Today, HIV – the virus that can lead to AIDS – is more treatable than ever. Of the approximately 108,000 people in the UK who are currently receiving treatment for the virus, the vast majority are living well and are functionally symptom free, with a negligible risk of passing it on to others. Elsewhere in the world, however, the picture is very different. Globally, there are 40mn people living with HIV, and over the past year, only three quarters of them had access to adequate medication. Now, as a result of cuts to the USAID programme, that number has fallen still further.
The country with the highest number of HIV cases in the world is South Africa, at eight million. More than one in ten of those people depended on PEPFAR – the US President’s Emergency Plan for AIDS Relief – for access to their medication. This was cut off, along with all other US foreign aid, on 20 January, the first day of Donald Trump’s second presidency. 12 days later, a limited waiver allowed PEPFAR to resume, but those responsible for receiving the aid across a number of countries report that it has not reached them. On 25 March, the US government failed to renew the programme, and three days later it clarified that it had no plans to do so.
Living with untreated HIV: individuals and families
Where need is so great that systems are operating at capacity, as in South Africa’s provision of anti-retroviral therapy, even a short delay can have catastrophic consequences. Research has found that it doubles the risk of death and that it also increases the risk of developing kidney, liver or cardiovascular disease. Some people develop flu-like symptoms, and they once again become infectious.
People are not always diagnosed immediately after becoming infected. Untreated HIV usually takes five to 15 years to develop into full-blown AIDS, but some of those who have lost access to treatment develop AIDS symptoms very quickly. If they can’t get medicine, what had become a manageable chronic condition can quickly be fatal.
The impact of untreated HIV extends beyond individuals. Families often face crisis when the main breadwinner becomes too ill to work, or needs somebody else to give up work in order to provide care. Relationships break down because of fears around sexual activity, or difficulty acquiring condoms. Where both parents fall ill, children risk finding themselves all alone in the world. South Africa already has 720,000 AIDS orphans. Often older siblings end up dropping out of school to care for younger ones, placing these family units at high risk of long term poverty.
Loss of life-saving services
Where US support remains available, clinics have been told that it may not be used for some patient groups, such as LGBTQ+ people, although they are at high risk. Funds are no longer available to treat pregnant women who have HIV, which means that they have a 15% to 45% risk of passing on the virus to their babies. Support for HIV education has also gone, making it difficult to prevent new infections. Monitoring programmes have been abandoned, so that for the meantime it is very difficult to know how HIV is spreading through the population, and to identify changing demographics of risk. Perhaps most depressingly of all, research into a cure has been badly hit, at a point when experts believe they were getting really close.
The dangers of spreading infection
When funding for HIV treatment is withdrawn and more people become infectious, there will inevitably be more infections. This means that a problem that was already difficult to tackle can be expected to grow exponentially bigger over time, with more and more people affected. To make it worse, infection in people who had been using anti-retroviral therapy and may continue to do so intermittently, when they can afford to get it privately, means an increased risk of the development of drug-resistant strains. Without proper monitoring, specialists will struggle to identify and begin work on tackling these before they have begun to spread through the population.
Global health is at risk
Infectious diseases have no respect for borders. When wealthy countries invest in tackling disease elsewhere in the world, they usually do so not just for humanitarian reasons or to cultivate soft power, but because they recognise that it’s in their own interests. Unfortunately, the recent promotion of individuals with strong ideological interests but little expertise to senior positions in the US health infrastructure, which would ordinarily advise on matters like this, seems to have resulted in this being forgotten.
There is a risk of a similar approach leading to cuts in the UK’s foreign aid budget, as senior Conservatives frequently push for these and Reform UK has pledged to slash it by 50%. In this context, it is not only HIV that gives cause for concern. Drug-resistant tuberculosis could easily return to pandemic levels. Ebola could expand its range and become more difficult to treat. And then there’s Covid-19 and influenza, two highly transmissible and potentially devastating viruses whose successful management depends on international cooperation, including funding for monitoring programmes in countries whose own infrastructure is not up to the task. Humans may think of themselves as very different from one another, and imagine that they can separate themselves into nations or into the deserving and undeserving, but all these diseases see are warm bodies.
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