This week’s issue covers challenges confronting the US National Institutes of Health under the new administration, the uncertain future of PEPFAR, continued legal battles over the foreign aid freeze and urgent efforts in Africa to secure sustainable health funding amid drastic aid cuts. Read on for more.

AVAC vs. Department of State 

On Wednesday, in response to the US government’s request, the Supreme Court ruled that the administration must release up to $2 billion in frozen foreign aid funding for work completed before February 13. This overturned a temporary stay granted by the Chief Justice last week. This was a small victory along the way. And on Thursday, the case was back in the District Court for a four-hour hearing where the judge ordered from the bench that the government must pay AVAC, the Global Health Council and other plaintiffs the outstanding balances they are owed by Monday evening.  

IMPLICATIONS: Thursday’s ruling is a “concrete step” forward, said the judge overseeing the case, but it does not rule on or indicate the fate of the $2 billion in payments owed to other aid organizations. Even if some contracts are eventually reinstated, the State Department has already cancelled 90% of USAID’s work and tens of billions of dollars in Congressionally approved spending, so it is unlikely implementing partners and programs receive the funding they need to continue this critical work. 

FOLLOW ALONG: Track progress on the case here.

READ: Trump administration ordered to pay select USAID partners by Monday—Devex

Threats to US-Funded Research

At a March 5 congressional hearing on threats to US-funded research, representatives debated strategies to counter security threats while investing in the US scientific enterprise. Republican committee members focused on restricting international students and researchers from US institutions, whereas Democrats focused on the threats from within. Specifically, administration and Congressional attacks on federal agencies, which jeopardize US leadership in discovery and innovation, and cuts to “indirect costs”, which are essential for maintaining research infrastructure and administrative overhead. “The money has to come from somewhere. The result [of these cuts] will be less research, driving many out of business. The impacts are potentially huge,” said MIT’s Maria Zuber who gave testimony at the hearing.  

In a related and unprecedented move, the NIH on Wednesday initiated mass terminations of active research grants that no longer align with its new “agency priorities.” Internal documents reveal that NIH staff are required to review projects for ties to diversity, equity, and inclusion—especially those involving transgender issues, or research in China—and to classify them into categories for easier cancellation decisions.  

And further, the NIH announced that it will centralize peer review of all grant and cooperative agreements, and research and development contracts within its Center for Scientific Review. 

IMPLICATIONS: Forcing federal grants and programs to adhere to partisan ideology is anti-science and anti-evidence. Subjecting funding decisions to political tests will undermine essential research and jeopardize long-term research and future discovery. Further excising key populations from research ultimately limits the benefits and interventions that result from publicly funded biomedical research for those most vulnerable to HIV and other diseases.

READ: Exclusive: NIH to terminate hundreds of active research grants—Nature

The Future of the NIH: Jay Bhattacharya’s Confirmation Hearing

At his confirmation hearing to become NIH Director, nominee Jay Bhattacharya faced tough questioning on future NIH priorities, and how he would balance scientific integrity and political pressures. When questioned about the proposed indirect cost rate cuts and their ramifications, Bhattacharya defended the policy, saying it would enhance research efficiency while sustaining vital infrastructure. Bhattacharya pledged to focus the NIH on chronic diseases, rebuilding public trust in science through transparency and debate, and undergoing structural changes to support innovative research.  

IMPLICATIONS: Despite concerns over Bhattacharya’s vaccine skepticism, AIDS denialism and racist views of immunology, his confirmation appears likely with a full Senate vote imminent. If confirmed, Bhattacharya would serve under Health and Human Services (HHS) Secretary Robert F Kennedy Jr. (RFK Jr.), who controls funding, administration and how science is communicated via the US CDC, NIH, FDA and other important health agencies. As the potential lead for NIH, Bhattacharya will be tasked with carrying out elements of RFK Jr.’s agenda of ‘Making America Healthy Again’. RFK Jr. was confirmed in February despite concerns over his vaccine skepticism, AIDS denialism, and racist views of immunology. 

