In the first week after his inauguration, President Donald Trump has stopped funding for PEPFAR, the President's Emergency Plan for AIDS Relief, jeopardizing the lives of people who receive HIV prevention and treatment through the global aid program. Trump also announced that he would withdraw the United States from the World Health Organization and ordered the Centers for Disease Control and Prevention to stop working with the international agency.
On the domestic side, late Monday, January 27, Trump ordered an immediate freeze on all federal grants and loans to outside bodies. This order excludes Social Security and Medicare payments but may impact HIV/AIDS grants such as those made through the federal Ryan White CARE Program and AIDS prevention funding.
PEPFAR
PEPFAR is a program that was established in 2003 by Republican President George W. Bush with broad bipartisan support in Congress. The program's pause has officials extremely concerned.
"PEPFAR provides lifesaving antiretrovirals for more than 20 million people — and stopping its funding essentially stops their HIV treatment," International AIDS Society President Dr. Beatriz Grinsztejn 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."
PEPFAR is credited with saving 26 million lives and preventing nearly 8 million cases of mother-to-child HIV transmission since its inception. With a budget of $6.5 billion, the program provided HIV treatment for more than 20 million people, PrEP for 2.5 million people, and HIV testing services for nearly 84 million people in low- and middle-income countries in 2024, according to the PEPFAR website.
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, ending this March. 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. 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. Four days later, Peter Marocco, the new director of the State Department's Office of 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.
On January 28, 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 reported.
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 allocated to date. All U.S. foreign aid combined makes up less than 1% of the federal budget.
According to the New York Times, 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.
Even a three-month pause in HIV treatment can be dangerous, experts pointed out. When antiretrovirals are stopped, the virus reactivates and begins to infect 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.
"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."
WHO withdrawal
In another executive order issued January 20, his first day in office, Trump declared his intent to withdraw the U.S. from the World Health Organization. Although congressional approval and a year's notice are required for withdrawal, the Centers for Disease Control and Prevention has already been ordered to pause its work with the global agency.
Among other reasons, Trump cited America's disproportionate share of WHO funding. The U.S. is WHO's top donor, contributing nearly $1.3 billion in 2022-2023, or nearly 20% of the organization's total budget.
Trump previously announced his intent to withdraw from WHO during his first term, in part due to its "mishandling" of the COVID-19 pandemic. But President Joe Biden took office before the one-year notification period ended and retracted the withdrawal.
Last week's executive order directs the secretary of state and the director of the Office of Management and Budget to pause future WHO funding and to recall and reassign U.S. government personnel or contractors "working in any capacity" with the organization.
WHO issued a statement in response, stating that the organization regrets the announcement.
"WHO plays a crucial role in protecting the health and security of the world's people, including Americans, by addressing the root causes of disease, building stronger health systems and detecting, preventing and responding to health emergencies, including disease outbreaks, often in dangerous places where others cannot go," it reads. "We hope the United States will reconsider and we look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and wellbeing of millions of people around the globe."
On January 26, CDC's deputy director of global health, Dr. John Nkengasong — who resigned as head of PEPFAR before Trump took office — sent a memo to agency leaders saying that all staff who work with WHO must immediately stop their collaboration and communications and await further guidance, the Associated Press reported.
"People thought there would be a slow withdrawal. This has really caught everyone with their pants down," Dr. Jeffrey Klausner of the University of Southern California, who collaborates with WHO on sexually transmitted infections, told AP. (Klausner used to be an official with the San Francisco Department of Public Health.)
The CDC, along with other national agencies under the Department of Health and Human Services, including the National Institutes of Health and the Food and Drug Administration, was ordered to pause external communications at least until February 1. Last week, for the first time in 60 years, the CDC did not publish its Morbidity and Mortality Weekly Report, which clinicians, local health officials, and journalists rely on to learn about disease outbreaks and other important public health developments. (MMWR published the first report of AIDS in June 1981.) The freeze also affects public meetings, speaking engagements, and travel.
Critics of the withdrawal argue that the U.S. can have more influence on global health as a member country, and if it withdraws, WHO decisions "won't reflect American interests and values," Lawrence Gostin, a professor at Georgetown University and director of the WHO Center on National and Global Health Law, wrote in an open letter to Trump.
The relationship is mutually beneficial, as the U.S. needs access to WHO's global surveillance data to monitor disease outbreaks, and the WHO needs U.S. funding, he added.
IAS officials said the move will affect global health.
"Inevitably, reduced U.S. funding and collaboration with WHO will weaken global health responses," IAS' Grinsztejn wrote in a statement on BlueSky. "This includes HIV testing, treatment and prevention programs, particularly in low- and middle-income countries most affected by HIV."
Updated, 1/29/25: This article has been updated to report that HIV medications continue to be distributed, for now.
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