Global Health Watch: CDC Cuts to HIV Prevention, Restructuring Foreign Aid

Issue 8: March 21, 2025

March 21, 2025

From proposed elimination of the CDC’s HIV prevention program in the US to the uncertain future of foreign assistance around the world, the US administration’s sweeping policy changes threaten decades of progress in both domestic and global HIV efforts. This week’s newsletter examines these proposed cuts, ongoing lawsuits against the foreign aid freeze, plans to dismantle USAID, while also exploring the fate of NIH grants in South Africa and the mounting repercussions on communities and lives. Read on for more.

US CDC’s Uncertain Future

The administration is looking to slash an estimated $700M to $1B from the CDC’s Division of HIV Prevention (DHP), a vital pillar in the national fight against the HIV epidemic. These cuts mark a significant shift from the first Trump administration’s goal to end HIV in the US by 2030 when it launched the landmark US Ending the HIV Epidemic (EHE) initiative in 2019. In a sharp turn, the administration is now considering a proposal to defund many aspects of DHP and shift HIV prevention programs from CDC to the Health Resources and Services Administration (HRSA), which leads HIV care and treatment programs but has no HIV prevention experience.

IMPLICATIONS: Cuts to HIV prevention funding at the CDC would disrupt programs within each state, which rely on federal funding to carry out critical services. This can be expected to trigger a dramatic rise in HIV, STIs, and tuberculosis cases, reversing decades of progress and imposing heavy financial burdens on state healthcare systems. Moreover, key populations most vulnerable to HIV in the US may see disruptions in vital access to prevention services, in addition to the ongoing, systematic, erosion of rights of these communities. The cruel irony of dismantling the President’s own vision of EHE, is only matched by the tragic timing: as AVAC’s Mitchell Warren told The Well News, “So just as we are poised to deliver the newest innovation [with approval of injectable lenacapavir for PrEP expected in June] that could dramatically impact the epidemic and achieve the goal of his first term, the administration is pulling the rug out from under the whole ecosystem—in the US and internationally.”

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AVAC vs. Department of State and Other Court Cases

The AVAC vs. Department of State and Global Health Council vs. Trump twin lawsuits against the foreign assistance freeze made small steps forward this week. Following last week’s ruling requiring the government to pay USAID partners for billions of dollars in foreign aid work completed before Feb. 13, a new status report from the government, as required by the Court, indicates that payment for overdue bills has begun – slowly. Even though overall foreign assistance has yet to be restarted, more organizations report that they are finally receiving payments—new obligations beyond February remain uncertain. The Government is considering whether to pursue further appeals.

In related news, on Tuesday, a different US District Judge temporarily blocked the US DOGE Service from further dismantling USAID. The judge ordered the government to restore the agency’s headquarters and reestablish email access for thousands of employees.

IMPLICATIONS: It is unlikely that many of USAID’s implementing partners and programs will receive the funding needed to continue their critical work given the mass termination of contracts and jobs and overall dismantling of the agency. As Mitchell Warren told the New York Times, “We’ve got to snap out of any paralysis or any disbelief or shock, and we’ve really got to look at what needs to be built in the future.” The additional ruling about DOGE found the executive branch actions to eliminate USAID’s functions and issue mass layoffs to be a violation of the constitutional separation of powers. This ruling marks a critical setback for the administration. It remains in effect pending further court order.

FOLLOW ALONG: Follow progress of the case on our website.

READ: Maryland Judge Orders DOGE to Stop Efforts to Dismantle USAID—Washington Post

US Government’s New Plan for Restructuring Foreign Aid

A proposal to overhaul US foreign aid programs to “better serve strategic interests” appeared this week. The plan calls for renaming USAID as the US Agency for International Humanitarian Assistance—narrowing its scope to global health, food security, and disaster response—and moving it under the State Department. It also proposes merging the Millennium Challenge Corporation and the US Trade and Development Agency with the US International Development Finance Corporation to leverage private sector investment, counter China’s Belt and Road Initiative, and promote a more transactional approach to foreign policy. The proposal deems current aid efforts “inefficient and fragmented” and suggests that programs should have clear end dates, measurable success, and enhanced accountability through technologies like blockchain.

IMPLICATIONS: This restructuring could narrow the scope of assistance available to vulnerable populations and low-income countries and leave less room for long-term capacity building. 

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Reauthorizing PEPFAR

In 2024, PEPFAR was reauthorized for just one year, breaking a 20-year trend of successive five-year reauthorizations that the lifesaving program has historically seen with strong bipartisan support in Congress. The current reauthorization expires next week, on March 25, amid unprecedented challenges. Champions of global health and evidence-based HIV prevention made clear the potential to end the epidemic or to lose decades of progress in fighting HIV at a March 13 US Congressional briefing.

Hosted by Congresswoman Robin Kelly (D-IL), the Congressional Caucus on Black Women and Girls, AVAC and the Global AIDS Policy Partnership (GAPP), participants all referenced the UNAIDS goal of ending AIDS as a public health threat by 2030. Angeli Achrekar, Deputy Executive Director of UNAIDS, described the grave risks of missing this moment: “The end is almost in sight. Yet, if we do not get to the end, we risk serious resurgence. Those gains, that have been made with so much investment and engagement by governments and American taxpayers, will be reversed. We risk backsliding in all this strategic engagement. It’s a reality we all have to face.” 

READ: PEPFAR: A Strategic Necessity for US Leadership and Global Health—AVAC

WATCH: Recording of the Congressional Briefing

The Impact of Funding Cuts and Frozen Aid

Nearly two months into the dismantling of foreign aid and funding for research, the threat to vulnerable communities is starkly evident. Last week, we highlighted how these cuts are affecting clinical trials and the development and rollout of new HIV prevention tools—such as long-acting injectables and HIV vaccines. This week, the World Health Organization, in a press conference, reported that the new administration’s pause on foreign aid has “substantially disrupted” HIV treatment supplies in eight countries, including Haiti, Kenya, Lesotho, South Sudan, Burkina Faso, Mali, Nigeria, and Ukraine, which will soon run out of life-saving medications.

Separately, former USAID Global Health director, Atul Gawande said in an interview that an estimated that 160,000+ will die from malaria per year, “hundreds of thousands [of the 20 million people dependent on HIV medicines] will die in a year” if USAID programs are not restored.

LISTEN: Atul Gawande on Elon Musk’s “Surgery with a Chainsaw”—The New Yorker Radio Hour

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NIH Grants Involving South Africa at Risk

It has been reported that the new administration is considering terminating NIH grants that support work in South Africa. This comes after an executive order in February alleging discrimination against Afrikaners. The potential cuts could impact the extensive South African research infrastructure and top institutions like the University of Cape Town, University of the Witwatersrand, and Stellenbosch University. The latest slew of proposed terminations come amid NIH turmoil where many grants have already been cut, including any related to diversity and vaccine hesitancy.

IMPLICATIONS: This would severely disrupt critical HIV and tuberculosis research. Such abrupt funding cuts would halt or undermine clinical trials and have far-reaching global repercussions, while undermining decades of collaborative progress.

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The Conference on Retroviruses and Opportunistic Infections (CROI) just wrapped up. The science showcased the great promise and importance of research and made clear just how much is at stake.

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