‘People are going to die’: US foreign aid pause hits life-saving HIV, malaria programs
Key takeaways:
- The State Department issued a 90-day review of foreign aid spending.
- Funding for PEPFAR, the President’s Malaria Initiative and other global programs have been paused during the review.
A 90-day review of U.S. foreign aid spending ordered by President Donald J. Trump has halted global health programs, including the U.S. President’s Emergency Plan for AIDS Relief and the President’s Malaria Initiative.
“Consistent with President Trump’s executive order on reevaluating and realigning United States foreign aid, Secretary Marco Rubio has paused all U.S. foreign assistance funded by or through the State Department and U.S. Agency for International Development (USAID) for review,” State Department spokesperson Tammy Bruce said in a statement. “He is initiating a review of all foreign assistance programs to ensure they are efficient and consistent with U.S. foreign policy under the America First agenda.”
The State Department’s stop-work order followed Trump’s signing of an executive order for government departments and agency heads to pause new obligations and disbursement of funds until a review, which will include consultation with the director of the Office of Management and Budget, according to the executive order.
According to USAID, The President’s Emergency Plan for AIDS Relief (PEPFAR) has saved more than 26 million lives since its initiation in 2003 by Republican President George W. Bush. The program has prevented nearly 8 million children from being born with HIV and currently provides HIV treatment for more than 20.6 million people globally, in addition to supporting more than 2.5 million PrEP initiations, accounting for roughly 90% of initiations of the HIV prevention medication globally.
The President’s Malaria Initiative was launched by Bush in 2005 to reduce malaria by 50% over the course of 3 years, but has been renewed several times because it provides medication and mosquito nets to battle the global malaria burden.
“United States foreign assistance programs promote stability in other countries to help stop crises from expanding directly to our doorstop,” Reps. Gregory W. Meeks and Lois Frankel, both Democrats, said in a letter to Rubio.
“Foreign assistance is not a handout — it is a strategic investment in our future that is vital for U.S. global leadership and a more resilient world. It directly serves our national interests and demonstrates our credibility to allies, partners and vulnerable people who rely on American assistance for survival,” they said.
Neither the State Department nor USAID responded to a request for comment, but Rubio has previously touted the program, such as in 2019 when he noted on X that, “Thanks to the generosity of the American people, investments in PEPFAR have saved millions of lives, prevented infections and transformed the global response to fight HIV/AIDS.”
PEPFAR funding has been relatively flat. The program began in 2003 with a 5-year, $15 billion budget and was reauthorized for another 5 years in 2008 with a budget increase to $48 billion. It has since been reauthorized three times, with no increases in budget. The last reauthorization was for only 1 year and ends in March,
Reauthorization was delayed in 2023 after Republicans and conservatives raised concerns that PEPFAR funds have been used for sexual and reproductive health, including counseling patients about abortion.
The International AIDS Society (IAS) said a freeze in PEPFAR funding could delay treatment for millions of people.
“This is a matter of life or death,” IAS president Beatriz Grinsztejn, said in a press release. “PEPFAR provides lifesaving antiretrovirals for more than 20 million people — and stopping its funding essentially stops their HIV treatment. If that happens, people are going to die and HIV will resurge.”
“It makes no sense to suddenly stop this incredible catalyst of our global progress toward ending HIV as a threat to public health and individual well-being,” she added.
References:
- IAS statement: PEPFAR freeze threatens millions of lives. https://www.iasociety.org/ias-statement/pepfar-freeze-threatens-millions-lives. Published Jan. 25, 2025. Accessed Jan. 27, 2025.
- USAID. 20 years of PEPFAR investment. https://www.usaid.gov/sites/default/files/2023-09/2023.09.11%20-%20PEPFAR-USAID%20One-Pager%20FINAL.pdf. Published Sept. 11, 2023. Accessed Jan. 27, 2025.
- U.S. Department of State: PEPFAR latest global results & projections fact sheet (Dec. 2024). https://www.usaid.gov/sites/default/files/2023-09/2023.09.11%20-%20PEPFAR-USAID%20One-Pager%20FINAL.pdf. Published Dec. 1, 2024. Accessed Jan. 27, 2025.
- U.S. Department of State: Implementing the president’s executive order on reevaluating and realigning United States foreign aid. https://www.state.gov/implementing-the-presidents-executive-order-on-reevaluating-and-realigning-united-states-foreign-aid. Published Jan. 26, 2025. Accessed Jan. 27, 2025.
- U.S. house of representatives foreign affairs committee. Letter to U.S. Secretary of State Marco Rubio. https://democrats-foreignaffairs.house.gov/_cache/files/3/7/3723c215-81d7-49f6-b47e-e281a526e5b4/0361821ECC417883CB0DEF54C9F37E80.foreign-assistance-pause-letter-to-rubio-final.pdf. Published Jan. 24, 2025. Accessed Jan. 27, 2025.
- U.S. taxpayer funding abortions in Mozambique ‘tip of the iceberg.’ https://chrissmith.house.gov/news/documentsingle.aspx?DocumentID. Published Jan. 16, 2025. Accessed Jan. 27, 2025.
- White House. Presidential actions: Reevaluating and realigning United States foreign aid. https://www.whitehouse.gov/presidential-actions/2025/01/reevaluating-and-realigning-united-states-foreign-aid/. Published Jan. 20, 2025. Accessed Jan. 27, 2025.
Perspective
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We know this movie. We’ve seen it for many years. Without easy, wide and affordable access to effective antiretroviral drugs at the individual and community level, HIV will explode. Individuals will experience immune damage and become sick and die. The virus will again be spread rapidly in communities to many who will be unaware of their infection. Mothers will give birth to infected infants. Without continued PEPFAR funding, drugs will rapidly disappear and testing to determine an individual’s infection status will not be available.
Although many were skeptical that such an aggressive, worldwide program could be possible — or that it would survive changes to the U.S. government — it has, in fact, worked amazingly well, with no serious charge of mismanagement or corruption. It has been an historic example of American leadership. U.S. scientists and companies have created most of the drugs and tests used in PEPFAR and have actively collaborated with generic producers to make supplies available at extremely low cost.
It’s hard to fathom what is happening and why. PEPFAR is a shining example of “America first,” and an interruption, even temporarily, risks losing the hard-fought gains the program has achieved. This should not be a political issue, and we should respond with a unified voice. PEPFAR funding should be immediately reinstated. If there are political discussions about how the program might be improved, those should take place while the lives of millions are protected.
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