UNITED NATIONS (CMC) — A new report, released by the United Nations (UN) agency with responsibility for responding to HIV/AIDS, says the decision by the United States (US) to freeze funding, has led to shuttered clinics and health workers being laid off around the world.

UNAIDS said that at least one status report on the impact of cuts has been received from 55 different countries up to the start of this week and that includes 42 projects that are supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR) and 13 that receive some US support.

UNAIDS said that two days after President Donald Trump’s executive order in late January declared a 90-day pause to all foreign assistance, the Secretary of State issued an emergency waiver to resume “life-saving” humanitarian assistance, including HIV treatment.

UNAIDS reported just over a week later that there was widespread “confusion” over how the waiver was being implemented on the ground.

The 16 reports received from UNAIDS country offices around the world during the period of February 17-21, showed that these waivers have led to the resumption of some clinical services, such as HIV treatment and prevention of vertical transmission, in many countries that are highly dependent on US funding.

However, UNAIDS said it’s unclear how long funding will last amid multiple reports that key US government systems and staff responsible for paying implementing partners are either offline or working at greatly reduced capacity.

In addition, the UN agency said critical layers of national AIDS responses are ineligible for these waivers, including many HIV prevention and community-led services for key populations and adolescent girls and young women.

At the same time, UNAIDS said data collection and analysis services have been disrupted in numerous countries, according to reports received last week, which note that the overall quantity and quality of HIV prevention, testing and treatment services has been eroded.

Staff working in health facilities are facing increased workloads and patients are experiencing increased wait times to receive lifesaving services, UNAIDS said, adding that other concerns persist, from hobbled health systems to addressing gender-related priorities.

“US Government statements to UN system organisations suggest US-funded programmes focused on gender equality and transgender populations may not resume,” the UNAIDS situation report said.

The situation report covers more granular analysis on the global AIDS response’s heavy reliance on US foreign assistance, extracted from the datasets managed by UNAIDS.

For example, the report stated that more than half of HIV medicines purchased for the Democratic Republic of Congo (DRC), Haiti, Mozambique, Tanzania and Zambia are purchased by the US.

Before the freeze, Washington provided two-thirds of international financing for HIV prevention in low- and middle-income countries, according to estimates from the Global HIV Prevention Coalition.

The report also identified Haiti among 20 countries that rely most heavily on funding from Washington.

“People living with HIV and key populations at higher risk of infection play a crucial role in maintaining the local services needed to stay healthy,” the UN agency said.