Groups fighting to prevent HIV on the ground in Senegal face a double blow of aid cuts – with Britain announcing a £150m cut to their biggest donor, the Global Fund to fight AIDS, Tuberculosis and Malaria on top of Donald Trump slashing US aid funding.
Senegal has already had its ability to stop the spread of the virus hollowed out by Trump’s cuts announced at the start of the year, which have hit services reaching some of the most vulnerable groups.
While aid from the United States Agency for International Development (USAID) made up a quarter of funding for HIV services in Senegal, another third comes from the Global Fund. On 21 November, the Global Fund will host a summit aiming to raise $18bn (£13.3bn) for its work for the next three years. The UK has announced a pledge of £850m – a fall of 15 per cent which it is estimated could cost up to 255,000 lives.
After the USAID folded following the announcement from Trump at the start of this year, around 25 sites – roughly a fifth of those in Senegal offering pre-exposure prophylaxis (PrEP) to prevent new infections – have been left scrambling.
“Does it mean that some people have had to stop the PrEP? Yeah, for sure,” said Ousseynou Badio, project lead for Alliance Nationale des Communautés pour la Santé (ANCS), a Senegalese national health alliance.
Ibrahim* began taking a daily medicine known as pre-exposure prophylaxis (PrEP) – which prevents potentially life-shortening HIV infection – two years ago after learning about the programme through a friend.
“At the beginning, I was quite hesitant to start on it because I didn’t know what I would find there,” he said. “I was quite scared”. In order to avoid discrimination, Ibrahim was not open about his sexuality. “I would have to hide and also be very careful,” he said, so he avoided HIV testing for fear of the result and of turning the “eye of the community” on him.
But with the support of the National Network of Key Populations of Senegal (RENAPOC), he did get tested, confirming his HIV negative status. He was then offered PrEP to help prevent him from becoming one of the up to 30 per cent of gay men in the country who have the virus. That is in comparison to the relatively low national infection rate of around 0.3 per cent. Since being on the medicine, “I think I’ve become more confident,” he told The Independent. Ibrahim is one of the lucky ones, his access to PrEP and support hasn’t been affected.
But the US, while protecting HIV programmes more than many other areas, has scrapped almost all prevention. Based on a questionnaire of 128 health workers and 18 leaders of community organisations in the wake of Trump’s cuts, the National Council for the Fight Against AIDs (CNLS) found a decline in access to PrEP, testing and condoms as well as decline in people living with the virus sticking to their antiretroviral treatment. The true impact of the budget cuts across the country won’t be known until at least end of this year, however, the council said.
The US already withheld money from the Global Fund this year, forcing them to make sudden cuts to their programmes. The consequences have been swift, including deaths.
‘We see the decisions of Trump’
The outpatient treatment clinic at Fann Hospital, in the south of Senegal’s capital, Dakar, is a muggy rabbit warren of offices and labs lined with humming equipment. Nestled in its nooks are shelf upon shelf of colour-coded cardboard folders, containing the records of anonymised patients. They are badged only by a number instead of a name for privacy. The internet is still not reliable enough for the hospital to make its records fully digital.
There, as well as offering drug treatment to HIV patients, they used to give out food kits to deal with the country’s ongoing problems with malnutrition.
“We no longer provide food kits that enable them to recover,” said the centre’s president Dr Ndeye Fatou Ngom. “When you do not eat well, so the treatment will not work well. And if you do not have enough to eat, naturally you cannot go and take your drugs at the hospital”.
For vulnerable groups, the impact is more than physical: “They lose hope,” Dr Ngom added, “and it can trigger depression. Most of them, they are depressed. When Trump made his announcement, people are saying: ‘what are we going to do’?”
A few steps away in the same complex, a cheerful youth centre is kitted out with colourful graffiti-style murals on the walls, seating made of old tyres and a garden growing on the roof. It also receives the bulk of its support from the Global Fund. Despite decisions being made four thousand miles away across the Atlantic from Africa’s westernmost tip, the news is reaching the centre’s members who were mostly born with HIV.
“We know what’s happening at the international level,” said Mamadou* who attends the centre, referring to declining funding. “We see the decisions of Trump”.
One project named Tagg Bi – bird’s nest in the country’s first language Wolof – has already had to come to an end after the US withheld money from the Global Fund. “We could share the issues we’re facing at home. We were also teaching the young people how to tell about their status and also how to protect themselves,” he said. It was up for renewal around the time Trump was elected for the second time, Mamadou added, “and so we lost funding. So it’s something we can feel and see”.
A US State Department spokesperson said: “Over the last year, the United States has provided more than $60 million of health assistance programming for Senegal to support to the most urgent health needs, including HIV prevention and treatment.
“As we work with countries to responsibly transition to self-reliance, the United States continues to fund life-saving HIV care and treatment services in Senegal. This lifesaving assistance supports seven health regions in Senegal with HIV testing, provision of anti-retroviral therapy, viral load monitoring, and peer support.”
“If you don’t meet our target in November … we will not be able to do what we are doing,” said the Global Fund’s portfolio manager, Mark Taylor. “I’m talking about the scope. So, things will have to be reduced”.
When the initial round of cuts were made, Dr Awa Diagne at CNLS, said, the US, “chose a pack of services that were life-saving that they authorised”, but they “forgot the prevention which is key”.
“What was interrupted was way more important than what they accepted,” she added.
This article was produced as part of The Independent’s Rethinking Global Aid project
* Names have been changed to protect identities
