 rebuild the global Fund to fight HIV. We were just 0:08:39.640 --> 0:08:42.720 talking about some of the challenges though that this fight 0:08:42.800 --> 0:08:46.160 already faces. How difficult of a task is he facing 0:08:46.200 --> 0:08:49.080 though in terms of the funding our position. 0:08:48.800 --> 0:08:53.040 From a POSA has a lot of respects globally and 0:08:53.400 --> 0:08:56.640 is a very diplomatic man, but it is going to 0:08:56.679 --> 0:08:59.960 be incredibly difficult. The Global Fund, which is an independent 0:09:00.120 --> 0:09:04.400 partnership whose money mainly comes from public sector donors, plans 0:09:04.400 --> 0:09:07.160 to raise at least eighteen billion dollars at IT as 0:09:07.160 --> 0:09:09.800 it launches its twenty twenty six to twenty twenty eight 0:09:09.840 --> 0:09:13.560 fundraising cycle, and success of the exercise will be crucial 0:09:13.600 --> 0:09:17.160 for expanding efforts to combat HIV and TB and malaria. 0:09:17.760 --> 0:09:22.200 But it fell short already in its most recent efforts 0:09:22.400 --> 0:09:25.559 a couple of years ago, and so you know, if 0:09:25.640 --> 0:09:28.000 it was already falling short, then it makes it an 0:09:28.080 --> 0:09:29.040 especially tall order. 0:09:29.120 --> 0:09:34.079 Now where can Ramaposa even look though for this funding? 0:09:34.200 --> 0:09:37.920 If the US in fact is going to continue to 0:09:37.960 --> 0:09:41.360 pull back on funding and contribute to aid, are there 0:09:41.400 --> 0:09:44.240 other countries that are then stepping up and saying they 0:09:44.280 --> 0:09:48.200 will contribute at least in regards to health and HIV 0:09:48.360 --> 0:09:49.480 in the fight against it? 0:09:50.559 --> 0:09:54.480 We have a very good relationship with China in South Africa, 0:09:54.760 --> 0:09:57.839 and there is a possibility that they could step in. 0:09:58.640 --> 0:10:03.920 I would like to believe that presented in the right way, 0:10:04.000 --> 0:10:06.840 it may be seen in the US as something that's 0:10:06.880 --> 0:10:10.640 worth considering still, and then there is a chance of 0:10:10.679 --> 0:10:14.280 other African governments perhaps stepping in somewhat or be it 0:10:14.920 --> 0:10:18.079 many have no regal room because there's also an urgent 0:10:18.200 --> 0:10:21.640 need to restructure their debt to cut debt service costs. 0:10:21.840 --> 0:10:24.880 Many African countries have debt service costs that are many 0:10:24.880 --> 0:10:28.360 times larger than their entire healthcare budget, so that is 0:10:28.640 --> 0:10:31.320 a real challenge. While not in the public sector, we've 0:10:31.320 --> 0:10:33.640 seen the Gates Foundations say that it plans to give 0:10:33.679 --> 0:10:36.600 away two hundred billion dollars over the next twenty years 0:10:36.920 --> 0:10:40.680 before shutting down entirely in twenty forty five, and that 0:10:40.800 --> 0:10:44.240 target represents a doubling and spending for that nonprofit, and 0:10:44.280 --> 0:10:46.199 they have said that much of that will be focused 0:10:46.200 --> 0:10:50.240 in Africa. So maybe even if it's not direct, there 0:10:50.320 --> 0:10:53.559 is there ripple effects from that that could could help 0:10:53.960 --> 0:10:54.920 this as well. 0:10:55.040 --> 0:10:57.760 Yeah, and we've heard Bill Gates in particular be quite 0:10:57.840 --> 0:11:00.800 outspoken and critical about some of these cuts that have 0:11:00.880 --> 0:11:03.559 been made in the US and how they're contributing potentially 0:11:03.640 --> 0:11:07.640 could contribute to setbacks in progress on some of these 0:11:07.720 --> 0:11:11.040 health fights, Jannis, When we think about some of the 0:11:11.080 --> 0:11:15.079 breakthroughs that we had, we talked about twenty thirty a 0:11:15.160 --> 0:11:18.360 goal that we had wanted for HIV AIDS to no 0:11:18.480 --> 0:11:22.199 longer be a public health threat. Are there any treatments 0:11:22.559 --> 0:11:29.000 or prevention that had previously been progressing potentially that could 0:11:29.040 --> 0:11:33.520 still make some headway even throughout all of these turbulent times. 