With U.S. global assistance all but gone, AID for AIDS needs unused HIV meds

Venezuelan-born New Yorker Jesús Aguais started his group AID FOR AIDS International (AFA) in 1996 in order to get the new, effective HIV drugs that U.S. patients had but could no longer use (due to side effects or resistance) into the hands of people in other, poorer nations who needed them. This was before the U.S. became the single largest supplier of HIV meds and other HIV prevention and treatment resources to poorer nations globally via the President’s Emergency Plan for AIDS Relief (PEPFAR), a program started by President George W. Bush in 2003, working in concert with USAID. 

Coming into power in January, the Trump 2.0 administration has swiftly and almost entirely dismantled USAID and has thrown PEPFAR into dysfunction and chaos. Overseas organizations and clinics receiving aid from PEPFAR have been told their funding has been spared, but despite lawsuits and rulings in U.S. courts, they have still not been able to access assistance. That’s left clinics shuttered, staffers out of work and recipients around the world without their HIV or PrEP (HIV prevention) medications. Additionally, the new administration has banned the distribution of PrEP via these channels to all but pregnant and breastfeeding women—yanking PrEP away from people in other groups who are highly vulnerable to HIV such as men who have sex with men, transgender women, sex workers, migrants and people who use drugs.

[UPDATE: About 83% of USAID programs—or 5,200 contracts—were terminated, announced U.S. Secretary of State Marco Rubio on March 10. The remaining 12%, or about 1,000, will be transferred to the State Department. The action came as a result of a six-week review, Rubio said.]

Since its 1996 founding, AID FOR AIDS has received massive assistance from USAID and PEPFAR to set up major HIV testing, treatment and prevention programs throughout the Caribbean and Latin America. Suddenly, that money’s gone—even from contracts previously approved by Congress—and those programs have crashed to a halt. With lawsuits against the foreign aid “freeze” still pending and the Trump administration ignoring rulings issued against them, many nonprofits have shuttered their overseas operations.

On March 6, POSITIVELY AWARE spoke with Aguais about the chaos and terror the U.S. freezes have left in their wake. During the interview, he also urged anyone with a supply of unexpired HIV meds to contact AFA’s Leonardo Klie at the email lklie@aidforaids.org or to call the AFA office at 212-337-8043.

Jesús, talk about what's happened since Inauguration Day, January 20.

Prior to that, we were running four programs—one in the Dominican Republic to do testing, treatment and prevention in migrants from Haiti and three [programs] in Peru, Colombia and Panama to do the same for migrants from Venezuela—millions of which are all over not only the U.S. but Latin America, many of them doing sex work for survival. 

‘...because we’re abandoning people on treatment all over the world, we’ll probably see the development of a new strain of HIV that will require the development of brand-new meds. This administration is really playing with fire.’

These programs reflected about $4 million in U.S. funding and comprised nearly 100 AFA staffers in those countries, including those who would greet migrants as they both entered and exited the treacherous Darien Gap jungle that divides South and Central America. 

This was so important because there is both a lot of sexual violence and survival sex work in that crossing. The overall goal of the programs was to make sure that nearly 100% of people with HIV know their status, are on HIV meds and are virally suppressed, hence unable to transmit their virus forward. [Levels, called “undetectable,” widely known to be optimal for stopping the forward spread of HIV; or U=U, undetectable equals untransmittable.]

But a few days after the inauguration, we got a notice from the U.S. government pausing those programs, even though the existing contracts were already authorized by Congress. So we had to tell our staff in those countries to tell everyone that there was no more testing, treatment or prevention for them. Then we got an actual letter of cancellation for the Dominican Republic program. Just like that—goodbye! This creates not just a future problem for the D.R. but for the U.S., because lots of Dominicans travel between the two countries.

How is AFA trying to meet this very scary moment?

We’re going back to our 1990s roots, calling on people or institutions to donate their surplus HIV or PrEP meds. We’ll figure out how best to use those meds but we simply can’t replace the financial support of the U.S. that way—it’s too vast. A part of this freeze is that they cut funding for UNAIDS’ distribution of condoms worldwide. This is a global tragedy. We’ve never seen anything like this.

And it appears that U.S. funding is not coming back anytime soon, yes?

It might be gone forever. I don’t know. We’re only six or so weeks into this administration and it feels like three years. But this isn’t the time to be scared or to freeze. It’s the time to act. We need people to talk about this to their representatives and at town hall meetings. If Congress hears pressure, we might at least be able to see a little light.

What’s tricky is that if people in the U.S. do stand up and yell, most of them will do it for domestic issues like the cost of living, losing Medicaid, etc. Relatively few Americans care about foreign aid.

We need to showcase what’s going to happen in other countries with the loss of this aid to show what will happen here if things like Medicaid get cut. So I believe this is an opportunity in a way to start up a new generation of AIDS activism.

The U.S. drugmaker Gilead is expected to have their major PrEP breakthrough drug lenacapavir—which requires only two injections yearly—approved in the U.S. by the FDA sometime this year. Do you know if advocates are talking to Gilead about a sort of charity venture so that the company would make lenacapavir available to your program countries in Latin America and also globally?

Conversations are happening. This is definitely the time for Pharma to step up. We need to continue crafting that message.

AFA receives other, non-federal funding, right?

We do have private money. But it’s not enough. And the past few years have been hard on us already. In 2020, we sent $12 million worth of HIV meds to people in 45 countries. Recently, it’s only been about $5 million because we never rebounded fully after COVID. 

You’ve been doing this work since 1996 and have seen so much success with the help of PEPFAR and USAID. What is this moment like for you personally?

That’s a really good question. All my professional experience up to now has gotten me ready for this. I’m very focused and cool-headed. And we’re taking this on. There’s no question about that. But none of us thought things would get this crazy.