Update: On January 28, Secretary of State Marco Rubio issued a waiver allowing providers to continue offering HIV treatment and medical care funded through PEPFAR, though the fate of HIV prevention services remains unclear, the New York Times reports. Rubio’s memo exempts “core life-saving medicine” and medical services, which would include antiretroviral therapy but perhaps not PrEP.

In the first week after his inauguration, President Donald Trump stopped funding for foreign aid projects, including PEPFAR, the President’s Emergency Plan for AIDS Relief, which provides HIV prevention and treatment to hundreds of thousands of people in low- and middle-income countries.

“PEPFAR provides lifesaving antiretrovirals for more than 20 million people—and stopping its funding essentially stops their HIV treatment,” International AIDS Society president Beatriz Grinsztejn, MD, PhD, said in a statement. “It makes no sense to suddenly stop this incredible catalyst of our global progress towards ending HIV as a threat to public health and individual well-being.”

Launched by President George W. Bush in 2003, PEPFAR is credited with saving 26 million lives and preventing nearly 8 million cases of mother-to-child HIV transmission since its inception, according to the PEPFAR website. In 2024, with a budget of $6.5 billion, it provided HIV treatment for more than 20 million people, pre-exposure prophylaxis (PrEP) for 2.5 million people and HIV testing services for nearly 84 million people.

PEPFAR was previously funded for five-year periods with bipartisan support, but last year’s congressional authorization was contested, and it was only authorized for one year, which ends this March. The conservative Heritage Foundation—which spearheaded the Project 2025 plan that appears to underlie much of Trump’s agenda—claims that the Biden administration has used PEPFAR “to promote its domestic radical social agenda overseas.”

The program recently came under fire after it was revealed that four nurses in Mozambique whose salaries were partially paid by PEPFAR had performed abortions, which are not allowed with program dollars, Reuters reported. U.S. officials vowed to henceforth require all staff to sign an attestation that they understand the prohibition on abortions. Nonetheless, some advocates fear that PEPFAR might not be reauthorized.

On January 20, Trump signed an executive order that halted almost all spending on foreign assistance programs, including PEPFAR, for 90 days. All U.S. foreign aid combined makes up less than 1% of the federal budget.

Four days later, Peter Marocco, the new director of the State Department’s Office of Foreign Assistance, sent a memo to officials and embassies worldwide ordering an immediate pause on new funding and stop-work orders on existing grants and contracts until Secretary of State Marco Rubio reviews and approves them, Devex reported.

“This is a halt to work that is saving lives around the world,” Asia Russell, executive director of the AIDS advocacy group Health GAP, told Devex. “It’s cruel, it’s anti-science, it’s anti-human rights, and it’s completely unnecessary.”

Even a three month pause in HIV treatment can be dangerous. When antiretrovirals are stopped, the virus reactivates and begins to infect CD4 T-cells and impair immune function. If medication supplies are disrupted, taking them inconsistently can lead to drug resistance. What’s more, people with a detectable viral load can transmit HIV to their sexual partners, and pregnant women can pass the virus to their babies.

While country governments also invest in their own HIV responses, the immediate stop-work orders could affect more than 190,000 clinicians and other health care workers and “massively disrupt the global HIV response,” according to amfAR, the Foundation for AIDS Research. “Even short cessations of these programs cause unnecessary suffering, loss to follow-up, and risk onward transmission that cannot simply be ‘turned back on’ when the suspension is lifted.”

The New York Times reported that people are already being turned away from clinics, providers have been told not to distribute HIV medications purchased with U.S. aid, and staff were told that PEPFAR’s data systems would be shut down. 


The U.S. is also the largest contributor to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The U.S. has pledged $6 million to the Global Fund for the current replenishment period (2023-2025), with about $2 million of it allocated to date.

“This is a crisis moment for global health and development,” Madhukar Pai, MD, PhD, of McGill University told CIDRAP. “I hope everyone in global health will advocate for the U.S. government to continue supporting these critical organizations and programs."

However, he added, “I wonder if this could be an opportunity for global health to be less reliant on any single nation or donor. I would love to see African nations step up, manufacture their own essential medicines and vaccines, and be less and less reliant on aid. I would love to see other G7 and G20 nations step up and make up for the acute funding shortfall that the U.S. government is creating.”