Impact of Trump's Executive Order to people living with HIV

By Osoro Nyawangah, MWANZA Tanzania

A move by the Trump administration to freeze funding for the United State’s widely heralded international HIV/AIDS program is sowing uncertainty globally and putting countless lives at immediate risk, according to health care providers and global health researchers.

Nearly all global health funding from the United States has been halted immediately by the Trump administration and that appears to include PEPFAR, the widely praised program created by President George W. Bush in 2003 to prevent HIV/AIDS.

Without access to their drugs, some patients whose infections are currently suppressed could see them flare in a matter of days to weeks, doctors said. They could also be left vulnerable to other illnesses and be more likely to spread the virus to others. Pregnant mothers with uncontrolled infections could pass HIV to their babies. 

With its $6.5 billion annual budget, PEPFAR — the President's Emergency Plan for AIDS Relief — provides HIV/AIDS medications for over 20.6 million people, keeping patients alive and preventing them from transmitting the virus.

It also offers testing and education on HIV/AIDS. According to a State Department fact sheet, PEPFAR has saved the lives of an estimated 26 million people since its inception.

The program has a history of bipartisan support in Congress.

On Friday, the State Department issued a cable putting into action the January 20th executive order from President Donald Trump that will halt virtually all U.S. foreign assistance for at least 90 days pending a review of all programs. The only exceptions are emergency humanitarian assistance and military financing for Israel and Egypt.

Courtesy

PEPFAR, funded solely by the U.S. government, was not specifically cited in the announcement. But a source at USAID, who asked for anonymity because they are not permitted to comment on the matter, confirmed that the stop on work applies "100% to PEPFAR." USAID is the agency primarily responsible for administering humanitarian and development aid.

That interpretation is shared by Jeremy Konyndyk, a top official with USAID during the Obama and Biden administrations and currently president of the aid group Refugees International. "As written, the stop-work order does not exempt global health programs," Jeremy Konyndyk wrote to NPR in an email.

On Sunday, the State Department confirmed the halt in an email to NPR. The United States "is no longer going to blindly dole out money with no return for the American people," State spokesperson Tammy Bruce said in a statement, calling the pause "a moral imperative."

The executive order is also going to impact to the millions of Africans enjoying free Antiretroviral Therapy. Of the estimated 25.6 million people living with HIV in the African region, 20.8 million were on antiretroviral therapy (ART) as of the end of 2022 according to the WHO Africa region report as of the end of 2022.

South Africa is one of the biggest recipients of PEPFAR aid, receiving $332.6 million in 2024. HIV clinics across South Africa notified their shocked clients this week that they have been forced to close immediately.

According to the latest data from the Tanzania HIV Impact Survey, approximately 1.5 million people in Tanzania are currently receiving Antiretroviral Therapy (ART), representing a large portion of the population living with HIV in the country.

Kenya's recent data, shows that approximately 78% of people living with HIV in the country are on antiretroviral therapy (ARV), which translates to around 1.1 million individuals out of the estimated 1.4 million people living with HIV in the country.

The World Health Organization expressed “deep concern on the implications” of the U.S. pause.

“A funding halt for HIV programmes can put people living with HIV at immediate increased risk of illness and death and undermine efforts to prevent transmission in communities and countries,” the statement said. “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.”