THE FOLLOWING ARTICLE IS WRITTEN BY DUMI GATSHA AND PRISCILLA AMA ABDO
Priscilla Ama Addo (she/her/hers) is a young health advocate who works with civil society organisations and non-profit partners in strengthening meaningful youth engagement in HIV and SRHR programing. She serves as a Junior Project Officer for Y+ Global and a Strategic Advisor for West Africa in partnership with Success Capital.
Dumiso Gatsha (they/them/their) is the founder of Success Capital, a grassroots feminist youth led, managed, and serving organisation working in the nexus of human rights and sustainable development.
Leaving others behind: People Living with and Affected by HIV, including broader SRHR Interventions
The Global Impact of Executive Orders
It has been almost 3 months since the United States issued executive orders that shocked the world and disrupted development, humanitarian, and public health systems. Most notably, impacting the global HIV and SRHR systems with gender binaries and life-saving treatment. There has been little reprieve from the US government’s commitment dating back to 1961. Providing relief and aid to over 120 countries and millions of people. Notably for countries recovering from conflicts, natural disasters, and crises. Health systems grappling with HIV/AIDS, Mpox, bird flu, COVID-19, and many others have benefited from the US government’s assistance and technical partnerships.. In 2023 alone, USAID allocated a total of $12.1bn to countries in Africa to improve healthcare, deliver food assistance, and promote security.
Millions of people have been impacted by executive orders catastrophically. Notably for people living with and affected by HIV. The US government has been a major funder of antiretroviral therapy (ART), prevention programs, health commodities, and support services for key populations, including sex workers, men who have sex with men, and transgender individuals. Without this funding, many health facilities in Africa have shut down. Interestingly, those that were impacted by the first Trump Presidency, like IPPF affiliates, learned from his first term. Notably, in Botswana, they continued to operate, having learned from the first instance. This is important to remind ourselves that the signs were there. From political rallies to US celebrities warning us about the Republican Party’s Project 2025.
The Global Gag Rule predated Trump as well, first enacted by President Reagan, prohibiting reproductive health, advocacy, and, over the years, some key populations like sex workers. Integrated health responses that benefited from the US included state and community-level family planning, maternal health, and gender-based violence prevention, which have all been disrupted. From much-needed contraceptives, HIV testing and counselling, or safe abortion information and services have all ended, including in more progressive legislative environments like South Africa. This has compromised health outcomes, notably increasing the risks of unintended pregnancies and unsafe abortions.
Shared realities in the majority world
The risks are great – reversing decades of progress in the fight against HIV, Malaria, and Tuberculosis. From compromising global health security through stalled surveillance, resourcing compromised health systems, multilateral institutions, to risking community drug resistance, higher transmissions, human rights abuses and gender based violence. These are all subject to political will, where corruption, maladministration and a disregard for democracy compromise domestic investments in health systems.
This reality compromises more than just health: Africa’s demographic dividend and aspirations for universal health coverage are compromised. We are left to navigate high state debt repayments, increased civil society competition for domestic resourcing, and ODA dependency that left health ministries comfortable with the status quo. We cannot deny that the US has played a significant role in strengthening health and development systems. However, it also played a significant role in compromising many majority world countries’ development trajectories. From inciting wars, even via proxy, to being one of the largest contributors to climate degradation. It was not out of morality or ethical global leadership. Glaringly, like many other former colonial powers, aid was nothing close to reparations or rehabilitation from the damage caused to the majority world. It served US interests.
What does this mean for us now, that the US empire can no longer continue to uphold the global systems it engineered itself to become a world power? Especially when the US and other philanthropies have doubled down on barriers to enablement and narrow partnerships that exclude young key populations, grassroots organisations, and feminist activists. These are the questions that young people, activists, and community health advocates have to ask ourselves. As our countries are feeling how deeply compromised our systems have always been, deepening gender, socioeconomic, and climate impact inequities will be reflected in our statistics publications in the next few months. The ripple effects will aggravate poverty and already delayed sustainable development indicators.
Looking Ahead
Even when the suspension was temporary, its effects have a long-lasting and wide impact. Governments, NGOs, and international partners are forced to seek alternative funding sources in an increasingly challenging donor and philanthropic landscape. Whilst domestic resource mobilisation is touted as an immediate fix, competing challenges compromise political will. The Democratic Republic of Congo, Sudan, coup-d’etat states in the Sahel, Kenya, and many other countries are facing democratic, climate, fiscal, humanitarian, and/or gender based violence challenges. The adoption of the African Union Convention on Ending Violence Against Women and Girls and the 2025 theme of Justice for Africans and People of African Descent Through Reparations should inspire us to do better. These not only provide pathways, mechanisms, and advocacy positions for us to push regionally and globally, but they also allow us to dream of better. We must decenter the US and others without absolving them from accountability for exploiting and extracting our resources. Global leadership in health is needed to ensure that lifesaving programs are not abandoned. We should not lose focus on the need for a pandemic treaty, ensuring global solidarity in generic manufacturing during times of crisis, and improving quantum commitments for loss and damage.
The actions of the US underscore the fragility of global health systems and multilateralism. We need more creative ways to diversify funding sources and strengthen public health infrastructure at national, district/provincial, municipal/city council, and community levels to safeguard the health service delivery. More importantly, find new ways of ensuring the respect of human rights of all people, particularly the most vulnerable populations.
The world cannot afford to lose progress in the fight against HIV or the gains made in SRHR. Blended financing, green bonds, health surities, social protections, and crypto philanthropy are a few examples that could shed like on the future financing of global health. However, key values and principles should be shared regardless of jurisdiction. This starts with solidarity, acknowledging the need for shared prosperity and upholding the principles of democracy. Without these or concerted efforts in upholding ourselves to the dignity of humanity, we might find ourselves with challenging narratives to tell future generations.
Authors: Dumi Gatsha and Priscilla Ama Addo
