Global Health Watch News Brief: Issue 1

The last week has brought an alarming series of developments affecting global health and human rights. Here’s a brief overview of critical changes and their implications:

  • Pause on PEPFAR and humanitarian programs: On Monday, US officials announced a suspension of all PEPFAR programs, threatening access to lifesaving HIV treatment and prevention for millions worldwide and jeopardizing decades of progress in global health. US officials were told to stop providing technical assistance to national ministries of health and PEPFAR’s data and computer systems were taken offline. On Tuesday, Secretary of State, Marco Rubio, a longtime supporter of PEPFAR, approved an “Emergency Humanitarian Waiver”, allowing “life-saving medications” to continue to be delivered. However, official guidance on how to interpret the waiver is lacking and it’s unclear whether providing HIV treatment can resume.

    IMPLICATIONS: More than 20 million people living with HIV could lose access to treatment, with widespread job losses expected across multiple countries. Most urgently, the delivery of ARVs funded by PEPFAR has already been disrupted. According to an analysis from amfAR, 222,333 people start new ARVs daily, meaning that many individuals now face the life-threatening possibility of interrupted treatment. Beyond these immediate impacts, the broader cessation of ARVs for over 20 million people would have catastrophic consequences. 

    Learn more from amfAR’s Country Analysis on treatment, testing and other social determinants of health. 
  • Federal financial freeze: Also on Monday, the new administration issued (via the Office of Management and Budget, OMB) a freeze on federal financial assistance, which impacts funding for research, healthcare, diversity programs, and energy projects among other efforts. Democrats are arguing that the freeze is unlawful and would harm communities across the US. Some states are pursuing lawsuits. Due to substantial community backlash and legal challenges, the administration rescinded the memo in less than 24 hours. The administration meanwhile asserts the Executive Order is still in effect

    IMPLICATIONS: The President’s pause on foreign assistance at the State Department remains in effect. Most international health and humanitarian efforts remain frozen, except for those covered by the waiver for “life-saving medications” referenced above. Even as the status of these federal funding freezes are still being clarified, the administration can be expected to continue to pursue strategies to impound, rescind, and limit access to federal funding for public health research and programs, and use misinformation and rhetoric to justify these actions. 

    Listen to Mitchell Warren on the Bhekisisa podcast, Weaponising aid: The cruel ways of #Trump2025. 
  • USAID leadership shake-ups: The new administration has placed career USAID officials on administrative leave, including leaders who run USAID’s Bureau for Global Health, impeding HIV prevention and civil society support worldwide. In addition, many of the agency’s institutional support contractors (ISCs), who comprise more than 50% of the Global Health Bureau, have already been, or are expected to be, let go. Contractors at the State Department Bureau of Global Health Security and Diplomacy (GHSD), including PEPFAR, were also laid-off Wednesday.

    IMPLICATIONS: This signals a deliberate effort by the administration to remove anyone seen as disloyal. Reports of loyalty tests for staff, including inquiries about their “moment of MAGA revelation,” reflect a broad-reaching plan to remove anyone or anything that could scrutinize the administration’s orders. Contractors at USAID and GHSD are essential to the Bureau’s operations, and their expulsion paralyzes the USAID, GHSD and PEPFAR.
  • Emerging threat as Uganda confirms new Ebola outbreak: Uganda’s Ministry of Health confirmed a new outbreak of the Ebola virus in its capital, Kampala. One death has been reported on Wednesday. This is the first outbreak since 2022, when it took four months to contain the spread of the virus.  

    IMPLICATIONS: The US intent to withdraw from the WHO and the suspension of communication with the US CDC, the country’s lead government agency, makes it impossible for infectious disease control to coordinate with their international counterpart to mitigate this threat.
  • National Institutes of Health employees may move to schedule F: In a publicly shared memo, employees of the National Institutes of Health (NIH) may be reclassified as “schedule F”, which strips them of key worker protections as civil servants. This move could allow the administration to dismiss or vet career employees and scientists based on their perceived loyalty to the administration’s political and ideological positions, including the research they oversee.  

