AVAC has taken an extraordinary step to protect global health. This week we sued the U.S. State Department and Presidential Administration to challenge the devastating freeze on foreign aid funding that is threatening lifesaving programs worldwide. Read about it in the New York Times and Devex.

Right now, critical HIV prevention initiatives—including those that support PrEP access and the development of new HIV prevention options—are being disrupted because of politically motivated funding decisions. But this lawsuit is about more than HIV prevention; it’s about holding the U.S. government accountable for its commitments to public health and human rights.

But we can’t do this alone. We need your support to sustain this fight and ensure that our partners and communities most at risk for HIV are not left behind.

Your Support Will Help Us:

• Fight to reinstate essential PEPFAR-funded programs. 
• Ensure the U.S. government follows the law and honors its commitments. 
• Continue to advocate for evidence-based HIV prevention strategies worldwide. 

With gratitude,

Mitchell Warren,
AVAC Executive Director

PS: Three Things You Can Do To Get Involved

• Read and share our weekly Global Health Watch news brief for the latest developments in US policy and implications for HIV and health equity and engage with us on Bluesky and Instagram.
• Learn more about our CASPR project, an Africa-led coalition of partners changing how prevention is pursued and delivered, that was halted by the US government.
• Learn more about AVAC’s programs and read the latest news.

This week has brought continued confusion around PEPFAR waivers, reports on the devastating impacts of the funding freeze and the fight to reverse harmful policies as the new administration attempts to dismantle USAID and shrink the federal government. These developments are threatening decades of progress in HIV prevention and treatment. Find details on these updates below.

New Developments

Global health organizations are challenging the US administration’s freeze on foreign aid and funding. AVAC and the Journalists Development Network in partnership with Public Citizen filed a federal lawsuit seeking to reverse the freeze, arguing it is unconstitutional and causes “needless death, destruction and immiseration.” This encompasses extensive harm to lifesaving HIV prevention and treatment programs. Similarly, the Global Health Council along with other large development agencies filed an additional, similar lawsuit seeking relief to protect the global health sector and ensure the continuation of vital foreign assistance.  

IMPLICATIONS: If successful, the lawsuits could result in the funding freeze being declared illegal. The new administration could face further court action if they ignore a finding of illegality. Reversing the freeze would allow PEPFAR and other vital programs to resume and protect global health initiatives from presidential overreach. 

READ:

• New lawsuit challenges US foreign aid funding freeze — Devex 
• Two nonprofits sue over Trump’s freeze on foreign aid — The New York Times 

The rollout of PEPFAR waivers has so far been mired in confusion and inconsistency. The latest tracking from amfAR and partners report that as of February 9, “most lifesaving services [from PEPFAR] remain paused”. Among PEPFAR-funded providers who were surveyed, 36% reported they had completely closed down. Only 10% had restarted offering services. As AVAC Executive Director Mitchell Warren told Science Magazine in ‘Madness’: Trump Freeze on Global HIV Prevention Efforts Sparks Disbelief and Anger, “This is not only bad politics in terms of government-to-government relationships, it is bad medicine, it is bad science, and it is dumb.” He further described the chaos to Bhekisisa, saying, “The flurry of actions really provides an unprecedented amount of whiplash, wondering each day what to do, what not to do.” Organizations are still waiting for formal certification letters, adding to the uncertainty.

A February 6 waiver from the State Department allowed some PEPFAR treatment and PMTCT programs to resume, but primary HIV prevention efforts—particularly access to PrEP and VMMC—have been explicitly blocked, except PrEP for pregnant and breastfeeding women. “People who may be at high risk, such as key populations, or were previously initiated on PrEP cannot be offered PEPFAR-funded PrEP…”. Advocates are calling for an immediate reversal.  

IMPLICATIONS: By blocking access to PEPFAR-funded PrEP for most at-risk populations, the administration is cutting off a proven prevention method. It is ignoring decades of scientific evidence and threatening to reverse progress, putting millions of lives at risk.

