Global Health Watch: PEPFAR Data, Latest in Health Deals, Lawmakers Oppose Redirected Global Health Funding, Pushback on Expanded Gag Rule

May 1, 2026

On the heels of the recent PEPFAR data release, a New York Times article by Stephanie Nolen, AIDS Creeps Back in Parts of Zambia, a Year After US Cuts to HIV Assistance, this week serves as an illustration of the consequences of the US policy decisions on lives. It shows what the policy shifts, funding disruptions, and data gaps covered in this issue, look like in Zambia: strained clinics, interrupted HIV services, and uncertainty for patients and providers relying on PEPFAR.

Recent PEPFAR Data Masks Deeper Disruptions

Continued analysis of PEPFAR data released by the US Department of State last week points to a much more nuanced and complicated narrative about the state of the HIV response. A Vox Future Perfect piece dissects the latest figures, covering July–September 2025, which the administration presents as a picture of continuity and efficiency: treatment numbers appear stable, and prevention among pregnant and breastfeeding women appear to make a targeted gain. But the article, alongside independent analyses by KFF, amfAR’s Brian Honerman and co-authors, Jirair Ratevosian, and AVAC, makes clear that this snapshot obscures deeper disruptions. Critical gaps in testing, prevention and workforce capacity are minimized, or left out entirely, to create a distorted picture of a resilient program.

The Vox analysis also calls out the absence of a full year of data. While the Department of State cited reporting and implementation challenges, previous datasets that were posted then subsequently removed in January 2026, tell a different story. Analyses by amfAR and the International AIDS Society of those unreleased figures reveal far sharper disruptions across testing, prevention and service delivery, particularly in the wake of the January 2025 foreign aid freeze. Taken together, the evidence suggests that the final quarter may represent the most stable period of an otherwise deeply destabilizing year—masking the scale and severity of the broader setbacks that may inevitably emerge farther down the road.

IMPLICATIONS: Incomplete or selectively framed data can shape policymaker perceptions, donor decisions and country-level planning, which could potentially justify further cuts or an urgent need to surge resources to counteract devastating actions stemming from the foreign aid freeze and stop work orders. And as Vox reports, “For years, one of PEPFAR’s strengths was its system that generated unusually granular public data about where the program was functioning well and where it wasn’t. That made it possible to spot problems and course-correct, part of what made PEPFAR so successful and helped save more than 25 million lives. Now that picture is much thinner… And it is unclear whether this kind of detailed HIV-specific reporting will continue at all under the terms of its America First Global Health Strategy.”

• What really happened after Trump slashed HIV funding—Vox
• AIDS Creeps Back in Parts of Zambia, a Year After US Cuts to HIV Assistance—New York Times
• What the Latest PEPFAR Data Reveal and Why It Matters—AVAC

US Lawmakers Challenge President’s Plan to Redirect Global Health Funds to Cover Costs of Dismantling USAID

A group of 17 US senators issued a letter demanding that the US Presidential administration reverse its plan to withhold $19 billion in congressionally-appropriated foreign assistance and spend down the funding as Congress directed. Led by Sen. Brian Schatz, Democrat of Hawaii, Ranking Member of the Senate Appropriations Subcommittee on State and Foreign Operations, the group highlights the administration’s plan to redirect $3.2 billion of the $19 billion away from lifesaving programs, including programs to combat HIV/AIDS ($330 million), malaria ($250 million), maternal and child health ($320 million) and global health security ($650 million) to instead cover the costs associated with abruptly terminating USAID and foreign assistance awards.

IMPLICATIONS: The dispute signals a deepening constitutional and policy clash over Congress’s power of the purse and the future of US global health leadership. If Congressionally-appropriated funds continue to be withheld or redirected by the administration, critical programs face continued disruption. This undermines years of investment and erodes trust with country partners and implementing organizations. Beyond the human impact, this move risks normalizing the diversion of Congressionally-appropriated funds for purposes unauthorized by Congress and sets a precedent that could destabilize future domestic and global health funding. These questionable budgetary maneuvers being tested in the global space, could also justify being used to scale back funding on domestic issues, including HIV.

• Schatz Leads Group Of 17 Senators In Demanding Trump Administration Comply With Law, Use Foreign Assistance Funding To Support Global Health, Food Aid, Help Save Lives As Congress Directed—US Senator Brian Schatz
• Senate Dems Accuse Admin of ‘Impoundment’ Over USAID Funds—Talking Points Memo
• Scoop: USAID tells Congress it has $19B to spend on closing out awards—Devex
• He Couldn’t Cut the Global Health Budget—But He’s Found a Loophole—Health Security Policy Academy

Countries Push Back on America First Health Agreements

Ghana has become the latest country to reject its bilateral memorandum of understanding (MoU) with the US as part of the America First Global Health Strategy. The West African nation, joins Zimbabwe which rejected its terms with the US, while Zambia continues to face pressure to open its mineral sector in exchange for foreign assistance. A new analysis in Think Global Health tracks the rollout of the MoUs, which transitions US support from traditional aid to cofinanced partnerships requiring greater domestic spending by national governments. The analysis finds wide variation in expectations and raises concerns about whether countries can meet these commitments or sustain essential health programs. The tracker also highlights limited transparency and uncertainty about the long-term impact on health outcomes.

