UNAIDS - Press conference: Impact of US funding cuts on the HIV response

OK, thank you very much. Today we're 24th of March and this is the UNAIDS press conference. Thank you very much for coming online and in the room. This is our director, executive director from UNAIDS. She will be giving remarks and then we will take questions. Also to my left is Anjali Ashrakar, who is the Deputy Executive Director. She's also here to field your questions. Merci beaucoup. Over to you, Winnie.

Okay. Thank you. Bonjour. Good afternoon. Good morning, wherever you are, members of the press. Thank you for coming. I'm here together with my colleague, Deputy Executive Director, Anjali Ashrakar. And of course, Charlotte, thank you for moderating. When I just taken up my role as the head of UNAIDS, that was in 2019, one of the first things I did was to visit Kenya. There I met a woman called Juliana Atieno. She had been diagnosed with HIV as a teenager. She had been raped when she was in high school. But she'd gone on to fight to get on treatment and was now working as what we call a mentor mother in the HIV language. That is someone who connects pregnant women to services, looks out in the community, encourages them to come to a clinic to get tested, to get antenatal care, and to stay on treatment until they have a baby who is free from HIV. So important is her role in the community in Africa, where there is strong patriarchy, men dominating women. You have even violence in families when one shows up as HIV positive. There's a risk of even being thrown out of a home if you go to a clinic and find you're HIV positive. Getting your husband to also come and be tested and that whole story, this the mentor mother does. She saves lives. She's a connector. I met her. I was so impressed by her. Now recently, I called her again because I know that the project she was working on, connecting people, pregnant women to the clinic, was funded by USAID. And I wanted to know whether she was OK. She told us that The project had received a stop work order from the United States in January, and that all the staff had been put on unpaid leave, including herself. She told us that mothers had panicked and were running to different clinics, trying to stockpile medicines, expecting them to run out. She said that she put on a plastic smile to these mothers to make them feel calm, but deep down, she was herself in panic. Because you know, Juliana, when I met her, had two little children, had just given birth to a baby girl four months earlier and was still breastfeeding. To prevent transmitting to her baby, she needed to stay on treatment herself. Wasn't sure whether she was going to be able to. She has no income. By the way, her income at that time, she told me, was $20 a month. She was not earning a salary. She was getting a stipend for doing this incredible work, lifesaving work. That $20 wasn't there anymore. She lives in a little slum dwelling. She rents it. She had an unemployed husband. There she was. But she was there, still optimistic, still struggling, still expecting to survive, and also keep other mothers alive and well, saving their babies. Now, that is Kenya. Kenya is less reliant on U.S. funding than many other countries. Actually, Kenya pays for 63 percent of its own HIV response. But now, think about a country like Tanzania, which depends 94 percent of its response from external supporters, mostly from the United States. So you can see. And then, even short-term interruptions to treatment are devastating for people living with HIV. If someone skips their doses, this leads to drug resistance. This leads to a viral load increase. And this leads to infections. So, I could give you more stories. I can tell you about a guy in Uganda, just 22 years old, Emmanuel, who said that the US-funded clinic he was going to was closed, and the government advised all people who were in such clinics to report to the government-funded hospital or clinic. But he said that that's what everybody did. And so he went, he waited six hours in the line, and at the end of six hours, they said they had run out of ARVs and told him to come back after two weeks. That's how resistance builds up. He doesn't take treatment for two weeks, he becomes, starts getting resistant to the drugs. So, and then gets sick. And then that's how we see deaths increasing. So this sudden withdrawal of US funding. has led to shutting down of many clinics, laying off of thousands of health workers. These are nurses, doctors, lab technicians, pharmacy workers, all kinds of data entries. It's a lot. And all this means that We expect to see new infections rising. UNAIDS has estimated that we could see new-- we may be having 2,000 new infections every day, more new infections every day. This is our estimate. And for Africa, the closing down all of a sudden of drop-in centers for girls and young women will be disastrous because more than 60% of new infections on the continent are amongst girls and young women. And many of them have been going to centers created to give them the privacy, the confidence to get what they need to prevent infection. So there we are. I could give you more examples. If you ask me later, I will give you some more examples of the evidence we are getting on the impacts, devastating impacts. We have estimated as UNAIDS that if the US assistance for HIV is not restored after the pause. As you know, the pause ends in April. And is not replaced by other funding. And we have not heard of other governments pledging to fill the gap. There will be an additional, in the next four years, 6.3 million AIDS-related deaths. 