READ:

• The Human Cost of PEPFAR’s PrEP Restrictions — AVAC blog
• Trump’s Foreign Aid Freeze Is Severely Limiting PrEP Drugs For HIV — Huffington Post 

The National Institutes of Health (NIH) announced that it would be capping “indirect” costs—used for facilities, administrative support, and compliance—at 15%, down from an average of 30-70%. This decision threatened to impose drastic funding cuts to public research institutions. However, lawsuits and backlash ensued and on Tuesday, a temporary pause was put on these plans. In addition, NIH’s Deputy Director and Director of Extramural Research have resigned, signaling major upheaval at the NIH. While the details remain unclear, it’s increasingly evident that something major is unfolding at the NIH. 

IMPLICATIONS: Indirect spending is vital to the success of biomedical research, training and care, including support for medical staff, research and safety equipment, salaries and tuition for the next generation of nurses, doctors and researchers. A decrease to the indirect costs to a standardized rate of 15% will have a devastating and long-lasting impact on US research institutions, particularly on state universities that rely on Federal indirect costs to support the advanced medical facilities required for research and healthcare. These cuts will affect current clinical trials, force labs to close, and erode US leadership in biomedical research.

Robert F. Kennedy Jr. was confirmed Thursday as Health and Human Services (HHS) Secretary despite concerns over his vaccine skepticism, AIDS denialism, and racist views of immunology. He now oversees the CDC, NIH, FDA, and other key health agencies—impacting funding, programs, and science communication.  

IMPLICATIONS: RFK’s history of promoting HIV/AIDS denialism and spreading misinformation about vaccines could undermine trust in established HIV prevention and treatment strategies. RFK’s leadership threatens to undermine evidence-based policies and could reverse decades of progress in global health. 

READ THESE OP-EDs:

• RFK Jr is in. Is health in America on its way out?, by Ida Juste — Bhekisisa 
• When ‘Just Asking Questions’ About Science Turns Into 300,000 Dead, by Gregg Gonsalves — The New York Times 

A judge ruled that the Department of Health and Human Services (DHHS), the Food and Drug (FDA) Administration and the Centers for Disease Control and Prevention (CDC) must restore online access to websites and pages with data and guidance on HIV monitoring, health risks for youths and assisted reproductive technologies. Other websites have yet to be restored.

What We’re Reading

• Potential Clinical and Economic Impacts of Cutbacks in the President’s Emergency Plan for AIDS Relief Program in South Africa: A Modeling Analysis — Annals of Internal Medicine
• Lifesaving Aid Remains Halted Worldwide Despite Rubio’s Promise — The New York Times
• US Aid Freeze Could Set Back Africa’s Fight Against HIV by Years, Researchers Warn — The Telegraph
• To Alarm of Scientists, Federal Health Data Is Disappearing — Undark
• As Trump Attacks, the HIV Community Reels—and Starts Fighting Back — Positively Aware

Resources

• Update: Deadly Pause, an updated report from CHANGE, tracking harms from the funding freeze
• Most Lifesaving Services Remain Paused: A Rapid Assessment of the PEPFAR StopWork Order, amfAR, CHANGE, Data ETC
• Litigation Tracker: A public resource tracking the legal challenges to the Trump administration’s executive orders, Just Security
• PEPFAR Key Populations Impact Survey, GBGMC 

Stay strong and stay united.

Donate today to help fund our efforts. Every contribution helps us keep the pressure on!

This evening, a federal district court granted our motion for a temporary restraining order (TRO) against the Trump administration’s wholesale freeze on foreign assistance funding. The order lifts the freeze and restores funding while our lawsuit against the administration moves forward.

The court order directs the administration not to suspend, pause, or otherwise prevent the obligation or disbursement of appropriated foreign-assistance funds in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025. It also bars the administration from issuing, implementing, enforcing, or otherwise giving effect to terminations, suspensions, or stop-work orders in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025.

“This order is not just an enormous victory for our clients. It is a victory for the world,” said Lauren Bateman, a lawyer at Public Citizen Litigation Group and lead counsel on the case. “Life-saving humanitarian work can resume, and thousands of American jobs will be saved. It is not hyperbole to say that this order saves lives.”

