By Michael Gwarisa
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has removed Voluntary Medical Male Circumcision (VMMC) programs from its list of HIV prevention and care initiatives set to benefit under the Life-Saving HIV Care and Prevention Services limited waiver.
The 90-day limited waiver, which permits the continuation of critical HIV care, treatment, and prevention services, comes amid concerns over service disruptions following the temporary suspension of U.S. foreign assistance. However, some programs have been excluded from the waiver, raising uncertainty among health analysts regarding their resumption even after the 90-day period.
Programs that will no longer receive PEPFAR funding include the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) initiative, community-led monitoring systems, certain prevention services such as voluntary medical male circumcision (VMMC), and the expansion of data systems beyond those necessary for patient management.
For purposes of this limited waiver, life-saving humanitarian assistance applies only to: Delivery of life-saving HIV care and treatment services through support for health workers (doctors, nurses, and other clinical and community health workers, etc.) delivering or monitoring HIV care and treatment to ensure continuity of service provision. These workers deliver care at hospitals, primary healthcare clinics, faith-based clinics, and community settings.”
The waiver prioritizes essential HIV interventions, ensuring the continuation of vital health services without interruption. Among the approved activities are:
- HIV Testing & Case Finding: Community and facility-based testing will resume, with a focus on re-engaging individuals who have discontinued care.
- HIV Treatment & Care: Antiretroviral therapy (ART) provision, viral load monitoring, and adherence support services will be reinstated.
- Prevention of Mother-to-Child Transmission (PMTCT): Pregnant and breastfeeding women will receive HIV screening, treatment, and preventive measures, including pre-exposure prophylaxis (PrEP).
- Advanced HIV Disease Management: Efforts to prevent and treat opportunistic infections, such as tuberculosis and cryptococcal meningitis, will continue.
- Supply Chain & Laboratory Support: Essential HIV commodities, including test kits, drugs, and laboratory equipment, will be procured and distributed.
- Pediatric & Adolescent Services: HIV-positive children will receive specialized care, including nutritional support and adherence counseling.
Recognizing cervical cancer as a major opportunistic disease, the waiver also allows continued screening and treatment for women living with HIV in 12 priority countries, including Zimbabwe.
While broader HIV surveillance and population-based surveys remain restricted, data management and health information systems essential for patient care and program oversight will be maintained.