6.3 million more in the next four years. At the last count, 2023, we had 600,000 deaths globally, AIDS-related deaths. So you're talking about tenfold increase. We also expect an additional 8.7 million new infections. At the last count, there were 1.3 million new infections globally, 2023. You're talking of losing the gains that we have made over the last 25 years. It is very serious. Today is World TB Day. Nearly one third of all deaths among people living with HIV are from TB co-infections. very, very closely related. The US cuts mean that today, 27 countries in Africa and Asia are experiencing shortages of staff, disruptions of diagnostics, treatment, and surveillance systems are collapsing. The door is being opened to millions more AIDS-related deaths through TB. Let me lastly talk about prevention. Prevention is actually being impacted even more than treatment. Since there was a waiver to PEPFAR, we've seen some services coming back, particularly treatment services. But challenges are there, particularly for key populations, girls and young women. These people who have been served by special services that help them to overcome stigma, discrimination, criminalization. I'm talking of LGBTQ people, sex workers, people who inject drugs, and as I said, girls and young women. Prevention services are not coming back that easily because the cuts, in addition to the cuts, there is also a pushback on rights. And people who have been experiencing discrimination stigma, who are criminalized, are afraid to come for services to places where they might face discrimination. So we're seeing the centers that we are providing them with prevention services not reopening for fear that this might not be consistent with the new guidelines. So there we are. I want to say that it was probably the greatest -- that the United States leadership has been really the greatest act of humanity in global health, just for HIV, but supporting the eradication of so many other diseases, progress against other diseases. We are so grateful for that. And we continue to count on American leadership in global health. The United States has been an incredible partner for us, UNAIDS, of course, Global Fund, working closely with their PEPFAR program. It is reasonable for the United States to want to reduce its funding over time. But the sudden withdrawal of lifesaving support is having a devastating impact across countries, particularly Africa, but even in Asia and Latin America. We urge for a reconsideration and an urgent restoration of services, life-saving services. I want to be clear that we cannot claim that the way we have worked, delivered for people living with HIV and at risk has been the most efficient or the best way to use money. I think some of the criticism is valid. about the strategy that has been used and how we have addressed our work. It is an opportunity to rethink and find more efficient ways of delivering life-saving support. But the suddenness The sudden withdrawal of services, I repeat, is devastating, is going to cost many lives and needs to be reversed quickly. America also has been a leader in innovation for health technologies, for HIV. Let's also remember that. America has dominated the field of innovation for HIV, whether it's diagnostics, prevention tools, treatment tools. A list of companies that have made fortunes out of working on this disease and have saved many lives. PEPFAR has saved like 26 million lives since it first came on board. 20 years ago, US innovations have led to a revolution in treatment. Now, we are at the cusp of another revolution in prevention. Treatment, we've brought 31 million people on treatment out of 40 million. 9 million people are not on treatment today. This amazing work has come from US leadership and European leadership. But now we have new tools. One of them is called Lenacapavir. I've called it a magical tool for prevention because it's proved to be 100% efficient and can be delivered as two injections per year. Right now, trials are going on for even delivering it as one injection per year, one injection per year. That is almost like a flu vaccine. Can you imagine one injection for an African girl will keep her safe? Now, if this could be rolled out ambitiously across all the-- we could cut down new infections to close to zero, we could see the end of AIDS. This is the opportunity that must be seized to drive down new infections, to get it down to zero. And then the challenge will be getting those who are living with HIV today on treatment, staying on treatment. That is a job we already know how to do very well. Now, This is an American innovation, lenacapavir. Gilead is an American company that stands to make the profits out of this innovation, only if, only if the president of the United States, his administration, see the deal that it is. It is an amazing deal. President Trump likes to cut deals. He's a deal maker. So I'm making this message directly to his administration. There is a deal here. It was a Republican president who led the revolution on treatment, President Bush, who started PEPFAR in 2003 and rolled out antiretrovirals. across the world. It could be President Trump, another Republican president, who leads the prevention revolution leading towards the end of AIDS. But the deal is that an American company is enabled to produce and to license generics across the regions to produce millions and roll out this injectable to those who really need it, the new infections. They are in middle-income countries, they are in the low-income countries of the South. To roll it out to all those people who need it, to make profits for Gilead, to create good jobs for Americans, and to save lives in the South. That's the deal. And I believe that this is an opportunity not to be missed. I want now to say that this, and this is my last point, that you see, this is also the way that developing countries, particularly the low-income countries, can be sustainable, can sustainably support their own responses. They were already on the path to progressively pay for their own responses. Many of them are on the path, and we UNAIDS have been supporting them to draw these roadmaps. Now, with a reducing number of people living with HIV, with no new infections, now the burden the financial burden becomes manageable for these countries, particularly low-income countries that face many challenges for their development. So I want to stop there and take your questions. And I'm also keen to hear you on what you think of the deal. that I'm putting down. Thank you so much.

