Introduction
For years, People Living with HIV (PLHIV) in Uganda have led healthy, productive lives, supported by crucial global funding for antiretroviral therapy (ART) and other essential services. However, the executive order issued by former U.S. President Donald Trump on January 24 abruptly halted funding, leaving PLHIV and stakeholders stunned.
The repercussions of this decision are far-reaching and threaten to reverse years of progress in HIV treatment and care.
The Impact on PLHIV; Interruptions in Treatment and Adherence
PLHIV have always been advised to start ART only when they are ready to adhere consistently. Joselyn, a PLHIV, shared her experience: “I was monitored for two months before being fully enrolled.” However, with the funding cut, many will be forced into dangerous practices, such as skipping doses to prolong their supply.
Additionally, some PLHIV may resort to sharing medications with loved ones, especially men who have historically been reluctant to seek healthcare. This could lead to treatment failure, increased drug resistance, and a rise in domestic tensions over medication access.
Decline in HIV Testing and Support Services
HIV Testing Services (HTS) have served as a gateway to essential healthcare. However, with dwindling resources, fewer people will be motivated to get tested and linked to care, leading to late diagnoses and higher mortality rates.
The multi-month drug refills (MMDR) strategy, which allowed PLHIV to receive ARVs for several months at a time, reducing transport costs and improving adherence, is also at risk. Facilities may revert to one-month refills, increasing the burden on both patients and healthcare providers.
Return to Unmonitored and Unsafe Treatments
Before ART was universally accessible, PLHIV relied on leftover medications from Europe, often without proper prescriptions or monitoring. Trump’s order could force some patients back into similar circumstances, jeopardizing their health. Uganda’s HIV treatment guidelines require a three-drug combination, while some regions, like the EU, have shifted to two-drug therapies. With limited options, patients may be forced to accept suboptimal treatments.
Financial and Social Consequences
The high cost of ARVs—estimated at UGX 70,000 per month for a single tin of 30 tablets—will push many into desperate financial situations. Some may engage in risky behaviors to secure their medication. Others may turn to traditional medicine, despite the well-documented risks of drug interactions rendering ARVs ineffective.
Those who can afford it may seek ARVs from private providers, who often prioritize profit over patient care. Meanwhile, stigma and discrimination are likely to increase as PLHIV are forced to disclose their status to anyone who might offer financial support.
In short, the entire HIV response in Uganda is at a crossroads, and there is no guarantee that this suspension of funding will not become permanent.
A Call to Action: Finding Alternative Solutions
To mitigate the crisis, the Government of Uganda (GoU) must take decisive steps:
- Prioritize Domestic HIV Funding: The government should eliminate unnecessary expenditures in sectors like defense and limping programs such as the Parish Development Model (PDM). Cost-sharing in hospitals and scrapping costly national celebrations could help free funds for HIV programs.
- Seek Alternative Funding Sources: Uganda must turn to non-traditional donors like China and the Middle East. In May 2023, Hon. Asuman Basalirwa suggested seeking funding from Arab nations if U.S. support was withdrawn due to the Anti-Homosexuality Act (AHA). Now is the time to act on this proposal.
- Operationalize the AIDS Trust Fund: This fund, together with the private sector’s One Dollar Initiative, could provide a financial cushion against funding uncertainties.
- Revitalize Workplace HIV Policies: Ministries, Departments, and Agencies (MDAs) should reactivate workplace policies to provide HIV services for employees, ensuring continued care at the institutional level.
By Richard Serunkuuma
Executive Director – Positive Men’s Union (POMU)
Board Member – National Forum of PLHIV Networks in Uganda (NAFOPHANU)
CAB Member – UVRI-IAVI Vaccine Research Program
Committee Member – Community-Led Monitoring (CLM)