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.
On Tuesday, contractors working with the U.S. Agency for International Development received memos to halt work immediately, sources told Reuters. That evening, 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,” according to the waiver seen by the Washington Post.
The waiver didn’t explicitly mention the President's Emergency Plan for AIDS Relief, a global health program that includes HIV treatment, testing and prevention drug distribution across the world, according to the New York Times. 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 program, which began in 2003 under the George W. Bush administration, received $6.5 billion in government funding in 2024. If aid to the 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.
Gumisayi Bonzo, director of a health nonprofit in Zimbabwe, told the Associated Press that stripping access to HIV medication would be life-altering.
“I have been religiously taking medicines for over two decades, I am living a normal life again, and suddenly we have to stop,” she said. “That’s a death sentence for many people.”
If treatments are interrupted, patients are more susceptible to getting sick and the disease could spread to others, Reuters reported. Inconsistent treatment could also lead to drug resistance.
“We can very rapidly return to where the pandemic is exploding, like it was back in the 1980s,” Dr. Steve Deeks, an HIV expert at the University of California, San Francisco, told the New York Times. “This really cannot happen.”
The program has nearly 200,000 providers; on average, they make around $3,000 per year, “making even short funding suspensions extremely difficult,” according to amfAR, the Foundation for AIDS Research.
Each day, the program supports more than 222,000 people receiving treatments, according to amfAR. The program also supports hundreds of thousands of HIV tests, newly diagnosing 4,374 people with HIV every day, including pregnant women.
“If H.I.V. testing falls by the wayside, it’s unlikely that we will be able to even diagnose people who need to go into treatment,” Dr. Glenda Gray, a pediatric HIV expert at Wits University in South Africa, told the Times.
If pregnant women are unable to get tested, they could unknowingly pass the virus to their children.
The World Health Organization, which Trump ordered the U.S.’s withdrawal from, called on the Trump administration to “enable additional exemptions to ensure the delivery of lifesaving HIV treatment and care.”
The global health body 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.”