Let's start with from AFP, Nina.

Thank you very much. Sorry. Can you hear me? Sorry, here, yeah, over here. Yeah, so I just wanted to ask you, it's Nina Larsen with AFP.

Yes, this is Nina from AFP.

You mentioned the risk that there could be 6.3 million more deaths within the next four years at the same time as infections will be rising if the aid is not reinstated. Could you sort of see the trajectory further along? I mean, if there are more infections, and I assume that you're looking at a very large number of more deaths if going forward if the aid is not reinstated. Thank you.

Very quickly, I've mentioned the projection for four years. In the longer term, we see the AIDS pandemic resurging, and resurging globally, not just in the countries where now it has become concentrated, low-income countries of Africa, but also growing amongst what we call key populations in Eastern Europe, in Latin America, we will see a surge of this, a real surge in this disease. We'll see it come back and we'll see people dying the way we saw them in the '90s and in the 2000s. That is the short answer to your question.

And Catherine, who's the ACANU president, Catherine Fiancambonga, over to you.

Yes, I'm here. Thank you. Thank you, madam, for being here. I have, in fact, a series of questions. You spoke about an estimate of plus 2,000 infections per day. What is the rate of infections today so we can compare? Also, you spoke about the fact that the pause ends in April. Have you already found some donors who would be ready to take it over and help you support your programs? You spoke also in the press about certain percentage of programs that have already been suspended. I think it was 43 percent. Please correct me if I'm wrong. The number, the percentage of programs that have already been suspended. So if you could give us the figure, share the figure. And also, how many staff have already lost their jobs in Geneva and in the field because of this...

Excuse me?

Yes, UNAIDS staff. What is the percentage or the number of UNAIDS staff who has already lost their jobs in Geneva or in the field? And my last question for the moment will be about Europe, because we've heard that young people seem to be less likely to protect themselves during sexual intercourse. So what about the risks also in Europe, and particularly you spoke about TB-caused infections, and we know that the, I would say, the heart of TB infection is in Central Europe. So what about the programs there? Thank you so much for your answers.

What was that last question?

So my last point was that you mentioned that one third of deaths are of TB caused infections. And if I'm not mistaken, the heart of infections regarding TB is particularly alive in Central Europe. And I'd like to know how your programs are able to continue their work there or have already been suspended.

Okay. Those are many questions. I hope I have tried to record them. First of all, congratulations, Catherine, on your role. It's so important that you've taken that responsibility. Then you ask about new infections and how many are they per day? At the last count, we had 1.3 million for 2023. How much does that amount to per day now?

About 3,500.

About 3,500. Thank you, Anjali. So we have 3,500, we're talking of another 2,000. So you see almost doubling the new infections. Second question was about how the next questions were very much around UNAIDS, if I understood them. One was about have we found new donors to fill the, you mean to fill the US gap?

Yeah, in prevention. If it's...

In prevention in countries.

I mean, no. In case United States of America, after this pause, that means from beginning May, doesn't support in another form, doesn't support financially in another form your work, your programs, have you... UN AIDS, always. Have you already identified... new donors, foundations, countries, individuals.

