Republicans skimp on Bush-era AIDS relief for Kenya

Republican lawmakers aim to scale back President’s Emergency Plan for AIDS Relief funds (PEPFAR) for Kenya, undercutting a successful Bush-era policy. Kenyans fear they will no longer be able to afford treatment, and progress will be lost.

First Look

When Ms. Minne Gachau’s husband died from AIDS-related complications in 2006, she was still too scared to confide in friends and relatives in her home in Nakuru, a city in Kenya’s Rift Valley, that she had also been diagnosed HIV-positive.

It was only after the couple’s young son also tested positive and started to receive antiretroviral treatment that Ms. Gachau sought medication for herself. Today, she works with pregnant women to prevent HIV transmission to their babies.

Ms. Gachau is one of the nearly 1.3 million Kenyans who have received HIV/AIDS treatment through a program launched in 2003 by then U.S. President George. W. Bush and renewed in five-year cycles ever since.

But in a change that has worried many beneficiaries of the program, called the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. government renewed its funding in 2023 for just one year after resistance from some Republican lawmakers.

Balking at the five-year renewal, Republican lawmakers said the program should ban any nongovernmental organizations that receive PEPFAR funding from promoting or providing abortion services.

U.S. laws already prevent the use of such funding for abortion services and the U.S. State Department says PEPFAR does not fund or provide abortion services.

The shorter renewal has raised concerns about the funding’s longer-term future in Kenya and beyond.

Progress on goals

Some 1.4 million people live with HIV/AIDS in Kenya, but the prevalence rate has nearly halved in the past 20 years – to 3.7% in 2023, according to the latest UNAIDS data.

The United States is the biggest foreign contributor toward the HIV/AIDS fight in the East African country, and the funding has helped put it close to reaching the U.N.’s 2025 goals for combatting HIV/AIDS.

The so-called 95-95-95 goals aim for 95% of people living with the virus to know their status, with 95% of those diagnosed receiving antiretroviral treatment. Among those who are receiving treatment, 95% should show viral suppression.

Since 2013, Kenya has reduced new HIV/AIDS infections by 78% and HIV/AIDS-related deaths by 68%, said Medhin Tsehaiu, UNAIDS country director for Kenya, crediting donors, including the United States, for this progress.

While there is no indication that the U.S. will pull out completely, the issue has highlighted vulnerabilities in Kenya’s funding base, Ms. Tsehaiu added.

“There is a need for Kenya to put in place sustainability plans to support the program because of how heavily dependent its HIV/AIDS funding is on donor support,” she said.

“Out of reach”

The news of a reduced funding cycle has concerned those who rely on the program, like street vendor Dickson Mwaniki, who received an HIV-positive diagnosis 19 years ago. Mr. Mwaniki’s medical treatment appears to have suppressed his viral load. His wife is HIV-free.

Mr. Mwaniki cannot afford to buy antiretroviral medication on his own – on a good day he makes about 1,000 Kenyan shillings ($6.27) selling hot snacks on the streets of Nakuru.

Without any support, a month’s treatment costs 5,000 Kenyan shillings, out of reach not only for Mr. Mwaniki and many others working in Kenya’s large informal economy.

Another recipient of free antiretroviral treatment, a young woman who asked not to be named, said she relied on her parents for economic support and might have to turn to sex work if she had to pay for the treatment herself.

As a young woman, she is among one of the groups at high risk for HIV/AIDS in Kenya, with 26% of new infections in 2019 among girls and women aged 15 to 24, according to the U.S. Agency for International Development (USAID).

At a clinic in Nakuru that has benefited from PEPFAR funding for 10 years, counselor Philemon Ogola said medical staff now only see one or two new cases a month.

The clinic, which sees about 500 people each year, has reported one death in the last year due to HIV/AIDS-related complications.

“Our measure of success in PEPFAR support is that in our facility we rarely see new cases,” Mr. Ogola said, adding that he was worried about the impact of any disruption to the funding.

“A majority of my patients that I see are poor people living below a dollar a day,” he said. “Seventy percent of them cannot afford [antiretroviral treatment] on their own.”

This story was reported by the Thomson Reuters Foundation.