“The freeze on foreign assistance funding is illegal and it is imperative that funding be restored,” said a JDN spokesperson. “For decades, the State Department and USAID support has helped journalists in some of the world’s most repressive and corrupt regimes stay independent of the state and ruling oligarchs. The public has benefited enormously from that work.”

“This decision represents a pivotal moment  for HIV prevention and global health equity,” said Mitchell Warren, AVAC Executive Director. “The Administration has a responsibility to end this massive disruption and harm to work that is essential to global health and national security. Foreign assistance programs don’t operate with an on/off switch, and any changes or modification should be made strategically, not in a chaotic manner that jeopardizes human health, life, and safety and security.”

Today, Public Citizen filed a lawsuit in the US District Court for the District of Columbia against President Trump, the State Department, the US Agency for International Development (USAID), the Office of Management and Budget (OMB), Marco Rubio, Secretary State and Acting Administrator of USAID, and Russell Vought, Director of the Office of Management and Budget, on behalf of the AIDS Vaccine Advocacy Coalition (AVAC) and Journalism Development Network, Inc. (JDN), seeking emergency relief from the freeze on funding for foreign assistance. 

By abruptly freezing foreign assistance funding, the administration has halted the life-saving work of organizations across the globe. The administration’s actions have also cost thousands of American jobs and counting. 

“The Trump administration’s freeze on foreign assistance funding is dangerous and illegal,” said Public Citizen attorney Lauren Bateman, the lead lawyer on the case. “When programs like the ones run by our clients are abruptly shuttered, the impacts are felt throughout the world—with the most vulnerable people bearing the deadliest impact.” 

AVAC is a New York-based non-profit founded in 1995 that works to help end the global HIV/AIDS epidemic by accelerating development and delivery of HIV prevention options. AVAC has been forced to abruptly stop CASPR, a coalition of African civil society organizations that supports research on HIV prevention and provides resources for local communities, including medical research trial participants, journalists, and policy makers. As a result, the rollout of emerging HIV preventative drugs across the African continent may be delayed, risking deadly consequences. AVAC has been forced by the illegal funding freeze to begin laying off members of its 46-person staff. 

“This funding freeze and the draconian actions of this administration are harming global health and security. In the name of economic efficiency, they are destabilizing public health, diplomatic relationships, communities, and economies,” said Mitchell Warren, AVAC Executive Director. “AVAC and many of our African civil society CASPR partners will be irreparably harmed by this pause. It takes time to build up these programs and relationships, but it is taking days to destroy them—and it will take more time to re-build, no matter who funds these efforts. USAID has made America stronger, safer and more prosperous for decades. It’s no time to throw that away.”

The Journalism Development Network, Inc. (JDN) is a Maryland-based non-profit corporation that supports a global consortium of journalists from more than 70 non-profit investigative centers and regional news organizations across the world. JDN receives funding from USAID for its Strengthening Transparency and Accountability Through Investigative Reporting (STAIR) program to support collaborative investigative journalism networks in Europe and Eurasia. 

The USAID funding freeze has shut down JDN’s operations in a number of countries, slashed nearly a third of its budget, forced it to lay off 20% of its staff and reduced salaries and work time for most of the remaining employees. If funding is not restored, JDN will have to permanently close some programs, including  operations in countries in Asia, the Pacific, Latin America and Europe.

“This illegal action by the government deprives small investigative media in low-income countries around the world of the funds they badly need to operate. These centers are critical to holding power to account in some of the toughest places in the world to report. Many are ex-pat journalists who could be deported back home where they risk arrest and torture.” said a JDN spokesperson.

The world is witnessing a catastrophic and entirely avoidable rollback of progress in the fight against HIV. In the past two decades, the President’s Emergency Plan for AIDS Relief (PEPFAR) has been a lifeline, providing treatment and prevention services that have saved millions of lives. But a dangerous new directive from the US government has frozen critical HIV prevention programs, including access to Pre-Exposure Prophylaxis (PrEP).

As AVAC Executive Director told Science Magazine in ‘Madness’: Trump Freeze on Global HIV Prevention Efforts Sparks Disbelief and Anger: “This is not only bad politics in terms of government-to-government relationships, it is bad medicine, it is bad science, and it is dumb.” 
 