Well, thank you. Got your question. You're now asking about us as UNAIDS. To tell you the truth, for me, always, I come from activism. That's who I am. My focus is always about people living with HIV, my cause, people living with HIV. people at risk and how they are being affected. And I also think about the work we do for them. Thinking about that, first, we had a budget, a core budget of $144 million in 2024. Out of that, 50 million was a contribution, very generous contribution from the United States. That's about 35% of our total core budget, the core budget. Now, that, we do not know whether it will be restored for next year. We don't know. We are indeed engaging with the United States government. What's important for us is to let them understand that the role of UNAIDS complements the role of PEPFAR. We do, in the whole ecosystem of HIV, We have our specific role, just like PEPFAR has its role and Global Fund has its role. Among our roles is the data role. We gather, because we have the presence on the ground in countries, we have the data role. We gather all the data that everyone uses, including PEPFAR. We also have our political role of setting the goals every five years, mobilizing the whole world to agree on ambitious targets and holding them accountable to them. That's our role. Without that, every country would take its own direction, set a very low bar for itself. We would not see ambition of the response. PEPFAR would not get the results. from the funding of American taxpayers. So, and that's just two of the roles. We play a community role, for example. The people who are most in need, who live with HIV, are on the margins of society. They need to be connected to the planning, to the delivery of services. That's our role, support communities of excluded people to come and get what they need, to claim their rights to services and to be part of the process. That's our role, to set the policies that must be there for the money to deliver. You need some clear policies, both on the science and also on rights, to make the money work. So all these things are ours to do so that PEPFAR can do its program work. So we are engaging with the American government and My colleague, Deputy Executive Director, leads that role to persuade the government that we are a complement, that if you put PEPFAR back, you also need UNAIDS to fit in, to plug in. That is very important. Regarding other donors, I mean, the European donors already contribute to us, already contribute, make contributions to the joint program. But we've been trying from a couple of years to engage some more and with some success, given that European countries have been reducing their aid budgets. As I talk now, some of them have indicated significant cuts because of commitments in defense and other reasons. So we are not seeing any of them promising to fill this gap, not at all. That's the answer. What we are seeing and hoping is that they will stay the course. They will stay the course and will continue to fight. In terms of what has been suspended, I didn't understand that question, but we are indeed in a restructuring process. We are looking at different scenarios of how we can manage to keep this important role going. But let me be clear. In looking at this, we are not trying to protect a brand. That's not me. That's not my way. I am an activist leading an activist organization. We are an advocacy body. We are looking at how to make sure that this important role we play continues to be played so that people living with HIV, people at risk, continue getting what they truly deserve, these lifesaving services, whatever way it comes, whether it comes as a smaller UNAIDS, whether it comes as a UNAIDS in partnership with somebody else, I don't know, but we are looking at many scenarios of the future, a future that could include less or even no contribution from the United States. We can't assume it. We can't assume the contribution. Now, how many staff have lost jobs? None, not Now, we are looking at these scenarios. We are in a restructuring process, but we haven't yet given anybody a pink slip, if that's a simple answer to your question. But indeed, they are going to be painful decisions to make, but these decisions are right now being considered. TB, it's true. in Eastern Europe and Central Asia, it is a big issue. I could pass that question to Anjali about what we are doing there. Can you? Thanks.

Yes, thanks. Thanks, Winnie. Maybe I'll comment on and complement some of the responses that Winnie provided. First, the I think it's important to note that of the 1.3 million new HIV infections that were described earlier, that's around the world. There's still in Europe and North America 56,000 new HIV infections. as of last year. So still significant amount of new infections that are still there. When you compare that to East and Southern Africa, for example, where there are 450,000 new infections, you can see the contrast. But again, our goal here, in order to get to the first question around the trajectory of where we're headed to end AIDS as a public health threat by 2030, The issue is, that we must, as a globe, we must drive down all of those new infections and all of the AIDS deaths in order to meet that goal of ending AIDS as a public health threat by 2030. So that's why, in a context where we don't have a vaccine or a cure, where the closest thing we have is to ensure that those people living with HIV are on treatment and virally suppressed. And these new tools that our executive director mentioned, like the long-acting injectables for prevention, these new tools are absolutely critical in order to scale so that the hope and the promise of achieving the Sustainable Development Goal 3.3, which, by the way, is one of the only goals that's actually moving in the right direction. And we can claim victory, but only if we take it to the last mile, which is so critical that we make sure that no new infections are occurring as we move toward the next five years, toward 2030, and that those AIDS deaths continue to be dropping.

Thank you, Anjali. Olivia Le Poidevin from Reuters, over to you.

