Trump’s aid cuts in east Africa led to unwanted abortion and babies being born with HIV – report

Doctors, nurses, patients and other experts describe the loss of decades of progress in beating the virus in 100 days after Pepfar was disrupted

Aid cuts in east Africa have led to cases of babies being born with HIV because mothers could not get medication, a rise in life-threatening infections, and at least one woman having an unwanted abortion, according to interviews with medical staff, patients and experts.

A report by Physicians for Human Rights (PHR) sets out dozens of examples of the impact of disruption to Pepfar – the president’s emergency plan for aids relief – in Tanzania and Uganda.

Pepfar, a leading US global health programme, launched in 2003 and is credited with saving millions of lives, mainly in sub-Saharan Africa.

The report is based on interviews with 39 doctors, nurses, people living with HIV, service providers and other experts. It focuses on the first 100 days after Pepfar-funded programmes were instructed to stop work as part of a US government freeze on foreign aid.

Health workers reported shortages of drugs to control the virus, resulting in increased serious infections in people living with HIV and children being born with the virus because mothers could not get medication to prevent it being passed on. Clinics have closed, and people are skipping vital doses to eke out their supply of medication, raising the risk of drug-resistance.

Some programmes have been able to resume activities in the months since the interviews, said Emily Bass, one of the report’s authors, offering “temporary mitigation” of the harms, but there exists a “narrow window” for the US Congress to act to secure resources that will stabilise remaining services and prevent the loss of decades of progress.

The Trump administration is reportedly refusing to release about half of the $6bn (£4.5bn) funding allocated by Congress for Pepfar in the 2025 fiscal year.

In Tanzania and Uganda, HIV prevention and treatment programmes were reliant on Pepfar. The stop work order meant clinics were unable to dispense drugs bought with US money for several days, before a waiver came through allowing treatment to continue.

Even then, disruption to supply chains meant doctors could not dispense as many drugs as usual, they said, perhaps giving patients supplies for a few weeks rather than months. Rumours spread that normal access was unlikely to return.

A mental health project research coordinator told PHR: “Someone did an abortion because of that rumour [that antiretrovirals were no longer available]. She said, ‘Oh well, I don’t want to have a baby who is HIV positive. I will be blamed myself, so I don’t want.’”

By late April, one clinic reported that 25% of the pregnant women living with HIV that it supported had given birth to a child with HIV. Its clinician said drugs had not been delivered and existing stocks would not stretch far enough.

Cover photo:  Midwife Leticia Nakandi at an HIV management centre in Kampala. Uganda’s programme to prevent mother-to-child HIV transmission is partly funded by Pepfar. Photograph: Philip Kairu/WHO