READ: Trumps’s pick to head NIH avoids major controversy at Senate hearing—Science

Undermining NIH Public Engagement 

HHS Secretary Kennedy issued a policy statement rolling back a 1971 policy that requires public comment on rules related to grants, loans, public property and benefits. This policy shift veils the decision-making process and could enable controversial changes to be imposed without public discussion or debate.  

IMPLICATIONS: This new directive will inalterably transform how NIH operates and significantly restrict the research community’s ability to engage in policymaking. It guts a critical mechanism established nearly 50 years ago for public and expert scrutiny of policy and stifles collaboration between scientists and government that has long driven scientific innovation and progress in public health. Moreover, this move further limits community engagement in NIH processes and research, losing valuable perspectives and insights that are necessary to enrich the impact of publicly funded biomedical research.  

READ:  

• RFK Jr. Kills Policy on Public Comment for Health Regulations—Axios  
• RFK Jr.’s Limits on Rule Comments Have Risk for Medicaid, Grants—Bloomberg Law 

PEPFAR in Jeopardy

Advocates continue to fight for the PEPFAR program. On Wednesday, AVAC, the Global AIDS Policy Partnership (GAPP) and The U.S. Congressional Caucus on Black Women & Girls Co-Chairs Representatives, Robin Kelly (D-IL), Yvette Clarke (D-NY), and Bonnie Watson Coleman (D-NJ) hosted, the congressional briefing, The State of PEPFAR. The briefing featured a broad panel with AVAC’s Senior Policy Manager John Meade, Jr. serving as co-moderator. Panelists included Friends of the Global Fight’s Chris Collins, Desmond Tutu HIV Center Director and AVAC Board member Linda Gail Bekker, Angeli Achrekar of UNAIDS and Jirair Ratevosian of the Duke Global Health Institute. They offered insightful analysis on how recent administrative decisions threaten global progress in HIV.  

“The hardest hit are key populations—Black gay men, sex workers, transgender people, people who inject drugs and Adolescent girls and young women—those already on the margins of society. Their clinics are shutting down, their communities are losing access to PrEP and HIV treatment,” noted AVAC’s John Meade, Jr. “Congress must act immediately to restore and protect funding for PEPFAR and global HIV programs. This is not a partisan issue—PEPFAR has enjoyed strong bipartisan support for over two decades because it works. It has saved lives, strengthened economies, and reaffirmed America’s role as a leader in global health.” 

READ:

• Trump Says ‘Male Circumcision in Mozambique’ is a ‘Scam.’ What’s the Program About?—NPR   
• FROZEN OUT: Impact Of the PEPFAR Funding Freeze on Programs for Key Populations—GBGMC 

Africa and Sustainable Health Funding 

The foreign aid freeze, dismantling of USAID and many other US actions under the new administration are accelerating discussions on how African governments will tackle the immense challenges ahead. At this week’s Africa Health Agenda International Conference (AHAIC) in Kigali, African leaders, advocates, and delegates confronted the funding crisis head-on, exploring urgent, innovative financing models to ensure the long-term sustainability of essential health programs. While some see this moment as an opportunity to build capacity and reduce dependence on external aid, others warn that without significant domestic reforms, the sudden loss of aid will intensify poverty, strain resources, and further impede development across the continent. 

