The freeze on foreign aid announced by President Donald Trump has raised serious concerns about the future of the President’s Emergency Plan for AIDS Relief (PEPFAR). Established by former President George W. Bush, PEPFAR is one of the most successful foreign aid programs, credited with saving millions of lives since its inception.
On January 27, 2025, the Trump administration ordered U.S. clinics and hospitals abroad, particularly those across Africa, to halt the distribution of life-saving antiretroviral medications. This decision threatens the health and wellbeing of more than 20 million people living with HIV globally. Immediate cancellations of appointments and medication distributions were reported across various nations, including Haiti, Brazil, and India, causing panic among patients and health professionals alike.
Just the next day, Secretary of State Marco Rubio issued what some have called merely a temporary “waiver,” attempting to ease fears, but the long-term outlook remains grim. PEPFAR has been lauded for preventing about 5.5 million mother-to-child transmissions and has provided life-saving drugs to approximately 26 million people since its launch.
According to reports from the Foundation for AIDS Research (amfAR), approximately 222,000 individuals pick up these medications daily, and the decision to freeze the funding could be catastrophic for countless lives dependent on these medications. Emily Bass, author of To End a Plague, shared insights on the fear and tension growing among patients. She recounted the heart-wrenching situation of clinics running out of supplies and needing to lay off staff as support from the U.S. dwindles.
One prominent voice speaking out against these cuts is Dan Foote, who served as U.S. ambassador to Zambia. He emphasized the significant repercussions, saying, “Ending PEPFAR will cause an AIDS explosion in Africa, which will lead to an AIDS epidemic in the United States, period.” Foote's warnings are not only about the immediate health crisis; he highlighted the program's integral role in U.S. national security, noting, “When we have a good name overseas, ordinary people put pressure on their governments to maintain or create alliances with the United States.”
But the freeze on funding hasn't just halted drug distribution—it has also cut off the data systems necessary to track and manage the distribution, ensuring continued support for HIV prevention. This has raised alarms among healthcare advocates, including former USAID global health head Atul Gawande, who called the cuts “catastrophic.” Gawande noted how 6.5 million orphans and vulnerable children with HIV across 23 countries are now hanging precariously as support lags.
The health impact could extend well beyond Africa. Experts warn of how disruptions to HIV care could set off increased outbreaks, and if left to spiral, result in new infections and complications, reigniting public health crises not only abroad but back on American soil.
Budget for PEPFAR has typically hovered around $7.5 billion, dwarfed by military expenditures, yet this investment carries monumental weight on lives globally. There have been no major corruption scandals throughout its selfless administration over the past two decades, adding to the credibility and reliability of the program.
Efforts and advocacy to end AIDS across continents have been bolstered by programs like PEPFAR, and as Jean William Pape, who oversees the distribution of ARV medications for PEPFAR in Haiti, put it succinctly, “The United States supplies 90 percent of our needs. Without help, thousands of Haitians would be dying every month.” This statement echoes the grim reality set forth by the cuts. The fear of returning people to the shadows of untreated HIV/AIDS is palpable.
While recent cuts to foreign aid have gripped attention, they mask the long and tiresome struggle of advocacy within the AIDS movement. The fight against AIDS was once heralded for its bipartisan support, with evangelical Christians playing significant roles managing hospitals and clinics distributing ARVs. The decision to freeze funding threatens to fracture this unified front.
The current administration might be forgetting the significance of PEPFAR—it’s not merely health care; it’s about American leadership and our values on the global stage. The risks of dismantling PEPFAR extend well beyond HIV treatment; they touch on humanitarian efforts aimed at fostering goodwill.
With the health and lives of millions hanging by the thread, the focus now lies on reinstigated support for PEPFAR. How the Trump administration will respond to these crises remains uncertain—but without immediate action, we may witness one of the most unfortunate public health reversals of our time.