Read more in a new blog post below by AVAC’s Director of Communications, Kenyon Farrow, The Human Cost of PEPFAR’s PrEP Restrictions. 

The Human Cost of PEPFAR’s PrEP Restrictions

The President’s Emergency Plan for AIDS Relief (PEPFAR) has long been hailed as one of the most successful and bipartisan efforts in global health. Established in 2003 under the Bush Administration, PEPFAR has saved millions of lives by providing critical HIV treatment and prevention services and building partnerships with countries and communities. But this work ground to halt last week, with a chilling pause on all work.

This week, the State Department approved a limited waiver to re-start some treatment and PMTCT programs is a small step forward, but far from a victory at all. And it is especially short-sighted and cruel in it approach (or lack thereof) to primary HIV prevention. One of the most effective tools in the fight against HIV has been Pre-Exposure Prophylaxis (PrEP), a medication regimen that reduces the risk of acquiring HIV by over 99% when taken consistently. Yet, with this new guidance, the Trump Administration is choosing politics over science, discrimination over compassion, and ultimately, death over life.

The February 6th guidance from the Trump Administration stating that “people other than pregnant and breastfeeding women who may be at high risk of HIV infection or were previously initiated on a PrEP option cannot be offered PEPFAR-funded PrEP during this pause of US Foreign Assistance or until further notice” is not only a dangerous deviation from sound public health policy—it is a death sentence for thousands of people at risk of HIV globally.

PrEP is one of the most powerful tools available in the fight against HIV/AIDS. Public health experts and epidemiologists agree that expanding access to PrEP is essential to curbing new infections. The administration’s directive effectively shuts the door on communities around the world, depriving them of life-saving medication and increasing the risk of new HIV transmissions. This move not only contradicts decades of scientific research but also undermines the very mission of PEPFAR: to save lives and reduce the burden of HIV/AIDS worldwide.

The restriction on PrEP access is particularly troubling in regions where the HIV epidemic is most severe, such as sub-Saharan Africa. In these areas, young women account for a disproportionate number of new infections, but so do men who have sex with men (MSM) and transgender individuals—groups that are now explicitly excluded from PEPFAR-funded PrEP under this new policy. By denying these populations access to PrEP, the administration is actively allowing the HIV epidemic to spiral further out of control.

Research has continued to produce newer modalities of PrEP that are long-acting products, which create even more possibilities for people to protect themselves for up to six months per dose. One long-acting prevention tool, injectable lenacapavir, is currently under FDA review and could provide a valuable option for people who have trouble with daily pill-taking or fear the stigma that is sometimes associated with ARVs in their communities. With regulatory approval and WHO guidelines expected by the middle of the year, injectable lenacapavir provides the best chance to drive down the number of new infections. So stopping current PrEP programs makes seizing this new opportunity that much harder.

This decision appears to be less about public health and more about an ideological agenda that seeks to police morality rather than protect lives. The new Trump Administration, just weeks into its second term is demonstrating a careless pattern of undermining global health programs, including cutting funding for international health organizations that provided comprehensive sexual health services. This latest move is yet another example of the administration prioritizing conservative politics over the well-being of vulnerable populations.

By selectively restricting PrEP access to only pregnant and breastfeeding women, the administration is effectively signaling that only certain groups are deemed “worthy” of HIV prevention. This echoes the stigmatizing rhetoric that has long plagued HIV/AIDS policy, one that associates the disease with so-called “immoral” behavior and seeks to punish those who are at highest risk. Such policies not only fail to address the reality of the HIV epidemic but also reinforce dangerous stereotypes that fuel discrimination and stigma.

The repercussions of this policy extend far beyond the immediate communities affected. As the largest funder of global HIV/AIDS programs, the United States has a moral and strategic responsibility—and opportunity—to lead with science and evidence-based solutions. The decision to restrict PrEP access will not only increase new infections but also put added strain on already overburdened healthcare systems. The cost of treating HIV is significantly higher than preventing it, making this policy both a moral and fiscal failure.

