Feature Story

The U.S. decision in January to freeze all funding for U.S. foreign assistance, including for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), has had a critical impact on several countries in Latin America and the Caribbean, exacerbating existing challenges in the HIV response. More than 20 countries in the region rely on these funds to deliver HIV treatment, prevention, and care services, including community-led services focused on the most discriminated and marginalized communities.

Following the decision to freeze all U.S. funding for foreign assistance, the U.S. Government issued a waiver allowing some funding to support lifesaving services. However, confusion about which services may be supported and a lack of support for some services means the situation remains critical, posing a serious risk of setbacks in the AIDS response in the region. While some key treatment services and prevention of vertical transmission have been gradually coming back into operation, most countries have been facing disruptions in their HIV treatment programs.

The lack of funding has led to a significant decrease in community-led HIV prevention efforts, a reduction in treatment adherence, counseling, and social support and monitoring activities. Consequently, there are increased risks of new HIV infections, of higher mortality rates, and a deterioration in the quality of care for people living with HIV, directly impacting their capacity to access treatment and to achieve viral suppression – crucial steps towards the global target of eliminating AIDS as a public health challenge by 2030.

In Colombia and Peru, the freeze has severely affected migrants and refugees, who are estimated to have an HIV prevalence two times higher than the general population. Approximately 4,000 migrants and refugees are receiving antiretroviral treatment (ART) in Colombia thanks to the government efforts and cooperation funds, but the withdrawal of such resources is directly impacting this vulnerable group and the country's capacity to include them in the health system. One community-led organization supporting HIV services among migrant and LGBT communities had to end contracts for 40 out of 70 team members, significantly reducing their capacity to provide essential services to reach such populations.

In the Dominican Republic, even though the government guarantees access to antiretroviral treatment, the pause in PEPFAR funding has left thousands without access to essential HIV services. PEPFAR supports around a third of HIV care services, including PrEP services, health human resources, and laboratory networks. The reduction in community assistance has made it difficult for people to access their medications, especially those who live far from care. The quality of services offered by the Comprehensive Care Services (known by the acronym SAI in Spanish) in the Dominican Republic has been highly compromised, with many staff and services entirely dependent on PEPFAR funds.

El Salvador has also been impacted, with PEPFAR projects supporting comprehensive HIV care clinics now suspended. This has caused a slowdown in care, and the opportunity for new diagnoses and early initiations of antiretroviral treatment is likely lost.

In Guatemala, the HIV epidemic is mainly concentrated among key populations such as transgender individuals, gay men and other men who have sex with men, and sex workers. The distribution of PrEP for these groups has been severely disrupted, with many organizations that rely on U.S. Government funding suspending their work. The reduction of personnel, including medical staff as well as outreach workers that were funded through PEPFAR has resulted in people being unable to access HIV prevention and treatment services.

Haiti has seen a significant impact on its HIV response, with PEPFAR covering around 60% of the national response. The stop-to-work order has thrown the response into disarray, causing anxiety for the 127,000 Haitians living with HIV who are on treatment. In the context of the humanitarian crisis and gang violence, more than 1 million people are now internally displaced in Haiti, many of them displaced multiple times– among them women, girls and children. Escalating violence has also led to the closure of 39% of health facilities, including two of the capital’s three major hospitals. Access to healthcare has never been more limited. The quality-of-service delivery of medicines has also been affected, with approximately 5,000 health workers receiving directives to stop working.

In Jamaica, 70% of HIV resources come from external sources – with PEPFAR covering around 50% of services. The pause in funding has raised concerns about the delivery of HIV prevention services for at risk populations delivered via civil society organizations. Civil society groups have reported that their institutional stability and survival are at risk, with many unable to guarantee the continuous employment of their field staff in charge of liaising with the most discriminated and affected populations who need HIV services.

In Panama, the suspension of a study on recent HIV diagnoses and the halt in laboratory sample transportation have further limited essential diagnostic and monitoring services. The country had already been facing significant disruptions, particularly among the indigenous Ngäbe-Buglé population, who are expected to face increased obstacles to accessing HIV services. In 2023, despite representing only 5% of Panama's population, the territory, which is home to approximately 225,000 residents, accounted for 30% of the nation's AIDS-related deaths among individuals aged 29 or younger, as reported by the Panama Ministry of Health.

In Brazil, on the other hand, the Unified Health System (SUS) guarantees uninterrupted universal and free access to health services, including HIV diagnosis, treatment and prevention for all people living in Brazil. The “A hora é agora” project, carried out in five capital cities with PEPFAR resources, worked to provide specific services such as doctors, reception and delivery of antiretroviral drugs and PrEP in addition to public health services, so the national response to HIV was not impacted by the cut in resources.

Latin America is one of the three regions in the world where new HIV infections have increased since 2010, with a rise of 9%, which highlights the urgency of addressing these disruptions. The Caribbean region has made significant progress in reducing new HIV infections and increasing access to treatment. Still, the freeze on PEPFAR funds threatens to reverse these gains and the ongoing process of creating sustainability roadmaps to increase national funding for the HIV response.

UNAIDS continues to work with various  partners to help mitigate the impact and find the best solutions and calls for the continuity of all essential HIV services in the region.

"United States support through PEPFAR has been a cornerstone of the HIV response in our region, including a key driver for strengthening the sustainability and resilience of national responses. The recent humanitarian waiver reflects the commitment of the American people to save lives and maintain momentum to end AIDS by 2030," says Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean. "UNAIDS will continue to convene communities, civil society organizations, governments, and partners to advocate for continued support and critical HIV services supported by PEPFAR.  It is also time for the governments of the region to play a leadership role in guaranteeing the right to health of their most marginalized populations."