PEPfAR: Distribution of US-backed HIV medications to poorest nations in flux after Trump order slowing foreign aid

PEPfAR: During a 90-day foreign aid freeze, Secretary of State Marco Rubio issued exemptions for life-saving humanitarian assistance, but the fate of HIV treatment for the world’s poorest nations remains uncertain. On his first day in office, President Donald Trump ordered a 90-day pause on any foreign assistance as agencies review to ensure they will not be “disbursed in a manner that is not fully aligned with the foreign policy” of the president. Contractors working with the United States Agency for International Development received memos to halt work immediately.

Rubio exempted humanitarian assistance which he defined as “core life-saving medicine, medical services, food, shelter, and subsistence assistance, as well as supplies and reasonable administrative costs as necessary to deliver such assistance. The waiver did not explicitly mention the President’s Emergency Plan for AIDS Relief (PEPfAR), a global health program that includes HIV treatment, testing, and prevention drug distribution across the world. The distribution of HIV medications seemed to be permitted under the waiver, but whether preventative HIV drugs and other services are allowed is not immediately clear.

The PEPfAR program, which began in 2003 under the George Bush administration, received $6.5 billion in government funding in 2024. If aid to the PEPfAR program is cut permanently, more than 20 million people across the globe living with HIV, including 560,000 children, around the world would no longer have access to life-saving treatment. Stripping access to HIV medication would be life-altering.

That is a death sentence for many people. If treatments are interrupted, patients are more susceptible to getting sick and the disease could spread to others. Inconsistent treatment could also lead to drug resistance. This cannot happen.

The PEPfAR program has nearly 200,000 providers on average, making even short funding suspensions extremely difficult.

Each day, the PEPfAR program supports more than 222,000 people receiving treatments. The PEPfAR program also supports hundreds of thousands of HIV tests, newly diagnosing 4,374 people with HIV every day, including pregnant women. If HIV testing falls by the wayside, it is unlikely that providers will be able to even diagnose people who need to go into treatment.

If pregnant women are unable to get tested, they could unknowingly pass the virus to their children. The World Health Organization (WHO), which Trump ordered the United State’s withdrawal from, called on his administration to “enable additional exemptions to ensure the delivery of lifesaving HIV treatment and care”. WHO warned of the consequences around the world and in America should PEPFAR funding be frozen.

A funding halt for HIV programs can put people living with HIV at immediate increased risk of illness and death and undermine efforts to prevent transmission in communities and countries. Such measures, if prolonged, could lead to rises in new infections and deaths, reversing decades of progress and potentially taking the world back to the 1980s and 1990s when millions died of HIV every year globally, including many in the United States of America.