'People Are Dying' Without U.S. HIV Funding

For all the media coverage of the U.S. State Department’s Jan. 24 order to pause U.S. foreign aid programs, it isn’t always easy to understand the impact of such a sweeping decision on individual lives. That’s why Emily Smith, Ph.D., an assistant professor with the Duke Global Health Institute and frequent blogger on public health issues, reached out to her colleague Dorothy Dow, M.D.

Dow, an associate professor of pediatrics and global health at Duke, has spent most of the last 14 years in Moshi, Tanzania, where she has been building a program to keep adolescents living with HIV on track with the medications they need to stay healthy. While programs that provide HIV medications were eventually granted a waiver from the State Department’s order, Dow says the situation in Tanzania is far from stable. 

“People are dying as we are figuring things out, and it’s inconceivable, really,” Dow reports in an interview on Smith’s Substack, part of her Friendly Neighbor Epidemiologist community on public health science. 

DGHI is reposting the interview, with Smith’s permission, to share Dow’s powerful perspective about how the order is impacting people who depend on HIV programs such as hers – people who, in many cases, likely wouldn’t be alive without them. 

In the interview, Dow cites an analysis by amfAR, the Foundation for AIDS Research, which estimated that for each day of the stop order, 15,000 people in Tanzania alone were not able to access medications provided by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) that allow people living with HIV to avoid HIV-related illnesses and prevent transmitting the virus to their partners. Thirty babies a day contracted HIV in the country because medications preventing mother-to-child transmission were not allowed to be distributed, according to the report. 

“The numbers are really hard to grapple with, but they are not just numbers when you are the doctor who is turning someone away,” Dow tells Smith. “We take a Hippocratic oath to do what’s right, and it becomes ethical versus political to some extent.”

Dow also describes the pain of seeing young people in her program, many of whom watched their parents die of AIDS and now have children of their own, grapple with what could happen to them without programs such as PEPFAR, which must be reauthorized by Congress before March 31 to continue. PEPFAR has been credited for saving 26 million lives across the globe since its launch in 2003. 

Dow and other Duke experts provided more analysis of the U.S. freeze on foreign aid during a DGHI Think Global panel discussion on Feb. 5. And for more conversations with friendly neighbor-scientists, subscribe to Smith’s Substack and follow the Friendly Neighbor Epidemiologist on Facebook.