    IMPLICATIONS: This shift could have a chilling effect on new researchers entering the field, potentially undermining the integrity and independence of scientific research. 
  • NIH clinical trials and participant travel continues with uncertainty: Despite NIH restrictions, clinical trials and participant travel to trial sites may still continue, according to an email to staff at the NIH from its Acting Director, Matthew Memoli. Scientists may also discuss ongoing research that was initiated before January 20, given there is no data sharing or public communication outside of those who are part of the research or its funding, leaving the impact on new research uncertain.

    IMPLICATIONS: Critical purchases and contracts related to human and animal health, security, and biosafety could proceed, but there are many unanswered questions, especially over the pause in grant reviews and funding decisions. 
  • Fighting the Global Gag Rule: One of the early actions of the new administration was the Executive Order to reinstate the Global Gag Rule. However, the Global Health, Empowerment, and Rights Act, a bill to permanently end the Global Gag Rule, was reintroduced in the House and Senate on January 28, making this Act all the more important. AVAC and partners have endorsed the act. Read Congresswoman Lois Frankel’s statement here and watch this space for further updates.
  • Confirmation Hearings for Russell Vought, nominee for Director of Office of Budget and Management: Russell Vought may be selected to lead the Office of Management and Budget (OMB), an influential office, which plays a key role in developing the annual budget request. In this position, Vought will essentially serve as a key gatekeeper, shaping the Executive Branch’s agenda. Confirmation hearings were scheduled for January 30. However, Democratic senators are demanding the vote be delayed, while debate escalates around federal domestic funding freeze.

    IMPLICATIONS: Vought, one of the authors of Project 2025, the conservative blueprint for reshaping the US government, is poised to implement the vision at the highest levels of government. If confirmed, he will have power over foreign assistance, research, and all the programs that save lives in the US and abroad. He will be able to accelerate firings, work stoppages, and withhold federal grants/funds already underway. His leadership represents a direct threat to public health and human rights.

    Live in the US? Call your Senator (202) 224-3121 to vote “no” on this confirmation and send a message to Washington that HIV prevention advocates stand firmly against Project 2025 and its writers.

In Case You Missed It

AVAC and PrEP4All urged donors at last week’s FCAA Summit to mobilize emergency funding and unite against these threats.Together, we can protect global health and human rights.

Read the opinion editorial in POZ Magazine.

What we’re reading

  • The New Yorker: Behind the Chaotic Attempt to Freeze Federal Assistance: Discusses the new administration’s attempt to freeze federal assistance, which led to widespread confusion and concern among federal agencies and aid organizations, highlighting the challenges and potential consequences of such a sudden policy shift. Discusses the new administration’s attempt to freeze federal assistance, which led to widespread confusion and concern among federal agencies and aid organizations, highlighting the challenges and potential consequences of such a sudden policy shift. 
  • Brownstone Institute: The State of Pandemic Preparedness, the WHO, and the US Withdrawal: Discusses the Executive Order withdrawing the United States from the World Health Organization (WHO) and ceasing negotiations on the WHO Pandemic Agreement and International Health Regulations, highlighting concerns about the potential impact on global pandemic preparedness. 
  • Project Syndicate: Trump at Davos: Reviews the new presidential policies in a world of competing crises, eroding institutions, and increasing geopolitical instability and how these actions are accelerating these challenges. and how these actions are accelerating these challenges. 

Resources

Working in Solidarity: Join the effort to track the Impact 

Introducing Global Health Watch! Tracking US actions and their impact

The last week has been intense and sobering. As strategic and dedicated advocates, we already know the profound impact elections have on our work and our world. Recent developments in the United States underscore the challenges ahead, especially with the new administration’s alignment with the Project 2025 agenda—a playbook designed to reshape US federal agencies and policies drastically. 