READ: Why Some Africans See Opportunity in Foreign-Aid Cuts—The Economist

What We’re Reading

• WATCH: “Lift the Freeze”: HIV/AIDS Advocates Win Supreme Court Victory in Fight over Trump Foreign Aid Cuts—Democracy Now
• Funding Freeze on US Foreign Aid is ‘Over,’ Trump Administration Claims—Devex  
• Defunded Aid Programs Are Asked by Trump Administration to Prove Their Value, on a Scale of 1 to 5—The New York Times
• The Global Fund will roll out the twice-yearly anti-HIV jab — with or without PEPFAR—Bhekisisa 
• WATCH: Trump USAID cuts make impact in South Africa—UK Channel 4 
• KFF Health Tracking Poll February 2025: The Public’s Views on Global Health and USAID—KFF
• US suspends aid to South Africa after Trump order—The Guardian
• As Ebola Spreads in Uganda, Trump Aid Freeze Hinders Effort to Contain It, US Officials Fear—The New York Times

Resources

• PEPFAR Watch
• Project 2025 Tracker
• Litigation Tracker—Just Security
• Impact of the Executive Order on COMPASS Tanzania Partners and Overall National HIV Response—COMPASS
• Federal Government Outlays—DataETC

This week has been marked by a further flurry of intense developments in global health, with aggressive political and legal actions by the new presidential administration and implications for PEPFAR, research, global health and more. Below is a roundup of the key issues and events shaping our work this week.

AVAC vs. Department of State 

Court cases against the US administration’s foreign aid freeze, including AVAC vs. Department of State, saw a lot of activity this week. Tuesday, the Federal Court ordered the administration to pay all invoices submitted and ensure reimbursement for work by midnight Wednesday. In response, the administration sought a temporary stay from the US Supreme Court. Chief Justice John Roberts, who handles emergency requests like this, granted the stay, allowing the Court more time to review the case and relieve the USG of its obligation to meet the February 26 payment deadline set by the lower court. At the same time, the overall case is still proceeding, and the lower court will hold a hearing of AVAC’s case (in combination with the related case brought by Global Health Council and partners) early next week (by March 4).    

IMPLICATIONS: The temporary stay issued by the Supreme Court does not imply how the Court will rule next week, and this is just one of a flood of cases challenging the new administration’s many questionable executive actions. We are witnessing a time when the US judicial system will be tested by the sheer volume of unconstitutional acts, and if the administration will comply with the rulings. 

FOLLOW ALONG: You can follow along with progress on the case at, https://avac.org/avac-vs-dept-of-state/. 

READ:  

• Chief Justice John Roberts pauses order for Trump admin to pay $2 billion in foreign aid by midnight—CNN
• Chief Justice Allows U.S. to Continue Freeze on Foreign Aid Payments—The New York Times 

Global Health Contracts Terminated 

Nearly 10,000 contract awards from USAID and the State Department were terminated on Wednesday, impacting a wide range of global programs. These cuts affect not only HIV programs, but also tuberculosis research and treatment access, malaria prevention, food and nutrition aid, and many other vital humanitarian assistance projects and programs worldwide.  

These cuts, affecting over 90% of the agency’s work and tens of billions of dollars in Congressionally approved spending, could bankrupt many implementing partners and shutter lifesaving programs, including critical components of PEPFAR.  

IMPLICATIONS: By cutting 90% of USAID’s work, including programing for HIV, like PEPFAR, many implementing partners do not have capacity to deliver live-saving HIV treatment and prevention programming, services and supplies. Tens of thousands of in-country health workers are unemployed; clinics shuttered; trust and confidence of patients, partners and governments are now gone. While the administration insists that foreign aid, which represents roughly 1% of the federal budget, has become wasteful and detached from US interests. However, these actions dangerously undermine the US’ global influence and soft diplomatic power. 

READ:  

• US Terminates Thousands of Life-Saving Health Grants Including For HIV and Malaria—Health Policy Watch
• The Trump administration kills nearly all USAID programs—NPR
• Trump administration ends funding for UN program fighting HIV/AIDS—The Guardian
• US Terminates Funding for Polio, H.I.V., Malaria and Nutrition Programs Around the World—The New York Times 

PEPFAR in Jeopardy 

PEPFAR, the US government’s flagship HIV/AIDS program, is confronting unprecedented challenges under President Trump’s second term. The executive order to pause foreign aid, the dismantling of USAID, which implements approximately 50% of PEPFAR’s investment, and intensified political scrutiny of PEPFAR, have all destabilized the program’s once-stalwart support, with reauthorization coming in late March.  