Thanks, everybody, for this briefing. Hi there. I have a few questions, if I may. Just in terms of, you were mentioning there about kind of people stepping in to help fund the gap that you're trying to do at the moment. One thing I noted in a report you recently released is that some governments had said that they might step in to help with funding, however, that they're not going to do that until such time as the US has completed its funding review. Hi there. Hopefully, that's better for you. Thank you. So I'll just repeat my question from the top. In one of your recent reports by UNAIDS, you were saying that some governments have said that they might step in to help with some funding after the US completely withdraws its funding. However, in the meantime, until such time as that review by the US is finished, they won't actually offer the money. And so my kind of question is, in this kind of interim period, kind of impact is that having? My second question is, could you just explain a bit more as to why you're concerned about the kind of key populations in Eastern Europe and Latin America in terms of the kind of broader surge? If you could just explain that, that would be helpful. And also, in terms of key population areas who are impacted, I noted also that testing for pregnant women is one of your areas of concern. Again, are you able to describe what kind of impact the shuttering of US-funded facilities for testing pregnant women is having? Thank you.

Thank you for your questions. First, I am uncomfortable talking about the impact of the US cuts, the pause, and the role that other donors play and can play without speaking about the role of developing countries themselves. I do not place them in that passive position. of sitting there waiting for money to come to them. This is not the case. They are fighting. These countries, particularly the low-income countries of Africa, are facing huge challenges today. They are the ones facing the worst impacts of climate change. They are facing, some of them, they are in debt distress. Others are close to debt distress. They are paying towards interest on their debts three, four times more than they are putting in the health of their people. This debt isn't entirely their own creation. Interest rates shot up globally during COVID and even shot up further Because of the war in Ukraine, which they had nothing to do with, they found their debt multiplying three, four times over. So these countries are facing the consequences of global challenges that they have contributed very little to, but they are now losing global solidarity. the support that really is justified support to them that compensates a little for much of what is unjust in the global economy. Many of these countries, Africa loses $88.6 billion through illicit financial flows, most of it tax dodging, just avoiding the rules, using the rules that help companies not to pay their taxes where they do their production. 88 billion. Their total bill for health is 144 billion, but they already lose 88.6 through tax dodging. You need to see this problem more globally, comprehensively. But these countries are fighting. We are following them. We are seeing so many of them trying to stretch already very weak, fragile health systems to absorb people living with HIV and people at risk. We are seeing some of them making small reallocations out of tight budgets that they have. We are seeing them asking civil society to work with them closely. They are coming to us to give them advice on smart ways to deal with the gap. So let's not assume that they are sitting there just waiting for help. They are fighting, and they need support. Coming to I think the question was very much around the impact if there is no gap filling. One thing I'm sure of is that the ingenuity, the unity of this movement of people living with HIV will fight. for survival. I see a changed way of responding to HIV. I can see us being forced to be innovative at the country level. I can see donors changing how they work. I mean, some of it is just was not going to be sustainable anyway. The parallel systems that exist through which PEPFAR delivers, this may not be viable anymore. There's going to be a lot of changes, but I can see that the change will be driven by people living with HIV themselves, demanding and fighting to live just like they did. How did they get treatment? It wasn't just handed to them. people living with HIV in the South and gay people in the North came together and demanded that ARVs that were already available in the North become available for everyone living with HIV. And that's how it happened, through a movement, through struggle. I see that I am optimistic, as always, as a fighter, as a social justice fighter, that We will mobilize the movement, we will make demands, and governments and companies will follow. I believe that. Key populations, why we talk about them is that, you know, new infections are growing. In middle-income countries, 41%, I believe, of new infections are in upper-middle income countries at the last count, 41%. And you see, when you say middle income country, you start to think these are rich countries, they are serving their people. No, you're talking of the poorest people, like black women I met in the favelas of Brazil, like the gay men, indigenous, black that I met in Colombia. It's like, yeah, these are people not being served. These are people where these middle income countries are amongst the most unequal countries in the world. There are people who go to work in jets and helicopters, and there are people who live in the worst slums in the world. And that's where the disease is. So we insist that to end this disease, we have to end it everywhere. There's no pandemic you can end by serving some rich people and leaving others out. So we insist that everyone should be reached, particularly, not only in low-income countries of Africa because they are poor, but in every country where people are at risk or are -- so if you're talking about prevention, people at risk, testing pregnant women. You know, it will be so sad because this is one area where we were making the fastest progress. Countries were moving towards ending mother-to-child transmission. But we are seeing this falling back, partly because the supply of the treatment, the pediatric treatment itself, is supplied in many countries by the brand maker, not generically. Production is controlled by one company. Supplies, we are beginning to see shortages in many countries. Angelique can speak more accurately on that. But also, pregnant women living with HIV want so badly to save their baby. They want so badly to save their baby, but many, many times the challenges around them accessing the services have to do with many other social factors, and that's where the ecosystem works. We've got these mother mentors, we've got counselors, we've got a whole army of support for them to be able to prevent the transmission to their babies. Now what we are seeing is that the system is being dismantled. Parts of it is falling apart. So that is what I would say about mother-child. I'm giving long answers, and yet there may be many questions. Could I leave it there?

