Report on the Impact of Foreign Aid Disruptions on HIV Services and Sustainable Development Goals in East Africa

Executive Summary

Recent disruptions to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in Tanzania and Uganda have precipitated a public health crisis, directly undermining progress toward several Sustainable Development Goals (SDGs). A report by Physicians for Human Rights (PHR), based on interviews with healthcare professionals and patients, documents the severe consequences of aid interruptions. These include medication shortages, new HIV infections in infants, and the closure of essential health services, representing a significant setback for global health and development targets.

Detrimental Effects on SDG 3: Good Health and Well-being

The aid cuts have directly compromised SDG 3, which aims to ensure healthy lives and promote well-being for all. The disruption of HIV prevention and treatment programs has led to a cascade of negative health outcomes, moving the region further away from the goal of ending the AIDS epidemic by 2030 (Target 3.3).

• Medication Shortages: Clinics reported shortages of antiretroviral drugs, forcing patients to skip doses or ration their supply.
• Increased Infections: Health workers observed a rise in serious, life-threatening infections among people living with HIV due to uncontrolled viral loads.
• Mother-to-Child Transmission: A critical failure in preventative care resulted in babies being born with HIV because their mothers could not access necessary medication. One clinic reported that 25% of its pregnant clients living with HIV gave birth to a child with the virus.
• Risk of Drug Resistance: Irregular access to medication significantly increases the risk of developing drug-resistant strains of HIV, complicating future treatment efforts.

Exacerbation of Inequalities (SDG 5 & SDG 10)

The service interruptions have disproportionately affected the most vulnerable populations, deepening existing inequalities and hindering progress on SDG 5 (Gender Equality) and SDG 10 (Reduced Inequalities).

Impact on Gender Equality (SDG 5)

Women and girls have been severely impacted, particularly in relation to their sexual and reproductive health and rights (Target 5.6).

• A waiver allowing some HIV prevention programs to continue was limited to pregnant or breastfeeding women, but supply chain disruptions still created critical gaps.
• The fear and uncertainty created by the aid freeze led at least one woman to have an unwanted abortion, fearing she could not prevent HIV transmission to her child.

Impact on Reduced Inequalities (SDG 10)

The aid disruption has intensified discrimination against marginalized communities, directly opposing the objective of ensuring equal opportunity (Target 10.3).

• Specialist services for key at-risk groups—including LGBTQ+ people, sex workers, and people who use drugs—were the hardest hit by the funding freeze.
• The closure of these trusted, specialized clinics forces marginalized individuals to seek help from mainstream government services, where they face a higher risk of stigma and discrimination.

Erosion of Trust and Partnerships (SDG 16 & SDG 17)

The crisis extends beyond immediate health impacts, damaging the institutional trust and international partnerships that are foundational to sustainable development.

• Weakened Institutions (SDG 16): The report found that the disruption has damaged public trust in domestic governments, U.S. foreign aid, and the reliability of antiretroviral medications, fostering fear and creating opportunities for the spread of misinformation and fake cures.
• Failed Partnerships (SDG 17): PEPFAR is a cornerstone of global health partnerships. The interruption of its funding jeopardizes decades of collaborative progress and demonstrates the fragility of international commitments to achieving the SDGs.

Conclusion and Recommendations

The suspension of aid has created a catastrophic, yet preventable, public health emergency that reverses years of progress in the fight against HIV/AIDS and obstructs the achievement of multiple SDGs. The PHR report concludes with urgent recommendations for the U.S. government to mitigate the damage and restore stability to these life-saving programs.

1. Immediately restore, renew, and protect global health funding for essential HIV services.
2. Provide full funding for global HIV programs in the FY 2026 budget, commensurate with need.
3. Reauthorize the PEPFAR program to ensure long-term stability and prevent future disruptions.
4. Support a planned, feasible, and transparent transition to country leadership and ownership of HIV programs.

Analysis of the Article in Relation to Sustainable Development Goals

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being
• SDG 5: Gender Equality
• SDG 10: Reduced Inequalities
• SDG 16: Peace, Justice and Strong Institutions
• SDG 17: Partnerships for the Goals

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

• Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
  
  Explanation: The entire article focuses on the disruption of the Pepfar program, which is a critical initiative in the global fight against the AIDS epidemic. The text explicitly states that aid cuts have led to a rise in life-threatening infections and babies being born with HIV, directly undermining efforts to end the AIDS epidemic.
• Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.
  
  Explanation: The article highlights the impact on pregnant women living with HIV who could not get medication to prevent mother-to-child transmission. It also mentions a woman who had an “unwanted abortion” due to fears of being unable to access antiretrovirals, which directly relates to reproductive health and rights.
• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
  
  Explanation: The aid cuts led to “shortages of drugs,” clinic closures, and disrupted supply chains for antiretroviral medications. This represents a direct failure to provide access to essential health-care services and medicines for people living with HIV in Tanzania and Uganda.

SDG 5: Gender Equality

• Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.
  
  Explanation: The article details how pregnant and breastfeeding women were severely affected. The inability of mothers to access medication to prevent transmitting HIV to their babies and the case of a woman resorting to an abortion due to lack of treatment access are clear infringements on their sexual and reproductive health and rights.

SDG 10: Reduced Inequalities

• Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
  
  Explanation: The article explicitly states that the US government waiver for HIV prevention programs excluded “key at-risk groups,” specifically mentioning “LGBTQ+ people, sex workers and people who use drugs.” It warns of “worsening discrimination” as these marginalized groups are forced to seek help from mainstream clinics, highlighting a significant inequality in healthcare access.

SDG 16: Peace, Justice and Strong Institutions

• Target 16.6: Develop effective, accountable and transparent institutions at all levels.
  
  Explanation: The report found that the disruption of aid and services has “damaged” people’s trust in their “domestic government, US foreign aid and antiretroviral medications.” This erosion of public trust in key health and governmental institutions undermines their effectiveness and accountability.

SDG 17: Partnerships for the Goals

• Target 17.2: Developed countries to implement fully their official development assistance commitments.
  
  Explanation: The article is centered on the disruption of Pepfar, a major US foreign aid program. The “US government freeze on foreign aid” and the refusal to release allocated funding represent a failure by a developed country to fully implement its development assistance commitments, with catastrophic consequences for partner nations like Tanzania and Uganda.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

SDG 3: Good Health and Well-being

• Indicator 3.3.1: Number of new HIV infections per 1,000 uninfected population, by sex, age and key populations.
  
  Explanation: The article directly mentions “babies being born with HIV because mothers could not get medication” and the exclusion of at-risk groups from prevention programs. A specific clinic reported that “25% of the pregnant women living with HIV that it supported had given birth to a child with HIV,” which is a direct measure of new infections.
• Indicator 3.8.1: Coverage of essential health services.
  
  Explanation: The article implies a decrease in this coverage by reporting that “Clinics have closed,” and specialist services for key populations have been “hardest hit.” This demonstrates a reduction in the availability of essential HIV services.
• Indicator related to access to medicines: The article points to a lack of access to essential medicines through statements like “shortages of drugs to control the virus,” “doctors could not dispense as many drugs as usual,” and people “skipping vital doses to eke out their supply of medication.”

SDG 10: Reduced Inequalities

• Indicator related to discrimination and exclusion: The article implies a measure of inequality by stating that HIV prevention programs continued only for pregnant women, leaving “key at-risk groups unprotected,” including “LGBTQ+ people, sex workers and people who use drugs.” The warning of “worsening discrimination” serves as a qualitative indicator of increased inequality in healthcare access.

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

Source: theguardian.com