There are already Executive Orders—which are directives issued by the President of the United States—that have significant implications for our collective work, in the US and around the world. This is, we fear, just the beginning. Administrative actions, such as pausing foreign assistance, including the lifesaving PEPFAR program; halting diversity, equity and inclusion (DEI) initiatives; curtailing public communications; and “scrubbing” agency websites represent a systematic effort to control narratives and stifle dissent. And many of the Executive Orders from this past week are aimed at changing who is in control of information.  

Some of the new political and policy shifts that we are tracking and what they mean for the programs and systems that matter most to HIV prevention efforts, include:  

AVAC will continue to track these developments, analyze their implications, and convene and coordinate with partners to strategize responses. Beginning this week, we will share a weekly synthesis and insights report, Global Health Watch to help navigate this challenging terrain and ensure our advocacy for an evidence- and rights-based, equitable response to the HIV epidemic continues.  

In addition, AVAC and PrEP4All published a new commentary in POZ magazine asking philanthropic funders gathered at this week’s Funders Concerned About AIDS (FCAA) Summit to adapt to these urgent threats. AVAC urges donor partners and advocates to support one another, and join together in an emergency effort, with immediate funding. As a united front, we can and must defend global health and human rights at this crucial time when collective action by donors, multilaterals, advocates and impacted communities is imperative.   

Stay strong, stay safe, and stay sane. It’s a long road ahead, but with our partnerships, we must persevere. 

Avac Event

Introducing the Dual Prevention Pill: Lessons Learned and What’s Next for Regulatory, Research, and Rollout

This webinar has been cancelled because funding was pulled by the new US administration. Follow critical developments in US policies and their impact on global health via our new newsletter. Learn more here.

Join the IMPT and guest speakers from AVAC and Population Council for a discussion on the dual prevention pill (DPP)—a single pill that combines oral pre-exposure prophylaxis (PrEP) and oral contraception (OC) to prevent HIV and pregnancy. If approved, the DPP will be the first multi-purpose prevention technology (MPT) to be marketed since condoms.

The discussion will include real-time learnings to inform the broader MPT field on the DPP’s regulatory approval process, acceptability study results in South Africa and Zimbabwe, implementation updates, and lessons learned. 

There will be a Q&A session following the presentations.

AVAC’s Most Downloaded Resources of 2024

From the implementation of DoxyPEP to the game-changing trial results of lenacapavir for PrEP, 2024 has been a landmark year for advancements in HIV and STI prevention. AVAC’s most downloaded resources capture these pivotal milestones, offering essential insights and tools to power your advocacy. Dive into the highlights and stay informed about the strategies shaping the future of HIV prevention.

AVAC’s Top 10

This episode of PxPulse looks at why and how the decisions that shape global health must be made by those facing the greatest risks. As the world evaluates the pandemic response and debates on decolonizing global health gain momentum, equity in global health has never been more urgent.

This graphic shows currently available options for HIV prevention, newly approved and recommended treatment, and those in development.

This plan provides a broad view of all the moving parts and identifies actions and actors responsible for ensuring time is not wasted and opportunity not squandered.

This PxPulse podcast episode goes deep on LEN for PrEP. Recorded just days before Gilead’s announcement that PURPOSE 2 also found very high efficacy, Dr. Flavia Kiweewa, a principal investigator of the first trial to announce efficacy, lays out the research findings and what they mean. And Chilufya Kasanda Hampongo of Zambia’s Treatment Advocacy and Literacy Campaign and Mitchell Warren of AVAC talk about how to change a long history of squandered opportunities to get rollout right.

This report examines disbursements by the U.S. NIH and the Bill & Melinda Gates Foundation and is one of few reports to track funding trends in vaccine and diagnostics R&D, and pipeline investments for some of the most common STIs.

Led by AVAC alongside a network of partners, the People’s Research Agenda puts forward recommendations to diversify and strengthen the HIV prevention pipeline, enhance investment and financial support for HIV prevention research and development, and guide an advocacy strategy that truly addresses the needs of communities across the prevention pipeline.

