MARY LOUISE KELLY, HOST:
South Africa has more people living with HIV than any other country - some 8 million people infected with the virus that causes AIDS. So when President Trump froze all global health aid last month, the impact for those working on the ground to fight the disease was profound. That is because PEPFAR, the President's Emergency Plan For AIDS Relief, contributes about $400 million a year to programs in South Africa. Linda-Gail Bekker runs one of those programs. She is director of the Desmond Tutu HIV Centre in Cape Town, which counts on U.S. dollars for some 80% of its funding. When we reached her today in Cape Town, I asked how'd she first hear of the freeze on foreign aid? What was her first thought?
LINDA-GAIL BEKKER: Well, we received a - what is now very well known as a stop work order. And this we received on 27 January. And I think it's absolutely correct to say we were completely caught off guard. And it took some time for us to understand exactly what that meant but then became very clear that this meant no work, no spending, no activities at all and that all staff would have to be put on furlough or in some kind of suspended work situation. This meant that in clinics, counselors would suddenly be, you know, off the floor. Certain clinics were completely closed. Other treatment programs were shut down - you know, extraordinary impact literally from one day to the next.
KELLY: So the funding freeze has been lifted for now, temporarily. U.S. Secretary of State Marco Rubio says there are supposed to be waivers for life-saving medicine. Is the money flowing? Have any doors reopened?
BEKKER: So the way, certainly, the treatment care and prevention programs work within the PEPFAR house - if you like - is the funding flows either through USAID or through CDC. So the CDC...
KELLY: The Centers for Disease Control and Prevention.
BEKKER: Correct.
KELLY: Yeah.
BEKKER: So the CDC component has issued some instructions to people, and so there is some movement towards reopening and resuming activities on that side. But the USAID side - there have been occasional messages to either say the stop work order remains in place. Please abide with it. Others have said, you know, hold on. We're coming (laughter). But, you know, there really has been very little communication from USAID.
KELLY: So I want to understand the stakes here. South Africa - Sub-Saharan Africa in general - has been the epicenter of the HIV crisis for so long. But in recent years, there was so much progress. AIDS-related deaths have plummeted. New infections have plummeted because of the availability of prevention drugs and treatments. Do you worry this current situation could threaten that progress?
BEKKER: Profoundly, Mary Louise. I mean, we - PEPFAR - I was there at the time when PEPFAR kicked in, in 2003. It was truly an emergency and an incredible lifesaver. And the first very important component of this was just to save young lives, keep families together, make sure that breadwinners continue to be able to provide, and very importantly, that children who were dying in droves would have their lives saved.
More recently, we've been making progress, one, towards self-reliance as a country but secondly also to bringing this epidemic under control. I am very concerned that by stopping this the way it has stopped, we are going to see regression on that progress because the virus does not stop. It doesn't care what the politics are.
KELLY: So what would you say to the argument that America has plenty of problems here at home, America has to take care of Americans first, and something like PEPFAR is not going to be something that the U.S. is going to fund going forward? I mean, what is the argument for what the U.S. might gain by investing in programs like this?
BEKKER: I mean, I think there are a number, and I want to say this with heartfelt sincerity. PEPFAR and other programs that USAID and - you know, and America has provided for the global community is what made and makes America great, in my opinion. It truly does set the country apart as an extraordinary world leader. The incredible expertise that has been generated by having the resources, the ability to treat, the ability to keep our health systems together, has enabled us to be able to pivot when other epidemics and problems have come along. And, you know, there's no doubt we are likely to see more of these.
So perhaps my comment is that, you know, we've built an amazing global expertise, a global understanding of communicable diseases, which affect the globe as a whole. And I think that's important to acknowledge as well, as a - sort of a dividend, if you like, of this investment.
KELLY: Linda-Gail Bekker, thank you.
BEKKER: Real pleasure. Thank you.
KELLY: She is director of the Desmond Tutu HIV Centre in Cape Town, South Africa. Transcript provided by NPR, Copyright NPR.
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