Donald Trump’s order to freeze most foreign aid funding will have a devastating effect on the President’s Emergency Program for AIDS Relief, or PEPFAR, which helps fight HIV and AIDS internationally has saved an estimated 26 million lives.
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There have been varying reports about how the program will be affected, but The New York Times viewed a State Department memo that says it definitely is included in the freeze of foreign aid, with few exceptions, for at least 90 days. PEPFAR, overseen by the State Department was started in 2003 by President George W. Bush, like Trump a Republican, and Trump supported it during his first term. Marco Rubio, the new secretary of State, had supported it while he was a U.S. senator.
Also, in another memo, “officials were informed that although the initial review of foreign aid is intended to be completed within 85 days, final decisions might take up to 180 days,” the Times reports. The order affects not just future funding but includes a stop-work provision on existing programs.
PEPFAR, which receives $7.5 billion annually, is the main source of HIV-fighting drugs to 54 developing countries, mostly in Africa, according to amfAR, the Foundation for AIDS Research. On a daily basis, amfAR says, PEPFAR is responsible for supporting more than 222,000 people on antiretroviral treatment; more than 224,000 HIV tests; services for 17,695 orphans and vulnerable children affected by HIV; 7,163 cervical cancer screenings; and care for 3,618 women experiencing gender-based violence. More than 20 million people depend on the program, including 550,000 children.
It's possible that the Trump administration could issue a waiver for PEPFAR. The order on funding exempts emergency food programs and military aid to Israel and Egypt. But even a brief interruption in funding would be devastating, health experts said.
“This is deadly,” Asia Russell, executive director of Health GAP, an AIDS treatment advocacy organization, told The Washington Post. “For PEPFAR, which is the bulk of the global AIDS response, it means stopping service delivery; many people will die and become HIV-positive.”
“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,” says an amfAR press release. Overseas health care workers in PEPFAR programs make just over $3,000 per year, “making even short funding suspensions extremely difficult,” amfAR notes.
“The call to review all foreign aid and pause funding was part of the Project 2025 playbook,” Jennifer Kates, director of global health and HIV policy at KFF, an organization that focuses on health issues, told the Post.Project 2025 was a blueprint laid out by the far-right Heritage Foundation for the next conservative president. Trump tried to distance himself from it during his 2024 campaign, but he’s already implementing many of its ideas.
Project 2025 had actually praised PEPFAR, but the Heritage Foundation had criticized the program recently, saying its funds were used to provide abortions in Mozambique, something that has not been proved. This came even though abortion is legal in Mozambique. A pittance in PEPFAR funds — $4,100 — that was used to pay health care workers who performed abortions in non-PEPFAR work was returned to the program, the Post reports, but Republicans in Congress have called for an investigation nonetheless.
“The first Trump Administration shepherded a strong PEPFAR that oversaw significant progress and success,” the amfAR press release concludes. “We call on the Administration to ensure seamless continuation of services by immediately providing a waiver to the stop work order and the 90-day suspension of services for the PEPFAR program.”