IMPLICATIONS: The structure of the bilateral MOUs signals a fundamental reorientation of US global health engagement—from partnership-based public health investment to strengthen mutual global health security cooperation, to a paradigm of conditional, transactional, interest-driven agreements. Tying health assistance to resource extraction, data access or political alignment risks undermining trust built with impacted communities, weakening multilateral cooperation on global health and fragmenting long-standing health systems. Early consequences are already visible.

• Aid cuts and a failed deal: Zimbabwe’s frontline health care under strain—Devex
• Exclusive: Ghana rejects proposed US health aid deal, citing data concerns, source says—Reuters
• Ghana Rebuffs US Health Deal – But South Africa and Zambia Struggle Without Aid—Health Policy Watch
• Why Ghana rejected US health aid deal over sensitive data sharing concerns—Graphic Online
• African Leaders Declare End Of Aid Era At Nairobi World Health Summit, But The Data Tell A More Complicated Story—Health Policy Watch
• Tracking the “America First” Bilateral Health Agreements—Think Global Health

Lawmakers Push Back on Expanded Global Gag Rule

A group of Congresspeople in the US House of Representatives introduced the Protecting Human Rights and Public Health in Foreign Assistance Act, a bill designed to block the US administration’s expanded Global Gag Rule (formally known as the “Protecting Human Flourishing in Foreign Assistance Policy”). Historically, the Global Gag Rule prohibited foreign nongovernmental organizations which receive US family planning funds from providing, referring, counseling or advocating for abortion, even with their own non-US resources. In January 2026, the administration expanded the policy to cover additional funding streams, institutions and issue areas, extending beyond family planning to include gender-affirming care and Diversity, Equity, Inclusion (DEI) initiatives. More than 80 organizations have endorsed the legislation to block the expanded Global Gag Rule describing it as an unprecedented effort to impose ideologically-driven restrictions across global health and development partnerships.

IMPLICATIONS: Evidence from past iterations of the Global Gag Rule shows detrimental impact across health systems—reducing access to contraception, increasing unintended pregnancies and abortion rates, and weakening integrated services, including HIV prevention, maternal health and care for LGBTQI+ communities. Advocates note that this latest expansion risks amplifying those harms by restricting how countries and organizations use their own funds and fragmenting partnerships that underpin effective service delivery. These restrictions may in turn drive key populations further underground and fracture service delivery.

• Shaheen, Rosen Lead Bicameral Legislation to Overturn Trump Administration’s Expanded Global Gag Rule—Foreign Relations Committee
• A Dangerous Shift in Maternal Health Policy—TIME
• Protecting Human Rights and Public Health in Foreign Assistance Act 2026 Social Media Toolkit—Take action and show your support

What We’re Reading

• In 2 years the Global Fund will cut SA’s grant by a quarter. In 8 years it will be gone—Bhekisisa
• Why America’s HIV epidemic hasn’t ended—Vox
• Securing NIH awards is getting more competitive — and confusing—STAT
• After pulling vaccine study, Bhattacharya criticizes long-running CDC publication—Science
• PEPFAR’s Dr. mike Reid Resigns on Substack: Equity, Authoritarianism, & the Future of Global Health—A Shot in The Arm podcast
• Critics slam Trump’s purge of National Science Board: ‘Wholesale evisceration of American leadership in science’—LA Times
• National Science Board Members Dismissed—Washington Post
• Key US science panels are being axed — and others are becoming less open—Nature
• We detected Aids through a federal early warning system. Trump has decimated it—The Guardian
• RFK Jr. is holding up $600M in vaccines for poor countries—Politico
• The US CDC on the brink—The Lancet
• Offline: President Trump—it is not too late—The Lancet
• Growing use of guest editors has turned some journals into a ‘playground of bad science’—STAT
• Russia’s internet blackout affects HIV services—Lancet HIV
• Exclusive: Here’s the Covid-19 vaccine paper the CDC censored—Inside Medicine
• What happened to Covid?—STAT
• Newly Approved HIV Treatment Option Is No More Than Fine — and Shows Just How Good HIV Treatment Is Today—NEJM Voices
• DoxyPEP halves overall syphilis cases, with possible indirect benefits for women—Aidsmap
• Health experts and partners launch Zim’s first STI advocacy agenda—CITE.org