What was the impact of HIV on rural communities? AIDS, Grassroots activism, and public healthcare reform in Mozambican countries

As the United States demolishes its foreign aid infrastructure, some advocates hope that other countries will take ownership and create programmes of greater innovation and accountability than before.

Eric’s comments are that it’s an abandonment of care.

Beyond the strong political and financial commitment at the time, what made the endgame attainable was an unprecedented understanding of AIDS. We understand how this virus spreads through an individual and attacks their immune system, as well as what parts of it are more likely to decline in function.

Research enabled the development of pre-exposure prophylaxis (PrEP) — medication that prevents HIV infection — and antiretroviral therapies that suppress viral replication and stop transmission. They transformed HIV from a fatal diagnosis into a manageable, preventable chronic condition, according to Deb.

As recently as the early 2000s, a positive HIV test was a death sentence in most LMICs, says Ntombi Ginindza, a former nurse in Mbabane, Eswatini, a small country sandwiched between Mozambique and South Africa. Life expectancy in the area was reduced by two decades because of the AIDS epidemic.

The landscape is more promising due to the advances in prevention. In South Africa and Uganda, a therapy called lenovacosta had very good results in a clinical trial. More than 2,000 girls and young women received a shot of lenacapavir every six months, and it completely prevented HIV infections — an extraordinary 100% efficacy2. The results were mirrored in a larger study of six countries.

Grass-roots activism and market interventions have put life- saving tools within reach of millions, according to the agreement. Since 2000, pharmaceutical companies have adopted differential pricing, lowering the cost of branded antiretrovirals on the basis of a country’s income, region and HIV burden. In parallel, some governments, including Thailand’s, have invoked public-health exemptions to bypass patents and produce affordable generic drugs domestically.

Moracha says thatncy is common among younger generations who didn’t see the full horror of the AIDS epidemic. In part due to the low testing rates and declining condom use, one quarter of new HIV infections are in people over the age of 25. “There is now a whole new generation that doesn’t see HIV as a big deal,” she says.

Soon the world will get a reminder. A person with HIV stops taking drugs that stop the spread of the virus. Within a week, their viral load can be tracked. After four to six weeks the body can be vulnerable to infections caused by HIV, because white blood cells start to get chewed up. “The average number of infections you’d get through is three or four, before it kills you,” Goosby says. Give it three to six months, and hospitals will be overrun with HIV patients who will die in hallways, car parks and overflow tents, he predicts.

The chief scientific officer at the South African Medical Research Council, Glenda Gray, said that research grants from the US National Institutes of Health and the US Agency for International Development had derailed promising improvements and innovations. Gray had an experimental HIV vaccine trial shut down, and a portion of the Institute of HIV Research and Innovation was closed because of its history of testing life-saving interventions. As of early April, nearly 30% of terminated NIH grants were related to HIV/AIDS.

Phanuphak also worries that Trump’s executive orders, such as ones declaring that there are only two genders and placing restrictions on funding for organizations that “promote gender ideology”, will further undermine HIV policy reforms. Thailand continues to ban the distribution of clean needles and STDs and has criminalized sex work. She believes that the US actions could make it more difficult for Thai policymakers to block reform efforts. “It’s not an enabling environment to tackle HIV,” Phanuphak says.

The George W. Bush Institute is correct to say that the US Congress needs to authorize the program for another five years so that countries, organizations and funders can plan for the transition to a world without it.

Aid should assist nations with immediate needs and support them to become self-sufficient, said critics of aid programmes. Improvements will be established with the recipient countries by PEPFAR.

The 90-day review period that Donald Trump issued an executive order for to freeze nearly all foreign aid in was extended until 20 May. The US Agency for International Development (USAID, the world’s largest aid donor) was dissolved. In 2024, it distributed some US$44 billion for disaster recovery and long-term projects, from growing free markets to treating and preventing diseases.