IMPLICATIONS: Jirair Ratevosian, who previously was PEPFAR’s chief of staff and Legislative Director for former US Congresswoman Barbara Lee of California, explores what a post-Trump global HIV response might look like with Mia Malan on this must-listen Bhekisisa podcast. “I think where all this is leading is to a State Department-led foreign assistance effort that will be implemented through partnerships that are not going to be as diverse and complicated as there were before. And there are some consequences…I think that we’re going to an era where the operating part will look very different, but I think we have to look at it as an opportunity…I’m hopeful this is one of those bright spots where, when you reduce the number of intermediaries, so to speak, you could actually save some money, give more of it to the program itself, and then that can hopefully lead to more productivity at the country itself.” 

READ:  

• The Outlook for PEPFAR in 2025 and Beyond—KFF
• Envisioning the Future for a Celebrated Global AIDS Program—Duke University Global Health Institute 

LISTEN: Would Pepfar survive Trump — and what would it look like?—Bhekisisa   

NIH Research Funding Concerns 

NIH funding continues to be at a standstill as final funding decisions remain in limbo—research grants are still frozen amid ongoing legal battles. In the meantime, an investigation suggests that individuals connected to Elon Musk’s Department of Government Efficiency (DOGE) task force now have access to the NIH’s financial systems, raising fresh concerns about the agency’s internal oversight. 

READ:  

• Revealed: NIH research grants still frozen despite lawsuits challenging Trump order—Nature
• DOGE is Inside the National Institutes of Health—Wired   

Mobilizing Amid Attacks on Science 

As scientists and advocates are confronted with the new administration’s assaults on scientific integrity, many are mobilizing.  

At the nation’s capital this week, protestors staged a “die-in,” to spotlight the dismantling of USAID and foreign aid, and the impact on countless lives and livelihoods under the new administration’s orders. A recent editorial in Science detailed how scientific leaders, universities, and professional organizations are organizing—through lawsuits, public statements, and advocacy efforts—to defend the integrity of science. “We will not change the principles and processes by which we serve the scientific community; those outside the United States should not have to alter their research agenda or methods because of bad decisions about science policy in the US.” 

The Community Health & HIV Advocates Navigating Global Emergencies (CHANGE) coalition is developing resources for advocates and organizing to protect access to HIV treatment and prevention. Find their resources featured in Global Health Watch and contact them at [email protected].  

READ:  

• Lay low or mobilize? HIV researchers agonize over how to respond to Trump administration’s attacks on science—Positively Aware
• Fired USAID workers and HIV activists hold ‘die-in’ to protest Trump and Musk—The Guardian
• Come together, right now—Science  

Resources

• PEPFAR Watch Funding Freeze Tracker 
• Project 2025 Tracker
• Funding Freeze Fallout: Tracking Furloughs, Layoffs, and Cuts, Devex  
• Overview of President Trump’s Executive Actions Impacting LGBTQ+ Health, KFF 
• Overview of President Trump’s Executive Actions on Global Health, KFF 
• Litigation Tracker: A public resource tracking the legal challenges to the Trump administration’s executive orders, Just Security  
• CHANGE South Africa Press Conference 

What We’re Reading

• As the U.S. Exits Foreign Aid, Who Will Fill the Gap?—New York Times
• By executive order: The likely deadly consequences associated with a 90-day pause in PEPFAR funding—JIAS 
• NIH ban on renewing senior scientists adds to assaults on its in-house research—Science  
• Q&A: How Trump’s USAID freeze halted the effort to develop an effective HIV vaccine in Africa—STAT
• Statement from Global Health Council on the Mass Termination of USAID and State Department Grants—Global Health Council statement 
• Lifesaving Services Terminated for 10,000 Children and 10,000 Pregnant Women—EGPAF statement 

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)