0:11:34.000 --> 0:11:38.760 Absolutely. One of the concerns with these funding cuts, specifically 0:11:38.800 --> 0:11:42.319 in South Africa, is that it's going to hit research funding. 0:11:42.520 --> 0:11:46.160 And South Africa has for decades been a medical research powerhouse, 0:11:46.840 --> 0:11:51.120 and we're now hearing of HIV researchers having to tell 0:11:51.160 --> 0:11:53.640 long time workers that the money's gone and so their 0:11:53.720 --> 0:11:57.240 jobs and that's rough effect is going to be significant. 0:11:57.360 --> 0:12:00.200 But that all being said, one of the areas where 0:12:00.240 --> 0:12:02.800 there is still a lot of hope. We recently saw 0:12:03.200 --> 0:12:08.640 an HIV prevention injection that's got one hundred percent efficacy 0:12:08.960 --> 0:12:14.840 being improved by the FDA, So lenar Kapevera is twice 0:12:14.920 --> 0:12:19.160 yearly injection, and that goal that twenty to thirty goal 0:12:19.200 --> 0:12:23.000 that we were talking about earlier factored in this because 0:12:23.200 --> 0:12:27.880 it's been in development for some time. The big issue 0:12:27.920 --> 0:12:32.800 with this is that the US company that makes it 0:12:32.880 --> 0:12:37.440 has set its price at about twenty five thousand US 0:12:37.480 --> 0:12:41.240 dollars per person per year. Wow, and that is not 0:12:41.400 --> 0:12:44.520 something that most of Africa could afford. When he was 0:12:44.559 --> 0:12:49.480 talking about having spoken to researchers at Liverpool University that 0:12:49.640 --> 0:12:53.440 said that they've estimated that this drug could be rolled 0:12:53.520 --> 0:12:57.000 out at a cost of forty dollars per person per year, 0:12:57.200 --> 0:13:00.360 and then within a year, as that market expanded for 0:13:00.400 --> 0:13:03.280 the drug, that could come down to twenty five dollars 0:13:03.280 --> 0:13:08.000 per per year. If that pricing issue could be resolved, 0:13:08.160 --> 0:13:12.240 then a kapaya is genuinely a game changer. And we're 0:13:12.240 --> 0:13:15.079 talking about the closest thing to vaccine that we've got 0:13:15.240 --> 0:13:18.920 for this disease. And if you are able to prevent 0:13:19.200 --> 0:13:22.160 its spreading in the first place, those new infection numbers 0:13:22.160 --> 0:13:24.360 are going to drop rapidly, etc. And that robber effect 0:13:24.679 --> 0:13:28.240 is significant. So there is hope, but there's certainly a 0:13:28.240 --> 0:13:31.440 lot of work to still be done. And you know, 0:13:31.720 --> 0:13:35.160 while we look at the NGOs that have had to 0:13:35.400 --> 0:13:40.240 cut staff there are a number of incredibly dedicated people, 0:13:40.280 --> 0:13:43.400 aren't there, who even though they're not getting a salary, 0:13:43.800 --> 0:13:48.520 are still going out and still working with communities where 0:13:48.520 --> 0:13:51.640 they have built at trust and they are still doing 0:13:51.679 --> 0:13:54.440 the work. And there is a lot of people who 0:13:55.040 --> 0:13:57.160 it's personal for them and they do not want to 0:13:57.160 --> 0:14:00.520 see these programs fail. And so I think that there 0:14:00.559 --> 0:14:04.160 are definitely soil the lightnings. That's going to be a 0:14:04.920 --> 0:14:05.880 tough job ahead. 0:14:06.520 --> 0:14:08.839 Jennis. Thank you so much for joining us and for 0:14:08.960 --> 0:14:11.640 all of your reporting. As always, you can read all 0:14:11.679 --> 0:14:15.520 of our coverage on HIV AIDS across Bloomberg platforms now, 0:14:15.840 --> 0:14:19.640 including Michelle Hussein's interview with Winnie Biannima. Will post a 0:14:19.680 --> 0:14:24.840 link to that in the show notes. This program was 0:14:24.880 --> 0:14:28.920 produced by Adrian Bradley and tiwa Adebayo. Don't forget to 0:14:29.000 --> 0:14:32.400 follow and review this show wherever you usually get your podcasts. 0:14:32.600 --> 0:14:35.400 I'm Jennifer's Abasanja. Thanks as always for listening.