This roadmap aims to build on existing progress while accelerating the pace of HIV prevention. With anticipated regulatory approvals and production scaling, this plan targets over 2.5 million LEN users in low- and middle-income countries by 2027. It focuses on structural barriers and integration of generics into national programs.

Good Participatory Practice Guidelines  have been shaping and improving clinical research since 2007. They provide a global reference guide for ethical and effective stakeholder engagement, helping ensure the priorities of trial participants and their communities are centered in clinical trials and broader research agendas.

DoxyPEP is a post-exposure prophylaxis used to prevent the acquisition of some bacterial STIs after sex. This advocates’ guide addresses questions regarding who will benefit most from DoxyPEP and how to implement this strategy broadly to ensure equitable access.

In 2024, Gilead Sciences released findings from the PURPOSE 1 and PURPOSE 2 trials testing lenacapavir (LEN) as HIV prevention. This advocates’ primer provides background on the product and trials; a summary of the early findings of PURPOSE 1 & 2; key questions and next steps.

Avac Event

Conference on Retroviruses and Opportunistic Infections 2025

The 32nd annual  Conference on Retroviruses and Opportunistic Infections (CROI) that took place from March 9–12 in San Francisco, CA convened researchers, advocates and others under drastically altered circumstances, as the new US Administration’s assault on global health and research devastates the HIV response. Foreign aid programs are frozen, US agencies championing science and global health are being dismantled, and US leadership around the world is receding at a critical moment.

Read our summaries:

View our Community Breakfast Clubs

The CROI Community Liaisons, AVAC and the  European AIDS Treatment Group organized a series of daily  Community Breakfast Clubs which were open to all. These live webinars featured researchers and advocates exploring some of the most consequential science and discussions from CROI.

Topics included:

  • Breaking New Ground: The latest advances in HIV cure
  • The End of AIDS — Near and Far? (40 Years of HIV)
  • Still Here! Living with HIV Long-Term
View the recordings

Avac Event

African Workshop on HIV & Women 2025

The inaugural edition of the African Workshop on HIV & Women will take place in hybrid format on 27 – 28 February 2025 in Nairobi, Kenya.

The time zone that will be used for this meeting is East Africa Time (EAT). If you need to convert the times to your timezone, this website might be of interest to you: www.WorldTimeBuddy.com.

This exciting new initiative is a regional workshop paired to the annual “International Workshop on HIV & Women”. It is an outstanding opportunity for both local and international healthcare providers, researchers, government, industry, and community representatives to discuss and further increase their knowledge on the issues related to HIV and women living in Africa.

The primary purpose of this workshop is to support changes that will provide a better quality of life for women living with HIV and reduce HIV transmissions in the region.

The format of the workshop enables attendees to learn from renowned HIV experts, discuss challenges, gaps, and opportunities for further learning and research. The debates and roundtables are an especially important vehicle to discuss issues and challenge dogma.

The workshop also provides a forum for early-career investigators to present their research and to personally meet with experts they view as mentors and inspiration for their work.

The meeting organizers hope this workshop will catalyze forming a community, where attendees continue to participate yearly and form valuable relationships and partnerships that lead to collaborative projects and positive changes.

Clinical Trial Designs in HIV Prevention

An introductory slide deck covering the basics of trial design in product development — definitions, phases, randomized control trials, and more.

Download

Avac Event

I Am More Than HIV Prevention – Results from the HPTN 091 Study with Transgender Women

HPTN 091, the I Am study, evaluated the impact of a multicomponent HIV prevention strategy to increase the uptake and adherence of pre-exposure prophylaxis (PrEP) among transgender women. The strategy included HIV prevention services, gender-affirming hormone therapy, and peer health navigation.

This webinar featured Dr. Tonia Poteat, study co-investigator, who will review the study findings and discuss implications.

Speakers:

  • Tonia Poteat, Ph.D., Duke University School of Nursing, Division of Healthcare in Adult Populations

This webinar featured Portuguese and Spanish translation thanks to HPTN.