Moreover, at a time when the world is grappling with multiple global health crises, the US should be strengthening, not weakening, its commitment to international health initiatives. This policy shift undermines trust in US global health leadership and sends a dangerous message to other nations that discrimination and exclusion are acceptable public health strategies.

Congress, global health advocates, and the public must demand the immediate reversal of this harmful policy.

The fight against HIV/AIDS is far from over. We cannot afford to take steps backward when so many lives are at stake. The Trump Administration’s decision to deny PrEP to those most at risk is a dereliction of duty, a moral failing, and a betrayal of the very principles that PEPFAR was founded upon. The world is watching, and history will not judge kindly those who choose exclusion over compassion, politics over science, and death over life.

Resources

• Too little, too late: What a PEPFAR waiver can’t do – Bhekisisa
• he Status of President Trump’s Pause of Foreign Aid and Implications for PEPFAR and other Global Health Programs – KFF
• PEPFAR Impact Tracker 
• Tracking the impact of the PEPFAR Freeze (survey)

By Samantha Rick

Among the first actions of the new US Presidential administration, was the announcement of the intent to formally withdraw the US from the WHO, which jeopardizes global health collaborations, data sharing, and inhibits WHO’s ability to address global health emergencies (the US contributes 15% of its overall budget and 34% of emergency funding) among other things.

What Does It Say?

The Executive Order states that the US intends to withdraw from the WHO immediately, pause any future transfer of funds to the WHO, recall US government personnel who have been working in any capacity with the WHO, identify other partners who can take on the tasks previously undertaken by the WHO in partnership with the US government, replace the recently released 2024 US Global Health Security Strategy, and cease negotiations on the Pandemic Accord and International Health Regulations.

What Does it Mean for Global Health Advocacy?

While global health advocates were anticipating an announcement of withdrawal from the WHO, there isn’t a blueprint for how this works as it has never happened before. There is no public information about the number of US government employees that will be recalled and how far-reaching that order will be.

There are concerns about immediate impacts, such as WHO Executive Board resolutions that the US was leading or co-sponsoring (such as one on UHC last year) and what will happen to those resolutions. It is not expected that any US government personnel will attend the Executive Board.

The longer-term impacts of withdrawal from the WHO would be catastrophic. The US provides 15% of the WHO’s overall budget, including 34% of the funding for global health emergencies. There are 70 WHO Collaborating Centers hosted in the US. These Centers are an essential and cost-effective cooperation mechanism, which enables the WHO to fulfill its mandated activities. The impact on data sharing is even messier, as researchers and companies across the country depend on data shared through the WHO and vice versa for disease surveillance, to guide protocols and policies, direct aid and funding, and much more. Outside of the impact on global research collaboration, the halting of funds to the WHO would have a severe impact on the WHO’s ability to fulfill the mandate and obligations that Member States have assigned to them, such as providing centralized data repositories and supporting increased surveillance efforts.

The withdrawal from the Pandemic Accord and International Health Regulations negotiations may seem on the face of it to be a boon, given some historical US positions that are aimed at protecting industry partners. However, the US has long been a stabilizing force in international negotiations, and particularly in these two. Over the past three years of negotiations, US leadership has kept negotiations on track. For example, the US has not been the main adversary in negotiations on the Pathogen Access and Benefits Sharing system (probably the most contentious section of the agreement) and its influence was useful in moving countries that were more opposed. Without that influence, it’s hard to see a force with more leverage to move all countries toward a concrete agreement.

Across the globe, there are interests with large platforms that are placing blame for the COVID-19 pandemic on the WHO as a scapegoat for the negative effects on people’s lives (the deaths, the loss of employment, the curtailing of social life, the feeling of imposition of masks and other public health measures). Many of the Executive Orders coming out are aimed at changing who is in control of information, including this one.

What’s Next?

Restricting access to information is a global phenomenon and a public health threat. Many countries follow the US’s lead, so partners and activists will need to mount sustained grassroots campaigns to protect public health and educate communities. Civil society must demand that governments continue their commitments to multilateralism and the advance of global public health.