How the cuts in health care impact HIV, hepatitis, and tuberculosis treatments
The Javier Milei administration's cuts to health services reached 40% of the management staff dealing with HIV, STIs, hepatitis, and tuberculosis. The voices of professionals and activists.
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BUENOS AIRES, Argentina. People living with HIV, activists, and former health workers in Argentina condemned the 40% staff cut at the Directorate of Response to HIV, STIs, Hepatitis, and Tuberculosis , following 360 layoffs on January 31. This represents a process of dismantling public health, in which the head of the health portfolio, Mario Lugones, announced a total of 1,400 layoffs. In line with this, President Javier Milei decided to withdraw Argentina from the World Health Organization (WHO) .
How do these changes affect the provision of services for people living with HIV? Presentes spoke with activists and former employees and officials of the Directorate to learn about the impact.
"Today, there's no one to ask if there are technical problems related to tuberculosis and hepatitis."
"It's very difficult to know the implications of laying off almost half the staff. There's no way to sustain all the management's tasks. Not to mention the disaster it means for the people who lose their jobs," Sergio Maulen, former head of the HIV, STI, Hepatitis, and Tuberculosis Response Directorate (2017-2020) and current independent consultant, told this agency.
Of a total of 71 employees in the Department, Lugones's administration laid off 29 on January 31st—a 40.8% reduction. Many of these areas were left without technical professionals.
“In the national tuberculosis program, only one social worker remained with a contract until the end of the year, and a sociologist is guaranteed only two more months. The HIV program, except for the pharmacy area, was left quite bare. The structure is made up of departments, and virtually all of its coordinators, who generally had the technical expertise, have been dismissed. Finally, in the hepatitis program, the hepatologist was dismissed. Two people with a lot of experience remained, but they are not professionals; they have administrative functions,” Maulen explained.
In this regard, he emphasized that "the national level not only purchases and distributes medication, but is also the expert technical institution to assist the provinces, since most of them have one or two people, not necessarily specialists. Today, there is no one to ask if there are technical problems related to tuberculosis and hepatitis."
"The idea is to transform the Directorate into a mere dispensary—at best—to distribute medication and resources, nothing more. There are no reagents, no condoms. They expect the social security agencies to resolve everything," warned one of the former Directorate employees, who preferred to remain anonymous for personal protection. He had joined the ministry 15 years ago and is now on the list of those laid off.
Total helplessness
The National Front for the Health of People with HIV, Hepatitis, and Tuberculosis warned that this measure leaves the ministry unable to respond to these diseases. They also explained that the intention to delegate to the provinces the role of ensuring the provision of medications and supplies to the entire population "undermines the optimal use of public resources."
“If that were the goal, it would complicate things enormously because, on the one hand, it makes everything more expensive. Making a large purchase for a country isn't the same as purchasing for each province. Furthermore, we have to determine whether the provinces have the capacity to provide all the money that would need to be allocated. On the other hand, many of them have teams with only one person. To begin responding to all the issues requires having equipment, knowledge, and learning new functions. Depending on where you live, you have more or less capacity to access quality healthcare, and at the national level, that would be somewhat offset. This would increase inequalities,” Maulen warned.
Hache Barreda, an activist and member of the Argentine Network of HIV-Positive Young People (RAJAP) , explained: “There are cases like Corrientes, where follow-up analyses or testing have been impossible for months. There's a disproportionate increase in 'administrative problems' in obtaining medication. Now, some provinces are probably investing in prevention supplies while others aren't. The virus's spread factors are deeply rooted in social inequality. For example, there are areas in the north of our country that lack investment in prevention and care services. This leads to a much worse mortality rate for these infections.”
Withdrawal from the WHO
"We will not allow an international organization to intervene in our sovereignty, much less in our health," said presidential spokesman Manuel Adorni when announcing Milei's decision to withdraw Argentina from the WHO. In response, the Huésped Foundation explained that this organization does not have the power to impose health policies. It is an advisory body made up of experts from around the world that, among other functions, has the capacity to coordinate the global response to health emergencies. In this sense, it has funding and support mechanisms for these situations, which Argentina will not be able to request now, should it need them.
