On Tuesday, the Trump administration issued a waiver of life -saving medications and medical services, as it has submitted a re -postponement of the HIV treatment program all over the world that stopped last week.
It seems that the waiver, announced by Foreign Minister Marco Rubio, allows the distribution of HIV drugs, but whether the waiver extends to preventive drugs or other services provided by the program, the President’s Emergency Plan for AIDS relief was not immediately clear.
However, Pepfar’s future is still in danger, with possible consequences for more than 20 million people – including 500,000 children – may lose access to life -saving drugs. Without treatment, millions of people with HIV in low -income countries will be at risk of full AIDS and early death.
“We can return very quickly to where the epidemic explodes, just as it has returned in the eighties,” said Dr. Steve Dicks, an expert in HIV at the University of California, San Francisco.
He said, “This cannot really happen.”
On Monday, the Trump administration ordered health organizations in other countries to stop distributing HIV drugs purchased with US aid. The guidance arose from freezing – which may become permanent – in PePfar’s activities, a program worth $ 7.5 billion supervised by the Ministry of Foreign Affairs.
Since it started in 2003, it is estimated that Pepfar has saved more than 25 million lives; More than 5.5 million children were born free of HIV and who could have had.
In South Africa alone, Pepfar will add more than half a million new HIV infections and more than 600,000 relevant deaths over the next decade, according to one estimates.
The organization employs 270,000 doctors, nurses, pharmacists and other health workers. They were told not to report or serve patients.
“The end of Pepfar” will create instability and may collapse many AIDS programs in many countries. South Africa.
Dr. Abdoul Karim said that the countries should stop relying on Peparfar and support their citizens, a goal that the program employees and its partners were working for. But perfectly, this shift will gradually occur, over the years through which Bavar will train local health workers and promise them to move.
“This is not a bad opportunity for countries to take more responsibility,” he said. “But I think they cannot do this if this is done in this type of random and unplanned way.”
Here is what he and others expect from the unexpected Pepfar.
A sudden stop for the treatment of HIV can turn quickly.
Every day, more than 220,000 people pick up HIV in the Pepfar clinics; The number included more than 7,400 children under 15 years of age, according to the data published on Tuesday by AMFAR, AIDS Research Foundation.
The drug works by suppressing HIV in the body. When patients go out of medications, the virus takes the opportunity to apostasy – quickly. Within a week, HIV levels will increase from uncovered levels to more than 100,000 copies per milliliter of blood.
“This may be a time as you are at risk of transporting the virus to others,” said Dr. Sally Bermar, a pediatrician and expert in HIV at Will Cornell Medicine.
After that, the virus will start attacking a specific type of immune cell, and paralyzing the body’s ability to repel other infections, including tuberculosis, which is often accompanied by HIV infection.
HIV levels initially may first cause symptoms, including sore throat, swollen glands and fatigue. The immune system is likely to mobilize enough power to suppress the virus temporarily, but HIV is skilled in hiding to find the appropriate opportunity to appear.
When this occasion arises, “they can develop means and progress,” said Dr. Dix.
Children may be among the most difficult blow.
Pepfar is famous for financing HIV treatment programs, but its money also goes to drugs for prevention, communication and test, and to support orphans and women with gender -based violence.
Dr. Glena Gray, HIV expert at Witches University in South Africa, said the loss of resources for each of these efforts will come out of the fight against AIDS.
She said: “If the HIV test decreases on the side of the road, it is unlikely to be able to diagnose people who need treatment.”
If a pregnant woman or breastfeeding she has H.IV. But she was not tested and not treated, as the virus may be transferred to her child. The higher its viral pregnancy, the more likely it happens.
It is unlikely that children with HIV are diagnosed with adults, and they may not be treated until the virus makes them very sick. Dr. Gray said that this progress can be much faster in children than adults, and it is clear that uncomfortable children are likely to die.
Invisible treatment pushes drug resistance.
Since people are losing access to medications, they may try to spread their supplies by alternately or sharing their pills with others. If the virus is repeated in people with partial protection only, it can learn to evade these defenses and become drug resistance.
People who live with the virus can pass the resistant virus to others.
“This becomes a big problem, because now, suddenly, the first -line drugs may not work when we have to restart them on treatment,” said Dr. Abdoul Karim.
The virus that resists treatments will also be better in evading vaccine candidates to be tested.
“We don’t just look at more drug resistance, but we look forward to losing any ability to make an effective vaccine,” said Dr. Bermar.
The end of Pepfar may also affect Americans.
More than a million Americans live with the virus, and more than 30,000 every year. If HIV becomes resistant to available drugs, it is unlikely to remain in low -income countries. The Americans, too, will be in danger.
They may also face indirect damage to Pepfar. Creating huge groups of immunodeficiency people may mean that other pathogens have an opportunity to spread. For example, dangerous Covid variables, including omicron, have evolved in people with HIV with HIV.
At the same time, people all over the world have benefited from the experiences under Pepfar, which indicates the importance of early HIV treatment, which indicates that pregnant women can be breastfeed safely as long as they are treated and that HIV infections It can be prevented with long -acting drugs.
Dr. Dicks said: “America has got an amazing amount of love all over the world because of what has been done.”
He added: “From a human perspective, I cannot imagine that anyone really wants to walk along this path.” “This does not make sense at any level.”