Yes, leave it there. I have one question from Christina Okello, who is a journalist from Radio France Internationale. My question to you, Ms. Byanima, is you mentioned that countries like Kenya fund the majority of their HIV response domestically. Do you believe other African countries can realistically follow Kenya's example? and what concrete steps can be taken to encourage more African governments to take ownership of the HIV response? Over to you, Winnie.

Oh, thank you for that question. Akello from RFE. I am proud of you because you are from my Anglophone region, and you are on RFE. Well done. You ask a good question. There are many countries who have been on the road towards self-sufficiency, self-financing. I mentioned South Africa, 76% of its response is funded from their own budget. South Africa is a country with 8 million people living with HIV, and it has put 6 million on-- it's the largest number. has 6 million on treatment, funded mostly by itself. Botswana, 66% of its response is self-financed. Ghana, 57%. We think, I mean, no, this is also a myth. Countries, governments don't want to be dependent. They try. So the idea that they are just sitting there, not trying, is wrong. They face enormous challenges, enormous challenges. They manage very, they are really right now in austerity, self-imposed austerity. So let us... Let us understand that it's not just Kenya. There are many who are trying, but there are many who are a long way, that's the truth, from getting there. I mentioned Tanzania, 94% dependent. Uganda, also about 90% dependent. Many countries are still a long way off. What can we do to get them there? Well, to tell you the truth, this disruption is a wake-up call. They are right now looking at how to do this. In Uganda, UNAIDS, working with networks of people living with HIV, has been engaging the parliament, parliamentary committee on HIV and health, to call for an increase in the budget for the HIV response. At the last meeting of the ruling party, the president committed to fill the gap that has been of about more than $370 million that the Americans were putting down for Uganda. So we are seeing countries trying. We are supporting them. And yeah, it's not-- I don't look at this as lack of will. This is also one of the myths that I really want to bust here, lack of will. You just have to look at the needs and the available resources and the debt. So these countries are really not just sitting there comfortably waiting to be supported. They are fighting. So a That's my answer to your question, that we have worked with them to make their roadmaps. They are on their way. And actually, when PEPFAR comes back, because it will come back, there's a promise to bring it back, one of the key things it can work on together with us, UNAIDS, is to work with the governments, the civil society, on realizing real transitions that are time-bound towards self-sufficiency. This is something that the United States, together with the other donors, the Europeans, can work with us on to build commitments towards these transitions. It's possible.

Merci. I see that Isabelle from AFAA, which is the Spanish press agency, has a question. Over to Isabelle. Gracias.

Good morning. Thank you. Firstly, I am interested in if you have details or you can share some information with us. Because you mentioned the lack of an American company which is the company that produces this treatment for prevention for injectables. And I would like to know if you were-- because I remember in January, I did an interview with you, and you mentioned already this. And I want to know if your agency was already planning purchase of this, uh, the, the procurement of this, uh, um, product to, uh, go for, for prevention, uh, programs. And in this case, if you can quantify the loss of business by this American company, if you, I mean, if they don't associate with UNAIDS, because we know that you, I mean, your procurements are very important for the developing countries at different prices, of course, than the market. And this is one question. And the second one is on, you mentioned the $144 million that the United States give for your core budget, but there is also the non-core budget. So could you clarify this? I understand that altogether it represents 65% of your finance. So if you could confirm this. Thank you.

