AMNA NAWAZ: Well, the 26th annual International AIDS Conference is under way in Rio this week, and the collapse of American and international funding for HIV/AIDS is on the minds of many.

A new report details the impact of cuts to the program known as PEPFAR, which has been credited with saving over 26 million lives since it was established in 2003 by President George W. Bush.

William Brangham has more.

WILLIAM BRANGHAM: Amna, that report was done by the global HIV-AIDS nonprofit amfAR.

It surveyed more than 166 organizations in 46 different countries about the impact of PEPFAR cuts and the broader dismantling of USAID by the Trump administration.

It found that more than 1,700 treatment sites globally had been closed.

For some perspective on what this means, we are joined again by Dr.

Atul Gawande.

He was the former assistant administrator of USAID under President Biden, is a writer and a surgeon at Brigham and Women's Hospital in Boston.

Dr.

Gawande, great to have you back on the program.

I mentioned the study from amfAR.

Their details will be presented in Rio tomorrow, but a lot of this we have already seen.

I mentioned already over 1,700 sites have closed.

That's places where people can get treatment, preventative medications, et cetera; 73 percent of groups that provide services to particularly vulnerable groups, sex workers, men who have sex with men, people who use injection drugs, those groups report that they have stopped providing at least one type of service.

More than 63 percent of groups that provide medication to prevent mother-to-child HIV transmission, which we know is such a powerful intervention, have reported disruptions.

Does any of this surprise you?

And what does this mean for the larger fight against HIV/AIDS?

DR.

ATUL GAWANDE, Former USAID Global Health Assistant Administrator: On one hand, it does not surprise me.

On the other, we're now finally starting to see some actual numbers about the magnitude of what's happened.

And here's what I took away that was really significant.

Some key pillars of fighting HIV is being able to get services to people who might be shunned from the medical system, people you named, like sex workers, people who inject I.V.

drugs, gay or transgender people.

The second thing that you have to do is not only get people on treatment.

You have to contact-trace and test people who they are in contact with.

And testing and prevention went way down.

The numbers aren't as sexy as the closing of a clinic, but those are the things that start to happen when you have a surge of HIV return.

The third thing is, there were some reports, for example, from 22 neonatal clinics, a network of hospitals in Africa where newborns come to.

And they found that mothers had a 50 percent jump in HIV rates and over 300 percent jump in those places finding women were not on treatment.

And that means more children are now at risk of being born with HIV.

But we won't know that for a while, especially when you have taken away the testing, taken away preventive measures.

WILLIAM BRANGHAM: Right, taking our eyes basically off this epidemic.

DR.

ATUL GAWANDE: Yes.

WILLIAM BRANGHAM: I want to play something that Winnie Byanyima said recently.

She's the executive director of UNAIDS.

Here's what she said.

WINNIE BYANYIMA, Executive Director, UNAIDS: The question is no longer whether we can end AIDS.

The question is whether we choose to end AIDS.

The end is no longer limited by science.

It's limited by inequality, by political choices.

WILLIAM BRANGHAM: I mean, it seems like the political choices, again, not the scientific choices, the political choices we are making are moving in the opposite direction right now.

DR.

ATUL GAWANDE: One hundred percent.

President Trump, in his first term, actually set the goal, which seemed like a crazy goal, end HIV as a public health crisis by 2030.

But since then, the technologies to make it possible have developed, including the whole range of community health work force going after making sure people don't fall out of the system, the data systems, but then an injection to prevent HIV for six months.

WILLIAM BRANGHAM: Right, lenacapavir.

It's a remarkable drug.

DR.

ATUL GAWANDE: It is.

"Science" journal called it the discovery of 2025.

The administration is rolling it out, but not like you're on a campaign to end HIV by 2030, when you have said South Africa can't get - - is no longer a partner on HIV at all, a place with one quarter of the world's HIV cases.

We don't even partner with them around the development of HIV vaccines, and HIV vaccines have been largely removed from federal funding.

So we are on a path that is not only not ending HIV.It's lost that commitment to saying we're going to even prevent it from resurging.

WILLIAM BRANGHAM: We asked the State Department for comment about this, and they argued that the amfAR's study's methodology was flawed.

They argue, in essence, that preventative and lifesaving treatments and medications are still getting out through different routes, through different partners, through different memorandums of understanding, and that the idea that there is some catastrophe here is misguided.

What is your response to that?

DR.

ATUL GAWANDE: Well, they have made deals with governments to carry out the programs.

Those deals are with far smaller dollars, and so they don't go as far.

They don't provide dedicated services for people who are shunned by the government medical systems that we talked about.

And we already see information like I outlined indicating people are not getting the prevention, they're not getting the testing.

And there are signs even of treatment not getting to people needed, like in the study of mothers with -- who have HIV and are arriving pregnant and not on treatment.

WILLIAM BRANGHAM: While we have you here, I want to ask you about this other outbreak, and that's Ebola.

I believe it's 3,200 cases right now in the DRC Congo.

What is your sense about how that outbreak is going?

DR.

ATUL GAWANDE: Not well.

This is now the third largest outbreak of Ebola in history, and it's on its way to being the worst outbreak ever.

And the reasons why is that our ability to respond was set back from the very beginning by the destruction of a lot of our infrastructure and capacity.

We used to have a full-time adviser with expertise on Ebola in the country.

Not there anymore.

And the investments weren't there anymore.

We have now got a massive spend that's still not keeping track with this disease; 80 percent of the cases are occurring in people who are not even on people's contact lists for tracing.

So we have got a long way to go, and we're not doing the work that would get it under control.

WILLIAM BRANGHAM: Dr.

Atul Gawande, always great to hear from you.

Thank you.

DR.

ATUL GAWANDE: Thank you.