Global Health Watch: Tariffs, NIH Cuts, Black-led HIV Research Agenda & PEPFAR’s Legacy

April 11, 2025: Issue 11

This week brought major developments for global health: new tariffs on pharmaceuticals are pending, a court blocks the cap on NIH indirect costs, and worries a leadership vacuum at the CDC is a cause for yet more concern. Amid the chaos, advocates rallied—defending PEPFAR’s legacy in Congress and launching a national Black-centered, Black-led HIV research agenda. 

Read on for highlights and implications and be sure to check out the What We’re Reading section, which is full of great pieces this week. 

Tariffs and HIV

As the administration created even more chaos with the on-again, off-again sweeping tariffs and threats of major trade wars, a new report highlights concern and potential effects on health systems—including HIV prevention and care. Finished pharmaceuticals are temporarily exempt, but essential components like diagnostic tests, syringes, excipients and other medical supplies may not be protected, raising alarms about cost increases and supply chain delays. And on Tuesday, the President announced at a dinner that new tariffs targeting pharmaceuticals are now officially “coming soon.” 

IMPLICATIONS: If global pharmaceutical manufacturers move their operations to avoid tariffs, FDA inspections—with many fewer resources in the wake of last week’s mass layoffs—could delay approval of new products. Clinics, hospitals and other health systems may face increased costs, limited availability of products and a more fragile supply chain.  

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NIH Overhead Cuts Blocked by Court 

A federal judge issued a permanent injunction blocking an administration policy that would have capped indirect cost payments at 15% for both new and existing NIH grants. The policy threatened to cut billions in support for universities, academic centers, and research institutions—jeopardizing infrastructure, staff, and ongoing studies. While the administration may appeal the ruling, it marks an important step in what could be a long legal battle over the future of federal research funding. At the same time, massive uncertainty remains at NIH, given the numerous staff and grant terminations. 

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US CDC Uncertainty

Internal memos reported by Inside Medicine indicate that the US CDC currently has no legally-required Acting Director, which leaves the agency in a leadership vacuum at a critical time. Dr. Susan Monarez, who previously served in an acting capacity, became ineligible for that role after being nominated for the permanent position on March 24. In the meantime, scientists and advocates are calling on federal and state health leaders to protect the nation’s only STD reference laboratory and reinstate over 30 scientists affected by the recent reduction in force (RIF) amid a growing public health crisis of rising STDs and drug-resistant infections. Colleen Kelley, chair of the HIV Medicine Association (HIVMA) testified before Congress Wednesday advocating for the CDC’s prevention division, continued funding in HIV care, prevention and research. 

IMPLICATIONS: Without a legally authorized director, decisions normally reserved for CDC leadership—including the acceptance of upcoming vaccine recommendations by the Advisory Committee on Immunization Practices (ACIP)—must now be made by HHS Secretary Robert F. Kennedy Jr., a known vaccine skeptic. This raises urgent concerns about legal compliance, scientific integrity, and public trust, particularly as thousands of CDC staff have been laid off and critical public health decisions loom.  

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Making the Case for PEPFAR 

On Tuesday, EGPAF’s Catherine Connor and Ambassador Mark Dybul testified at the US House Appropriations Subcommittee hearing on PEPFAR, issuing powerful affirmations of the program’s life-saving impact—and the bipartisan commitment to its future. Lawmakers from both sides showed strong support for PEPFAR. They also shared an interest in innovation—including the promise of long-acting PrEP—to strengthen the program’s next phase. Their testimony came at the same time that Michel Sidibe and colleagues published new data in a Lancet Correspondence underscoring PEPFAR’s legacy—in saving an estimated 26 million lives, and also in catalyzing a 212% increase in domestic health investment across PEPFAR-supported African countries, since 2004. In the same issue, Lucie Cluver published updated modeling of the impact of potential PEPFAR cuts

READ/WATCH:  

A Black-led Agenda for HIV Research

PrEP in Black America (PIBA) and more than 80 Black researchers, scientists, and community leaders, launched the first-ever national Black HIV Prevention Research Agenda this week, a call to action and a blueprint to end HIV in Black communities. The agenda centers Black voices, leadership, and lived experience to influence how HIV prevention research is conducted, funded, and implemented. AVAC’s John Meade described the launch as a moment of “reckoning and resistance,” pointing to the urgent need to protect public health infrastructure, advance equity, and resist political threats to HIV research and LGBTQ+ rights. This domestic research agenda importantly complements the People’s Research Agenda that AVAC and global partners released last October. The two documents provide a truly global, community-led perspective on the future of HIV prevention research. 

