Trump’s proposed budget for Fiscal Year 2018 (FY18) includes cuts of $1.08 billion in global AIDS funding. On June 6, Hilary McQuie of HealthGAP spoke at the World AIDS Museum about those cuts. She spoke about how they would affect HIV in African countries.

Florida has a critical role in whether those proposed cuts become reality. It has several key “players” on relevant committees: Sen Marco Rubio (R-FL), Rep. Mario Diaz-Balart (R-Miami), and Rep Tom Rooney (R-SW Florida). McQuie urged attendees to contact those three to stop these proposed cuts.

Between 37 and 40 million people worldwide live with HIV. About 70 percent of them live in African countries. In African countries, more straight people live with HIV than gay and bi men do. When HIV strikes straight people during their child-raising years, it leaves many orphans in its wake. Millions of potential orphans could destabilize resource-poor countries. Only outside funds could stave off disaster.

According to McQuie, two major sources provide most of these funds: The President's Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis, and Malaria (GF). The second Bush administration and the Black Congressional Caucus jointly developed PEPFAR. The GF also began in the early 2000s as a public-private partnership.

Global HIV-funding decreased during the 2008 great recession. It has yet to recover. Decreased funding coincided with breakthroughs that allowed people to see an end to the epidemic. These breakthroughs include antiretroviral therapy (ART), access to inexpensive, generic ART, effective prevention of mother-to-child-transmission, PEP, PrEP, and programs for voluntary male circumcision. Decreased funding reduced the potential benefit of those breakthroughs.

McQuie reported that research indicates a path to controlling HIV in Africa by 2030. In order to do so, African countries would have to achieve the “90/90/90 goals” by 2020. The “90/90/90 goals” have three sequential components. The first would be to diagnose HIV in 90 percent of those infected. The second would be to prescribe ART to 90 percent of those diagnosed. The third would be to suppress the virus in 90 percent of those taking ART.

Out of 54 countries in Africa, 21 receive PEPFAR funding. According to UNAIDS, in African PEPFAR countries, annual HIV related deaths decreased by 227,100 between 2010 and 2015. Among these countries, 14 reported decreased HIV-related deaths, and five reported increased deaths. Ethiopia and Nigeria failed to report data.

In half of the PEPFAR African countries, 57 percent or more of those diagnosed with HIV are receiving ART. Botswana reported 78 percent and Rwanda reported 79 percent receiving ART. Despite poverty, African countries are making major progress against HIV. That progress depends on global HIV-funding and access to inexpensive generic antiretrovirals.


LGBT HIV Issues in Africa

Heterosexual transmission drives the HIV in Africa. Gay and bi African men, however, have higher infection rates than heterosexuals do. Global HIV researchers use the label “key populations” for stigmatized groups like LGBT people, drug users, and sex workers. Outside funding can ensure access to services for key populations despite stigmatization.

Hostility to LGBT people varies among African countries. Uganda’s infamous “Anti-Homosexuality Act of 2014” has earned it the dubious distinction of most hostile. In contrast, South Africa became the first African country to recognize same-sex marriage in 2006, nine years before the US did.

South Africa has one of the most pro-LGBT political cultures in the world. It arose from grass roots activism led by LGBT people of color. These cuts pose the greatest risk to LGBT Africans.

HIV in African countries differs from HIV in the US. The shared suffering, however, can provide a way to break out of narrow nationalism.

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