No seat at the table
Washington has started talks with African countries about future health funding. In Botswana, most NGOs are not included.
Negotiations about the future of Botswana’s HIV response are underway. The organizations who provide services to the communities most at risk of infection were not invited.
As part of its new America First Global Health Strategy, the Trump administration is drafting bilateral deals with African countries to fund global health programs, including HIV services. The team from the State Department arrived yesterday in Botswana to start talks there.
While the government provides most clinical services in Botswana, including HIV treatment, community outreach has been the responsibility of non-governmental organizations.
This includes identifying people at risk of HIV and testing them. The organizations enrolled those who were negative on preventive drugs and those who tested positive gained access to lifesaving treatment. The NGOs even delivered it to their homes in instances where they lived in remote settings or struggled to pay transportation costs.
NGOs were also responsible for the services targeted at vulnerable communities, including sex workers, gay men and transgender women, who might not feel comfortable visiting a government clinic.
These organizations have relied on U.S. funding. Most of it has been terminated since Trump took office.
This is both an ideological shift — the administration does not want to aid some of these communities any longer — but also a strategic one. Traditionally Washington has funded HIV programs through NGOs — both local groups and international — but the Trump administration wants to change that and give money directly to Botswana’s government. Batswana officials will then determine how funding is allocated.
The problem, as I heard over and over again, is that Botswana’s government has shown no real interest in supporting the work that NGOs have been doing. NGO leaders said the lack of engagement was evident in the aftermath of Trump’s January order to temporarily stop all global health funding.
“The government did not intentionally try to understand the work that we’re doing and the gap left by the stop-work order,” one of them told. “They can only get this from calling us to the table to understand what exactly happened with the stop-work order.” But that never happened.
Instead, the government has remained focused on clinical delivery of HIV testing and treatment. That has left NGOs worried that even with funding from Washington, Batswana officials won’t prioritize the community-based work they were doing.
The government seemed to underscore that point when it declined to invite most NGO leaders to the negotiations with the team from the U.S. State Department.
Some organizations did make it into the room. The leaders of Botswana’s faith-based HIV service providers were invited to give presentations during the meetings yesterday. It’s likely this is at the behest of Washington, which made an exception for faith-based groups when it said it wanted to stop funding NGOs.
In Botswana, faith-based organizations are running some important programs in communities, but not at a scale large enough to reach everyone who needs services and specifically not for vulnerable communities.
If they are the only groups providing community outreach under the new agreement, services for gay men, sex workers and other marginalized communities are not likely to reappear.