READ

The Future of Injectable Lenacapavir for PrEP

Clinical Infectious Diseases covered two viewpoints offering different perspectives on the future of injectable lenacapavir for PrEP—and the future of HIV prevention more broadly.

What We’re Reading

Update on AVAC vs. Department of State

Two months ago, AVAC sued the US government over an Executive Order that froze all foreign assistance. 
 
Since then, the court has ordered the government to restart certain payments and uphold its legal obligations. But delays, resistance, and appeals continue—putting global health, HIV prevention, and US credibility on the line. 
 
Read our update on the case and watch our latest episode of PxPulse Live where AVAC’s Executive Director Mitchell Warren and Public Citizen litigator Lauren Bateman unpack the latest legal developments.

Resources

Impact of PEPFAR’s Stop Work Order on PrEP

The impact of the stop-work order on PrEP is expected to be severe. In a set of slides and on our website, PrEPWatch, we have posted the results of an analysis drawing on key informant interviews with representatives of Ministries of Health and PrEP implementers between 27 January 2025, when stop-work orders were issued by the US government, and the end of February 2025, when the vast majority of USAID-funded projects received official termination notices. Find the latest here.

Trials & Projects Halted by USAID Funding Suspension

The stop-work orders have disrupted USAID-supported HIV prevention research, halting critical investigations in vaccine and next-generation PrEP strategies.

The abrupt suspension of these trials also raises serious ethical concerns. Stopping trials mid-course undermines trust in research, jeopardizes community engagement, and abandons participants who volunteer their bodies for scientific discovery. It will take years to build back this critical infrastructure—for HIV research and beyond—as well as the community partnership and trust needed to ensure smooth and ethical research.

HIV Incidence, Age 15-49

Looking backward and then into the future, this chart shows actual HIV rates alongside projected rates with and without current prevention strategies (PrEP, VMMC, and free condoms).

Global PrEP Uptake and PEPFAR’s Role, 2016-2024

AVAC’s Global PrEP Tracker has documented cumulative PrEP initiations on a quarterly basis for nearly a decade. This graph presents the final data collected while PEPFAR was fully operational—PEPFAR support was responsible for 79% of PrEP uptake globally in the last year and reached 83% by the end of September of 2024. Data on the fourth quarter of 2024 is inaccessible since PEPFAR was taken offline in late January.

PxWire Volume 15, Issue No. 1

In this special edition of Px Wire, AVAC is going beyond a quarterly update of biomedical HIV prevention. In this issue, we look at how the new US Administration’s attack on global health can be expected to devastate HIV prevention, including the capacity to deliver existing PrEP options, the scale up of new PrEP products, and the paralyzing impact on research and development. A PDF version of this report is also available.

From Research to Rollout: The impact of USG global health pullout

New Vision newspaper frontpage thumbnail

The United States’ presidential regime has launched a sustained, multi-pronged attack against foreign assistance, scientific inquiry, due process and good governance. It threatens economies, human rights, international partnerships, global health at large, and the rule of law. For HIV prevention, a single sentence, issued in a February 6 advisory from the US Department of State, has derailed the entire field, potentially setting back the HIV response by years, if not decades. Read on for resources to support your advocacy and fortify our solidarity at this critical time.

Progress in PrEP Uptake: Threatened

global PrEP uptake and PEPFAR's role

PEPFAR has been pivotal to accelerating PrEP uptake, significantly expanding HIV prevention coverage. The freeze on foreign aid prohibits funding to PEPFAR’s PrEP programs and poses a serious threat to global efforts to control the epidemic.

AVAC’s Global PrEP Tracker has documented cumulative PrEP initiations on a quarterly basis for nearly a decade. This graph presents the final data collected while PEPFAR was fully operational—PEPFAR support was responsible for 79% of PrEP uptake globally in the last year and reached 83% by the end of September of 2024. Data on the fourth quarter of 2024 is inaccessible since PEPFAR was taken offline in late January.