Video Recording and English Audio / Spanish Audio / Portuguese Audio / Slides / Resources

Advocacy: Now more than ever

We are in a period of profound uncertainty, remarkable progress and tremendous concern—for the state of the world, for the state of global health and HIV, and for the specific work that AVAC and our partners do. We’ve seen incredible advances in biomedical prevention in 2024 with the introduction of the dapivirine vaginal ring (DVR) and injectable cabotegravir (CAB) for PrEP and the spectacular clinical trial results of injectable lenacapavir—the combination of which could transform lives if rolled out with speed, scale and equity.  

For many of us, the unfolding developments in the United States, which continue to ripple across the global health community, are sparking anxiety around whether we can sustain the progress the field has made over decades while continuing to develop effective HIV prevention options and ensure access to those options for everyone who needs and wants them.  

At AVAC, we see strength in staying focused on developing what we need and delivering what we have. We are doubling down on delivering high-quality, impactful work, supported by ongoing collaboration with our partners to meet our mission in a shifting environment.

Your help is instrumental to the success of this work. If you appreciate our insights, resources, infographics, coalition-building, and evidence- and rights-based advocacy, please consider making a contribution to ensure that this work can continue.

As we recognize World AIDS Day this weekend and next week’s #GivingTuesday, a global day dedicated to giving back, we ask you to consider supporting AVAC so that we and our partners can continue to deliver the effective and impactful advocacy that is needed now more than ever. This means continuing to put people and communities at the center of our work, ensuring that the global response is connected to the real needs of affected people.

Many thanks in advance for your partnership and support.

Advancing Choice and Equity: New tools and a changing landscape

As a new US presidential administration takes shape, our commitment to championing choice, science, and rights remains unwavering. This critical moment demands intentional strategies to protect progress in HIV prevention and global health equity while staying true to our mission and values.

Given the concerning rise of health misinformation on X (formerly Twitter), we must find new ways to share accurate, science-based information. Starting this week, we’ll begin to transition our presence to BlueSky, an open-source alternative to X, alongside Instagram and Facebook. Learn more about Blue Sky here and be sure to follow us.

Read on for the latest insights on CAB for PrEP and new resources on PrEP delivery, STI R&D, and the political challenges and the priorities in 2025 and beyond.

Trials to Impact: The Latest Insights on CAB for PrEPAn Advocate’s Guide to Research in Pregnant and Lactating Populations

The Biomedical Prevention Implementation Collaborative (BioPIC) is leading an integrated and adaptable strategy to deliver new HIV prevention products, with a particular focus on longer-acting PrEP methods. The BioPIC’s Adaptable Product Introduction Framework, emphasizes the need to conduct early-stage activities alongside Phase III clinical trials, and conducts Think Tanks to pinpoint evidence gaps and share insights from modeling and implementation studies. This work is driving more effective, people-centered product delivery. Read more on recent CAB for PrEP insights and visit the Evidence Gap Tracker.

READ THE INSIGHTS

Resources on PrEP Delivery, STI R&D, and More!

Video Recording and English Audio / Ukrainian Audio / Portuguese Audio / Spanish Audio / Slides / Resources

Recording / Alison Footman Slides / Mandisa Mdingi Slides / Cécile Ventola Slides / Birgitta Gleeson Slides

KFF’s Jen Kates and AVAC’s Suraj Madoori lay out the challenges and the priorities in 2025 and beyond. 

In the days, months and years ahead under a new US Presidential Administration, advocacy for choice, freedom, science, and rights will require intentional strategies to protect hard fought gains in HIV treatment and prevention and in global health generally, and to safeguard policies and programs that advance it. And there will be major implications for the global AIDS response.

LISTEN TO THE PODCAST

An Advocate’s Guide to Research in Pregnant and Lactating Populations

Check out our updated graphic in this advocates’ guide, which shares background on the need for research in pregnant and lactating populations and how advocates can advance inclusion.

READ MORE