Thank you. I will start with that last one. No, it's not 65%. None core, you're right, that we also get a contribution from the United States. This varies because it's targeted to specific activities. If I can mention, I mean, for 2024, it was close to, it was around 60 million. $60 million. And if I look at the total budget, the total budget was about 220 million. So 60, 50, 100. So they were close to a half. They were about a half, a little bit more than a half of our total budget. That's a lot. And so we are facing quite a shortfall. But let me say, We are not on a cliff about fall over. We saw the cuts coming. We started our restructuring process actually in December last year, well before the pause. We had our high-level panel reviewing how we operate. It started its work last year in June. So we've been monitoring the declines in aid. As I said, it's not just this pause. It has been a decline generally in aid coming from all the donors. So we are managing very responsibly. We do not have a liquidity problem as such, so we are not about to to fail in our contractual obligations to staff or to fail to pay their salaries, no, but we do face a very difficult future and we're looking at that. But right now, we are managing responsibly and our staff are safe. We are not failing to pay, and we are not in a liquidity crisis, but we are restructuring to fit in a much smaller envelope and to change the way we work, change ourselves. So regarding Lena Capoville, when you mention that, I get excited, because for me, I see real opportunity here. The company is called Gilead. It's an American company. It's doing very well. Actually, Gilead, let me see, it turned in, it declared a profit last year of $480 million. Declared, I have to underline, because these companies don't always tell the truth. They hide. So it's a rich company. It has an innovation. something that actually they were already looking at how to sell it in the richer markets. It's our pressure with civil society that pushed them now to license six companies to produce generics, one in Africa. Now, they also entered an agreement with Global Fund and PEPFAR last year to roll out 2 million of this magical product, of this long-acting injectable. For us at UNAIDS, as the data source, we know that to reach the goal of ending AIDS as a public health threat, in 2030, the SDG goal, we would need to be rolling out 10 million in the next three years, not two. So we were pushing Gilead and saying, you can do better. Don't delay the production of generics so that you can maximize on your brand. License more companies. roll out. After all, during COVID, didn't we vaccinate 440 million people in one year? One year, 450 million people were vaccinated globally. What's hard about 10 million? So we've been pushing Gilead. Now, Gilead is right to be scared. I think that's why they are keeping quiet, because they were also depending on this market-shaping role by PEPFAR. and Global Fund and us on the ground who organize the countries, get the policies in place so that the rollout can happen. But now, this whole system was getting an important contribution through PEPFAR, through Global Fund, and through us. So they are right to worry. Their deal is in trouble. And on that note, I am an ally to them. We, UNAIDS, they are our allies. These companies have been our allies, but we are critical friends, because we -- look at what they are doing. They are not transparent. They were not being transparent on the countries where -- how they are selecting countries where the generics will go. 120 countries. But they don't include some of the countries with the high numbers of infections because they are looking at profits, right? They are not transparent on prices. They say it will be at no cost. But even though they say it's at no cost, they don't tell us their production cost. So how are we to know they are not making profit? We don't know their production costs. So there were things that we were still pushing them on to do right, to stop playing this monopoly card and delaying and hiking price. But we are allies because they were moving slowly in the right direction. A long answer to your question. So to Mr. Odeh, I say, let's work together fight for PEPFAR to return and help shape the market, and let us convince President Trump to do a deal on prevention.

Merci. Thank you. Last question will be from Jenny Lee Ravelo from Devex. Over to you, Jenny.

Jenny.

Hi. Thank you. Hi. Thank you so much, you know, for doing this press conference and for taking my question. I just want to clarify, because Reena, you mentioned about 50 plus 60 million in US funding. I just want to get a sense, is that the total funding that's been terminated by the US government to UNAIDS? And also, a second question is about the restructuring. You mentioned that you're in the middle of a restructuring process right now. But have you, what potentially be the worst case scenario that you're looking at? Because some staff are concerned that, you know, up to 40% are thinking they may lose their jobs. So, yeah, thank you so much.

The first question, I didn't quite get it. Can you repeat it? Your first question.

Yes, just want to clarify if the 110 million total US funding was terminated by the US or just part of that was terminated?