At the time of the foreign aid freeze, PrEP uptake had reached 8 million initiations since 2016, an achievement that’s taken almost 10 years to reach—too slow and too small to reach UNAIDS targets, but a robust foundation to finally accelerate PrEP uptake with next-generation PrEP. Current US policies, instead of expanding PrEP coverage, are leading to the closure of programs, and will reverse global progress against HIV.

Without primary prevention, the HIV epidemic is poised to rage on, with incidence among adults on track to triple over the next ten years. This HIV Synthesis model, developed by the HIV Modelling Consortium, estimates the impact of stopping all HIV prevention services across Africa from now through 2036—including PrEP, voluntary medical male circumcision (VMMC), and free condom distribution.

For the last 8 years, AVAC has proudly worked with PEPFAR to document PrEP uptake and its impact around the world. That stopped in January with a stop work order from the US government. But protecting access to PrEP is vital. Are you leading a PrEP program? Whether supported by PEPFAR or not, we invite you to work with us to ensure global data on PrEP is not lost. Find us at [email protected].

PrEParing for New Products: Is rollout still possible?

Wired magazine headline: this new drug could help end the epidemic—but US funding cuts are killing its rollout

Read more in The Gears of Lenacapavir for PrEP Rollout.

The chaos in foreign assistance programs (including discontinuation of major PrEP programs), cuts in staffing and new demands on donor commitments will make decisions on the procurement of LEN for PrEP more complex and uncertain. In December 2024, the Global Fund and PEPFAR announced a plan to reach 2 million people with LEN for PrEP over three years. Exactly how funding to support this unprecedented introduction program will move forward, in the absence of significant US investment, is far from certain. The other stakeholders, including Global Fund, Gilead, CIFF and the Gates Foundation expressed commitments to the deal, but major questions remain. In the meantime:

The Latest R&D in the Prevention Pipeline: Supported or undermined?

Representative headlines from the New York Times and Science magazine.

The stop-work orders have disrupted USAID-supported HIV prevention research, halting critical investigations in vaccine and next-generation PrEP strategies.

  • The BRILLIANT and ADVANCE projects’ clinical, preclinical, and experimental trials testing HIV vaccine candidates have been suspended.
  • The MATRIX projects’ driving innovation with next-generation PrEP and MPT products, fast-dissolving inserts and vaginal films and rings, have been forced to stop their clinical trials.
  • The MOSAIC projects’ have suspended all implementation science activities, including the CATALYST study, investigating choice among oral PrEP, injectable cabotegravir and the dapivirine vaginal ring. Other implementation studies are continuing, but access to the commodities, much of which was procured by PEPFAR is questionable. See AVAC’s Integrated Study Dashboard for details.
  • The Coalition to Accelerate and Support Prevention Research (CASPR) has also been paused. Led by AVAC in partnership with a number of leading African civil society organization, CASPR focuses on building an enabling environment for HIV prevention R&D. (Note: In early February, AVAC lead a lawsuit against the State Department seeking emergency relief from the freeze on foreign assistance, including funding for CASPR. The case, AVAC v. United States Department of State, is pending.)

These disruptions delay the development of urgently needed HIV interventions and threaten the sustainability of research infrastructure all over the world, with particularly egregious impacts on the research capacity of regions most impacted by the epidemic.

The abrupt suspension of these trials also raises serious ethical concerns. Stopping trials mid-course undermines trust in research, jeopardizes community engagement, and abandons participants who volunteer their bodies for scientific discovery. It will take years to build back this critical infrastructure—for HIV research and beyond—as well as the community partnership and trust needed to ensure smooth and ethical research.

Prevention Playlist

AVAC develops a wide range of resources to inform decision making and action. Check out the latest:

Join

  • Subscribe to Global Health Watch: AVAC’s weekly newsletter dedicated to breaking down critical developments in US policies and their impact on global health. avac.org/signup
  • Seeking Visuals and Videos: Leading groups in Washington, DC, are urgently trying to collect videos and photos documenting the impact of the US government’s foreign aid freeze, such as clinic closures despite the waiver. Non-professional phone videos and photos are welcome. Send to [email protected] for more details
  • CHANGE: In response to the unfolding crisis, more than 1,300 people from civil society organizations around the world have launched CHANGE—Community Health & HIV Advocate Navigating Global Emergencies—a coalition formed to support urgent action. [email protected]

Use

Watch/Listen

Read

  • AVAC v United States Department of State. On February 10, 2025, AVAC and another nonprofit organization sued the new US Administration, seeking emergency relief from an Executive Order that inhumanely froze all funding for foreign assistance, AVAC

We’re Going Back to Court

New developments in our legal battle against the United States government

Three weeks ago, AVAC, as well as the Global Health Council and partners, sued the U.S. State Department and government officials including the President, to end the freeze on foreign assistance funding that is harming global health and development programs, including lifesaving HIV prevention efforts. 