On the other hand, consultant Maulen considered that, although the outlook for the withdrawal "is not clear," the provision of services will very likely be affected. "The WHO is the one that approves the factories and medicines, negotiates the low prices, and performs quality control. The same applies to all vaccines purchased through the same mechanism," he explained.
A year of libertarian management
Before Javier Milei took office, the Directorate's Communications team regularly updated social media, held courses, and organized training sessions at universities, community participation centers, Community Health and Action Centers (CeSACS), and regional health promoters. All of these activities are key to ensuring the prevention of HIV, hepatitis, and tuberculosis, a task that is ignored today. "Many people wrote to us via private message. We promoted the Salud Responde hotline 0800-333-3444, a tool that this administration has been eliminating. That link no longer exists, and there is no updated information," explained the former Directorate employee who was part of the team.
Since Augusto Almada took over as head of Institutional Communications and Press at the ministry, he decided to redeploy the people in charge of communications. "He assigned many of them to do media monitoring and press clipping, even though we know the ministry hasn't said a word to the outside world for a year," he shared.
Last year, under the Libertarian administration, the Directorate's operations were far from what they used to be. "There were shortages of medications. Purchases were made, but they took a long time to arrive. There were many months without medication. Prevention activities are practically paralyzed," Maulen described.
One problem highlighted by all those interviewed is the lack of reagents for people living with HIV to undergo follow-up tests. “Viral load tests are suspended in many places. These tests tell us how our health is, whether the medication we're taking is effective, whether we need to change it, whether we need to start treatment, or how someone who stopped taking it is doing. There were no resistance tests, which tell us which medication is effective. There was also no bone density test, which studies the condition of bones because medication causes wear and tear,” Mariana Iacono, coordinator of the International Community of Women Living with HIV/AIDS .
The government's response
In the face of allegations of the public health system being depleted, the health ministry defended the measures taken under the umbrella of a "restructuring." After the cuts to the HIV and Vaccines departments, the outcry grew, and Deputy Minister Cecilia Loccisano had to come out and support the decision . "We set out to reorganize the health system, efficiently managing resources, which are not abundant. Because as Mario Lugones says, the money is there, but it's being poorly managed," she shared on her X account. She listed a series of alleged overspending carried out between 2021 and 2023 and spoke of a disproportionate structure and oversized areas. She also maintained that having reduced the staff by almost half will not affect "the functioning or fulfillment of the responsibilities of this ministry."
"They have to reveal what the irregularities are. Everything can be improved, there's no doubt about it. But our experience so far is that, with that excuse, areas have been cut until they disappear. The programs have ongoing audits; it's always been like that," Maulen responded.
Overview of the country
In Argentina, there are 140,000 people living with HIV, according to the latest official data from the Ministry of Health. There are an average of 6,400 new diagnoses per year. Of these, approximately 70,000 receive antiretroviral treatment in the public health system. However, the trend has increased since the COVID-19 pandemic.
“Although the number of cases in Argentina is stable, after COVID, we knew there would be a surge in cases because prevention, diagnosis, and treatment activities were halted. We're at a peak for all infections. Furthermore, we're in a context of many people losing their jobs. Tuberculosis is closely linked to poverty, so the social situation also affects it,” explained the former head of the Directorate.
The role of the HIV, STI, Hepatitis and Tuberculosis Directorate
“It's important to highlight the many things the Directorate does that are invisible until they're no longer done. When social security funds fail to provide medication, the State, as the ultimate guarantor, is the one that complies and delivers the medication. It provides it to people without coverage and also fills the gaps in the social security funds. Furthermore, in the case of the national tuberculosis program, medication is delivered to 100% of the country's population,” Maulen shared.
“Updated, improved treatment regimens are being designed. The treatment of three or four pills was reduced to two. A first-line regimen was achieved, compared to countries that have long since changed this regimen in pursuit of improving people's quality of life,” reported the recently fired former employee of the Directorate.
In addition, the Directorate carried out activities to disseminate reliable information, preventative measures, and provide training on the subject.
The Self-Convened Assembly of Health in Struggle reported that those laid off are losing their children's positions in the ministry's kindergartens. They also reported that ministry employees, even from other departments, are being pressured to fill the positions of those laid off. They are calling for a protest on Tuesday, February 11th at 11:00 a.m. in front of the National Ministry of Health.
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