Okay. First, the terminations were about all their funding. However, we've been talking with them and seeking clarity. There wasn't full clarity. And I cannot say, but I think that the termination was probably around our non-core rather than the core funding. But we are in a discussion, and the discussions are very positive. So I want to leave it there, unless Anjali wants to add to that. Then regarding restructuring, Jenny, I'm giving you no numbers. Because as I said, we are looking now at scenarios of the future. We have not come down to any numbers. This is speculation. And, Jenny, Devex, you shouldn't add to the speculation by reporting rumors. You are now hearing from the source. We have not reached any numbers. There are no numbers that we have. reached. We are still looking at scenarios of the future. And we will get to numbers, and at that point, we will -- we keep our staff informed. We have a staff platform through which we are talking to all the staff and consulting. And so, worst-case scenario, worst-case scenario is supposing we do not get any more funding. in the future from the United States, supposing the European donors, who some have already said they are reducing their aid, but they haven't told us yet. You know, for example, today, I think we are going to hear the Secretary to the Treasury in the House of Commons spelling out cuts to their government. And that might include some more details about how they are moving from 0.5 to 0.3 of their GNI for aid, percentage of GNI for aid. So we will get, and even then we will not know yet what that means for us. The French have said they are going to cut their aid by 30%, the Belgians by 25%. So all this may have implications for us too, and we are looking at a scenario where those might mean reductions as well. So worst case scenario is about more reductions from Europe, as well as the possibility of zero from the United States. But as I said, I mean, we are engaging, we are engaging, and we are seeing, I mean, for example, We're moving ourselves from core funding to more non-core funding, and we are being successful. Last year, we got the French coming on board with some significant funding for Western Central African countries that is non-core, and also for some countries in Asia that's non-core. So we're doing more to raise non-core. We are also looking at the problem without any -- what's the word now? The English is lost. We are being very realistic about core funding continuing to come down. But we are also stepping up in another direction and looking at different futures. That's all I can say. No numbers, Jenny, sorry.

Thank you so much for attending.

Before you end, I would like my colleague to fill in for some of the questions that I was answering.

Over to Anjali.

Great. Thank you. Thanks, Winnie. I'll maybe just complement on a few things. First, on the question around Jenny from DevX, The US government gives UNAIDS resources through USAID and through CDC. These are all PEPFAR resources from the State Department. So what was terminated was the resources coming from USAID. which in total is 50 million core and then roughly 40 million of non-core, which is what Winnie described. But we will see how this unfolds as the review is completed. One question that I wanted to come back to from Isabel. UN AIDS, we don't procure products, but as Winnie said, one of the most important things that we do as UN AIDS is we can help set the global market. And we do this by global target setting. And we're in the process right now of developing the targets for 2030 that will take the world to end AIDS as a public health threat by 2030. And our goal is to be ambitious there, both with treatment, but especially with prevention targets, because there's a real opportunity. So you'll see how we're mobilizing around setting the market, setting the ambition. The question around Olivia from Reuters on in Latin America, I think the question around key populations in Latin America and the Caribbean. There are about 120,000 in Latin America, 120,000 new infections in Latin America, and many of those are among marginalized populations, especially key populations, which is why, as Winnie described, we're really needing to focus on where the virus is, where the virus is being transmitted. And mostly, it's in these marginalized populations, like key populations in Latin America or adolescent girls and young women on the continent of Africa, for example. So we really need to make sure interventions are focused where they're needed. Your question around prevention of mother-to-child transmission, that is That is one of the services that we know is part of the waiver from the Secretary of State, Rubio. And so those services should be picking up to ensure that women that are going into antenatal clinics are indeed being tested, and then those that are positive for HIV will indeed be put on treatment so that their baby will be born without HIV. Because there's been a disruption in these services, we know that there have been There have been challenges with testing in ANC centers, but also with babies being born with HIV needlessly. So it is, we've modeled this out, and we know that if prevention of mother-to-child transmission or, you know, this does not continue forward, there'll be about 350,000 babies that are born with HIV in the next four to five years, and that's something that we really worry about. So Again, we're really working at the country level, we as UNAIDS, working with the governments, with civil society, with all the partners on the ground to really make sure that those essential lifesaving services are indeed moving forward and that country governments are not forgetting about the importance of prevention, because it is critical to sustainability. So those are just the few that I would add. Thanks.

Merci beaucoup. Thank you so much. Thank you very much to Eunice and your help. Just know that, as I said in the chat, we have situation reports on UNAIDS.org. These are updated every week. We also have country impact reports that are updated daily. Thank you so much. Merci beaucoup.