The health clinic where Alice Okwirry collects her HIV medication in Nairobi has been rationing supplies of antiretrovirals (ARVs) to one-month refills since the US government froze foreign aid. Meanwhile, millions of life-saving doses sit on the shelves of a warehouse on the outskirts of the city, unused and unreachable. The clinic is a half-hour drive from the warehouse, but for Okwirry, they may as well be an ocean apart. 

Without US funding, distribution from the warehouse, which stocks all US government-donated HIV medicine to Kenya, has ceased, leaving supplies of some drugs worryingly low, according to a former United States Agency for International Development (USAID) official and a health official in Kenya. The 90-day foreign aid freeze, ordered by US President Donald Trump after taking office on January 20, has upended the global supply chain for medical products to fight HIV and other diseases. It also blocks the distribution of drugs that long ago reached their destination countries.

“I was just seeing death now coming,” said 50-year-old Okwirry, who was diagnosed with HIV in 2008 and has a 15-year-old daughter, Chichi (also HIV-positive). Okwirry used to receive six-month supplies of antiretrovirals (ARVs) from the clinic but now only gets one month. “I asked Chichi, ‘What about if you hear the drugs are doomed?’” Okwirry said, growing emotional. “She told me, ‘Mom, I’ll be leaning on you.’” 

Last month, the US State Department issued a waiver exempting funding for HIV treatment from the freeze. But the USAID payments system in Kenya is down after the cuts, meaning contractors who implement the programmes cannot be paid, said Mackenzie Knowles-Coursin, the former Deputy Head of Communications, USAID, East Africa. He resigned on February 3 in protest at the dismantling of the agency. “[Those working on the] projects are left wondering, ‘Well, how am I going to resume activities if you’re not paying me money?” he said, adding, “The waivers that have been given are really on paper.” 

Knowles-Coursin added that officials in Washington have not authorised the release of money required to distribute the $34 million worth of medicine and equipment at the warehouse. According to a Kenyan government document seen by Reuters, about $10 million is needed for the distribution. The Mission for Essential Drugs and Supplies (MEDS), a Christian charity that runs the warehouse, supplies drugs to about 2,000 clinics nationwide, according to its website. Knowles-Coursin said that the commodities at the warehouse include 2.5 million bottles of ARVs, 750,000 HIV test kits and 500,000 malaria treatments. USAID referred a request for comment to the State Department, which did not respond. MEDS did not respond to requests for comment either. 

Kenya’s Cabinet Secretary for Health, Deborah Barasa, said she expected the government to mobilise funds to allow the supplies at MEDS to be released within two to four weeks. “We have identified the required resources,” she said in an interview. 

Fear and anxiety

Kenya has the seventh-largest number of people living with HIV in the world, at around 1.4 million, according to World Health Organisation (WHO) data. The President’s Emergency Plan for AIDS Relief (PEPFAR), the leading US vehicle for funding HIV treatment, supplies 40% of Kenya’s HIV drugs and supplies. A health official in Kenya, who asked not to be named because of the matter’s sensitivity, said stocks of two critical HIV treatments, Dolutegravir and Nevirapine, were low but did not know precisely how much remained nationwide. Dolutegravir is often used to treat HIV and tuberculosis coinfections. Nevirapine is often used to prevent mother-to-child transmission. CS Barasa said there would be enough Dolutegravir to last five months and Nevirapine to last eight months once the MEDS stocks were released.

For the time being, some patients can only get refills of their ARVs for one week at a time, said Nelson Otwoma, Director of the National Empowerment Network of People Living with HIV/AIDS in Kenya. Lawsuits aiming to compel the Trump administration to restore funding for humanitarian programmes and reinstate thousands of fired or furloughed USAID workers are working their way through American courts. On Monday, Secretary of State Marco Rubio said the Trump administration had cancelled over 80% of all USAID programmes. In an internal brief last month, the Kenya government’s council on syndemic diseases estimated that the US cuts had created funding gaps of around $80 million. Finance Minister John Mbadi told senators last week that the government was reviewing whether to allocate emergency funding to compensate for USAID cuts before it delivers the 2025/26 budget in the coming months.

(Source: Reuters)