Despite low prevalence, USAID shutdown to affect HIV projects in various Indian pockets

With a view to assist India’s goal to eliminate HIV by 2030, international fund agency USAID had received sanction to extend the five-year grant for the Regional Operational Plan of U.S. government’s project PEPFAR (President Emergency relief fund for AIDS) by two more years until 2026, days before the agency was ordered to suspend operations by the Trump government. 

Also Read:What is USAID? Explaining the U.S. foreign aid agency and why Trump and Musk want to end it

USAID is an implementing partner for PEPFAR, with another US government agency — Centres for Disease Control and Prevention (CDC) providing technical support. 

Unlike in African countries where the HIV epidemic is severe and a majority of work occurs through foreign funding, in India, the central government funds most of the HIV-related activities. Also, the country-wide prevalence of HIV in India is low at 0.2% and estimate annual new HIV infections are 66,400, according to the India HIV Estimations 2023 report. 

\Nevertheless with 500 field workers employed with USAID’s anti-HIV projects who reached out to two lakh HIV patients left high and dry, the shut down is set to temporarily provide a set back to India’s HIV elimination goals, until an alternative is devised. 

“Even as the prevalence is low, India is still the third largest country with regards to HIV cases. Cases are more concentrated in southern region and certain emerging pockets in north and north east of India where USAID through PEPFAR has been supporting the Indian government to lay out infrastructure and infuse human resource aid to support awareness and treatment activities on the ground to achieve elimination goals,” an official closely working with USAID on Project Accelerate, which identified and engaged vulnerable populations to provide preventive and treatment services for HIV said. 

While the HIV programmes are overseen by National AIDS Control Organisation (NACO) and State AIDS Control Societies (SACS), they at times face a human resource crunch to reach vulnerable groups. “To find solutions for this issue, the government took assistance from technical partners such as USAID whose HIV-related ‘Project Accelerate,’ employed outreach workers to reach vulnerable communities like LGBTQIA+, men who have sex with men, people who inject drugs, orphan and vulnerable children, sex workers and so on to get them to test and treat for HIV,” the official said. 

“These interventions were targeted at high prevalence pockets of Pune and Thane in Maharashtra, five districts in Telangana, whole of Andhra Pradesh, and Manipur, Mizoram and Nagaland in north east,” they further said. 

Over 500 field level workers employed under various HIV-related projects in India who were reaching out to over two lakh patients abruptly find themselves removed from the project after the shut down instructions that arrived in January earlier this year. They helped with facilitating testing, giving reminder calls for taking crucial anti-HIV medicines, facilitating child care, and updating data from sites. “Even if HIV patients reach out to workers, they may help them in their own capacity, officially there is nothing much they can do. Orders have come to remain very low key,” the official said. 

Officials say that this will effect the quality of services being provided at government facilities in certain high prevalence pockets which tend to get over crowded as the government staff will lose technical assistance that they used to get earlier. “The one-on-one attention will be compromised, as the field workers helped fix appointments for check ups and dispensation of drugs,” said the official. 

Also, a digital platform – ‘SafeZindagi,’ which helped patients with booking treatment and seeking counselling services under Project Accelerate has also been shut down. 

Sources working closely with Project Accelerate said that the temporary suspension of USAID activities does not affect the salary component of the staffers. Between 2019 and 2024, a grant of $32 million was received for PEPFAR, and this grant had been extended by two more years. 

“A quarterly advance of close to$2 million has already been received for the project, and salaries will hopefully be paid out, but we cannot show any expenses from January 25 for office electricity, meetings, trainings, rent. Staffers have been asked to stay at home,” according to the source.

The Indian government has started concerted efforts to integrate the well being of transgenders which also serves as a preventive step for controlling HIV. Significant progress has been made by Ministry of Health, Ministry of Social Justice and USAID towards running ‘Mitr Clinics.’

“President Trump in his introductory speech said that there are only two genders. In light of non-recognition of trans-rights, the speculation is that an entire vertical of focusing on transgender rights may be removed. Also, programmes related to anti-abortion and family planning may take a hit,” the source added.