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Many countries' AIDS drugs and treatment are paid in part by U.S. foreign assistance. It's through a longstanding program that's been credited with saving millions of lives over the years. But last week, the Trump administration put into place a freeze and a stop-work order on most U.S. foreign assistance.
Since then, in South Africa and other countries, clinics where people go for their medications have had to lay off staff and even close their doors altogether, which means many people who rely on these clinics for AIDS medication have been forced to suspend treatment. So for those who rely on them for AIDS medications, they're forced to suspend treatment. And as Ari Daniel reports, stopping that treatment can mean trouble for the patient and for the broader goal of keeping HIV transmission under control.
ARI DANIEL, BYLINE: HIV was once a death sentence, but antiretroviral medications taken as a daily cocktail now allow people to live reasonably healthy lives.
SUSAN CU-UVIN: It doesn't mean that you're cured of HIV, but it controls the amount of virus in your body so that you don't get very sick.
DANIEL: Susan Cu-Uvin directs the Providence/Boston Center For AIDS Research. She says the drugs kill the virus at different points of its life cycle, keeping it from replicating. They're so effective that HIV transmissions plummeted between sexual partners and from mothers to children.
CU-UVIN: Any person who has HIV has been given a life. Stopping antiretroviral therapy means death, means sickness.
DANIEL: And this is why. Let's say someone's taking their HIV medications, and then for some reason, they stop. The drug levels begin to drop in their body. That's when the virus comes out from hiding. Chris Beyrer directs the Duke Global Health Institute.
CHRIS BEYRER: There are viral reservoirs of HIV in the body. We don't know where all of them are, but either way, the virus will come back.
DANIEL: Meaning that within days or weeks after a person stopped taking their meds, the patient will come down with what feels like a dreadful flu.
BEYRER: You're achy. You have night sweats. You have fever. And some people - they may feel like they're acquiring HIV all over again, with rash and high fever, headaches, nausea.
DANIEL: The disease will then progress.
BEYRER: Eventually, all those people will develop clinical AIDS and the very serious complications, like opportunistic infections, that a healthy immune system protects you from.
DANIEL: Everything from shingles to fungal and parasitic infections to, especially in Africa and Asia, tuberculosis - any one of which can kill someone without a functioning immune system. But here's the other problem with stopping antiretroviral treatment. During the period when drug levels in the body are declining and viral levels are growing, that's when the virus is most likely to become resistant.
BEYRER: Because you don't have enough drug in the body to fully suppress replication - and if you develop resistance to one of these antivirals, you generally are resistant to the whole class.
DANIEL: Forcing someone to move on to a second or third line regimen of drugs that are pricier and harder to get - plus...
BEYRER: If you do have a resistant virus, you can transmit it.
DANIEL: These are the reasons why public health experts, like Susan Cu-Uvin, are so worried.
CU-UVIN: Without antiretroviral therapy, the virus comes back in revenge.
DANIEL: And without intervention, she says, death from AIDS is all but certain. For NPR News, I'm Ari Daniel.
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