The view from Geneva
The World Health Assembly meets the growing AIDS crisis with a shrug
***Thank you for reading this newsletter. I would encourage you to also visit forsaken.life, a website I have developed documenting how the U.S. cuts to the AIDS response are actually affecting people’s lives.***
If you were in Geneva for the World Health Assembly this week, you’d be forgiven for not realizing that an AIDS crisis is unfolding.
Yes, there was acknowledgment of U.S. President Donald Trump’s dramatic cuts to foreign aid, including the elimination of vital HIV services. And to the fact that, instead of attempting to fill that gap, other major donor nations, including the United Kingdom and France, are also in retreat.
Meanwhile, critical multilateral donors, like the Global Fund to Fight AIDS, Tuberculosis and Malaria, are also facing significant budget cuts because they, too, depend on these national donors. So there’s little hope they’ll fill the gap.
And yet, if this funding crisis is not addressed, there will be 600 additional AIDS-related deaths each day for the next four years, according to UNAIDS. And 2,300 more people infected with HIV on top of the 3,500 daily HIV infections the agency was already predicting.
In Geneva, though, the funding disruptions are not an emergency, but an opportunity. A chance to rethink how HIV and other health programs are funded. To compel more domestic financing and to look for more private-sector funding. To build new models that will eventually chart a better future.
This summary captures that broader sentiment: “Yes, the withdrawal is disruptive. It risks lives and stalls momentum. But it is not only a wake-up call—it’s also an opening, creating space and incentives for reinvention.”
A wake-up call at what cost?
This framing already felt a bit divorced from reality. And then U.S. Secretary of State Marco Rubio chimed in from Washington to announce that no one has died as a result of the U.S. funding cuts – which is a lie – and that 85 percent of the people benefiting from the President’s Emergency Plan for AIDS Relief are still receiving services. It is an unlikely estimate that also does not account for the fact that services that do exist are significantly diminished.
Those claims, despite their obvious untruth, generated little outrage at the WHA. Maybe some eyerolls.
Instead, the talk in Geneva – even among officials from the countries most affected by these cuts – seemed relentlessly focused on future opportunities.
There was South Africa’s Deputy Minister of Health Joe Phaala acknowledging that, “while it is a challenge, it is important that we work smarter and better with the diminishing funding sources.”
Amma Twum-Amoah, a key health leader in the African Union Commission, explained the moment was “not about replacing partners, but increasing our stake in our own future and that of generations unborn.”
And Zimbabwe’s Finance Minister Nthuli Ncube came armed with specific ideas, including taxes on cigarettes, alcohol and unhealthy foods, which could then be directed toward filling funding cuts.
These are all admirable sentiments, and Ncube’s ideas have real merit, but they are not going to address the immediate funding shortfalls or quiet the current suffering.
To be fair, it’s not clear what else these governments can do in the face of these unprecedented – and unprecedentedly abrupt – cuts. Poorer nations have limited budgets to draw on and are mired in debt repayments that eat away at whatever money they could allocate to health.
But the head of one multilateral organization told me this week they expected to be inundated with emergency requests from government officials. Or at least to be approached about possibly reallocating funds. Instead, all they’ve heard from officials is that they’re in control of the situation.
Meanwhile, my experience, at least in Uganda, was of a government that very much does not have control of the situation. That had no real answers for how to preserve decades of gains against the pandemic.
I am skeptical of the claim from the multilateral leader. Even if government officials are inert, I know those organizations are hearing from civil society and activists with very clear demands for how to use existing funds to meet the biggest emergencies. And those organizations have their own people on the ground who must be all too aware of the enormous disruptions to nearly every facet of the AIDS response.
What this all adds up to is an emergency that global leaders seem unwilling to grapple with, whether because of its scale or because they can hit on no obvious solutions to meet the immediate needs. Easier, then, to focus on an unspecified future.
A few voices attempted to call out this whitewashing. UNAIDS Executive Director Winnie Byanyima used her platform to ask the international community to “come together to protect the gains made in the response to HIV and see this battle through to the end.” In doing so, she recalled “the darkest days of AIDS – the millions of lives lost, and the existential threat to global health security.”
Those deaths are climbing again, she warned. But the leaders gathered at this year’s World Health Assembly seemed determined to look past them.