On January 24, 2025, the United States government issued an executive order to freeze all foreign aid programmes, including The President's Emergency Plan for AIDS Relief (PEPFAR), for 90 days. An international team of researchers, led by Dr. Jan Hontelez and Professor Sake de Vlas from the Department of Public Health at Erasmus MC, demonstrated that this decision could result in 150 thousand additional deaths and 200 thousand new HIV infections in sub-Saharan Africa.
Over the past decades, PEPFAR has been instrumental in scaling up life-saving HIV treatment, and many countries in sub-Saharan Africa still heavily depend on US funding to sustain service delivery for millions. The freeze resulted in an immediate termination of all activities and dismantling of programs. Although a limited waiver option became available shortly after the initial freeze decision, its implementation remained incomplete.
The research team used the established STDSIM model, and estimated the impacts of various freeze scenarios, including waiver scenarios, on HIV deaths and infections in 7 countries - Ethiopia, Kenya, Malawi, South Africa, Tanzania, Zambia, and Zimbabwe - together accounting for about half of all people living with HIV in sub-Saharan Africa. The model took into account that the effects of the freeze will be felt long after the initial 90-day period, due to logistical challenges in re-starting programs, and due to increased transmission.
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Research
- eClinicalmedicine: The impact of the PEPFAR funding freeze on HIV deaths and infections: a mathematical modelling study of seven countries in sub-Saharan Africa
- The impact of the PEPFAR funding freeze on HIV deaths and infections: a mathematical modelling study of seven countries in sub-Saharan AfricaNews
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