On February 13, a US federal district court immediately granted a temporary restraining order and directed the government to lift the freeze and restore funding while our lawsuit progresses. Since then, the administration has repeatedly refused to restart funding, and the court has made clear more than once that the continued freeze is unlawful.  

“The government comes to this Court with an emergency of its own making,” our lawyers wrote in a filing.

The lengths that the government is willing to go to flout a court order, all for the goal of ending life-saving humanitarian assistance, is staggering,” they said.

Now we have a court date: this Thursday, March 6 at 2pm Eastern Standard Time, we will be in Washington, DC, to make the case for human rights, health and dignity – and the government paying its bills.

This fight is far from over, and your support has been instrumental in reaching this point, and together, we can continue to champion the rights and health of communities worldwide. 

How you can stay connected:

These are immensely challenging times for all of u, and it is easy to be paralyzed, overwhelmed and depressed. But we’ve all come too far for that to be the new normal.  Lives, economies and democracies depend on our collective ability to stand up and fight back. 

New Product Introduction Update

Spotlight on Eastern and Southern Africa

A graphic showing ongoing studies of injectable cabotegravir and the dapivirine vaginal ring in eastern and southern Africa.

Avac Event

CROI 2025 Community Breakfast Meetings

The Community Breakfast Clubs are virtual webinars coordinated by the CROI Community Liaisons, the European AIDS Treatment Group, AVAC, and their global collaborators. They feature researchers and advocates discussing some of the most consequential science being presented at CROI.

Session Recordings

Breaking New Ground: The latest advances in HIV cure
March 10, 2025

AVAC, the CROI Community Liaison Subcommittee and European AIDS Treatment Group hosted the first virtual Community Breakfast Meeting (CBMs) for the 2025 CROI meeting. Speaker details and recording below:

Moderator: Michael Louell, University of Washington-Seattle, Fred Hutch Center for AIDS research 

Speakers

  • Dr. Katie Bar, University of Pennsylvania, CROI Scientific Program Committee 
  • Dr. Marina Caskey, Rockerfeller University 
  • Dr. Steven Deeks, University of California, San Francisco (UCSF) 
  • Ms. Doreen Mora Moracha, HIV Cure Advocate- Kenya, CROI Community Educator Scholar

The End of AIDS — Near and Far? (40 Years of HIV)
March 11, 2025

AVAC, the CROI Community Liaison Subcommittee and European AIDS Treatment Group hosted the second virtual Community Breakfast Clubs (CBCs) for the 2025 CROI meeting. Speaker details and recording below: 

Moderator: Grace Kumwenda, AVAC 

Speakers: 

  • Dr. Chris Beyrer, Duke Global Health Institute
  • Chilufya Kasanda, Treatment Advocacy and Literacy Campaign – Zambia, CROI Community Educator Scholar
  • Dr. Mitch Matoga, UNC, Malawi

Still Here! Living with HIV Long-Term
March 12, 2025

AVAC, the CROI Community Liaison Subcommittee and European AIDS Treatment Group hosted the third and final virtual Community Breakfast Clubs (CBCs) for the 2025 CROI meeting. Speaker details and recording below:

Moderator: Sean Hosein, European AIDS Treatment Group – Canada

Speakers:

  • Kennedy Mupeli, Center for Youth of Hope – Botswana, CROI Community Educator Scholar
  • Dr. Peter Hunt, University of California San Francisco, CROI Scientific Program Committee
  • Dr. Laura Waters, The Mortimer Market Centre – London

Avac Event

Can Africa Finance its Own Non-profit Sector?

The webinar will explore whether shifts in the US government’s funding is a setback or an opportunity to rethink Africa’s reliance on Western aid.

Featuring:

  • Angelo Katumba — Senior Program Manager: AVAC
  • Yvette Raphael — Executive Director of Advocates for the Prevention of HIV in Africa
  • Dr. Michael Kiragu — AICS Associate & Grant Fundraising Expert