Confusion, chaos and outrage have been the disorder of the day since President Trump on January 20 halted funding to foreign aid programs for 90 days pending their review. This included the President’s Emergency Plan for AIDS Relief (PEPFAR), which provides lifesaving HIV meds and services to over 20 million people, mostly in Africa.

Amid the resulting pushback and fury—including street protests in DC—several of Trump’s executive orders have been rescinded, and court rulings have paused other funding freezes (thought it’s unclear whether the Trump administration is abiding by the legal decisions). Additional lawsuits are being filed to challenge Trump’s blockage of foreign aid. This week, AVAC, which focuses on HIV prevention throughout Africa, and the Journalism Development Network, became the latest nongovernmental organizations to file lawsuits seeking emergency relief from the funding freeze, reports The New York Times.

AVAC is joining a federal lawsuit challenging the illegal foreign aid freeze. Global health funding saves lives, and we cannot stand by as it is dismantled. Read this piece by @stephanienolen.bsky.social, www.nytimes.com/live/2025/02...#healthjustice

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— AVAC (@hivpxresearch.bsky.social) February 11, 2025 at 12:26 PM

In addition, the Department of State issued a waiver specifically to restart several of PEPFAR’s programs—but, tellingly, not most of those involving pre-exposure prophylaxis (PrEP) to prevent HIV.

So what the heck is being funded, and who’s on the ground to provide the HIV services? For that matter, what exactly does PEPFAR accomplish anyway, and what would happen if the United States ended the program?

With so many fast-moving parts, it is nearly impossible to offer definitive answers. But here are a few basics to know.

How much does PEPFAR cost, and what does it provide?

Launched in 2003 by Republican President George W. Bush and managed by the Department of State, PEPFAR has received about $120 billion in U.S. funds. The program has enjoyed bipartisan support, with Congress reauthorizing its funding every five years. Recently, it became enmeshed in U.S. abortion politics (despite the fact that PEPFAR doesn’t provide those services), and last March, lawmakers failed to fully reauthorize it, choosing instead to fund it for one year—for $6.5 billion. This means that even if Trump’s freeze on foreign aid were lifted and all programs resumed immediately, PEPFAR could not be considered secure because the program is once again on Congress’s proverbial chopping block.

PEPFAR works with partners across 55 countries and to date has saved 25 million lives and enabled 7.8 million babies to be born HIV-free. According to a PEPFAR fact sheet posted December 1 by the Department of State, data for fiscal year 2024 include:

  • 20.6 million people on HIV meds;

  • 2.5 million people newly enrolled on PrEP to prevent HIV;

  • 83.8 million people tested for HIV;

  • 2.3 million adolescent girls and young women reached with comprehensive HIV services;

  • 6.6 million orphans, vulnerable children and their caregivers received critical care and support;

  • 342,000 health workers directly supported by PEPFAR.

More than 20 million people around the world rely on the HIV services provided by PEPFAR. The stop work order puts millions of lives at risk. Learn more: www.amfar.org/press-releas...

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— amfAR (@amfarofficial.bsky.social) January 27, 2025 at 3:45 PM

A fact sheet compiled by amfAR, the Foundation for AIDS Research, highlights what could be lost each day during funding pauses. According to those stats, each day PEPFAR provides:

  • More than 222,000 people with HIV meds;

  • More than 224,000 HIV tests, newly diagnosing 4,374 people with HIV—10% of whom are pregnant women attending antenatal clinic visits;

  • Services for 17,695 orphans and vulnerable children impacted by HIV;

  • 7,163 cervical cancer screenings, newly diagnosing 363 women with cervical cancer or precancerous lesions and treating 324 women with positive cervical cancer results;

  • Care and support for 3,618 women experiencing gender-based violence, including 779 women who experienced sexual violence.

Providing these services is a complex endeavor involving more than cutting a check. Nearly 60% of PEPFAR funds go through the U.S. Agency of International Development (USAID), which employs over 10,000 people. But, as the New York Times reports, the Department of State plans to slash that workforce to 290—in addition to cutting much of USAID’s funds and grants.

Foreign aid is 1% of the US budget and helps millions! Elon Musk is lying to you. Spread the word tonight as he buys $40M in ads at the Super Bowl to try to convince you otherwise. Stop Musk. Help millions. youtu.be/PqUESHfuO_8

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— Gregg Gonsalves (@gregggonsalves.bsky.social) February 9, 2025 at 5:28 PM

Democracy Forward’s legal director, Robin Thurston, describes the Trump administration’s move—with direction by Elon Musk—as an “unlawful seizure of this agency” that has “generated a global humanitarian crisis.” Lawsuits aim to put an end to the firings and cuts.

What would happen if PEPFAR were paused for 90 days?

A 90-day moratorium on PEPFAR programs, as initially planned, would result in 6.3 million AIDS-related deaths (a 10-fold increase) within the next four years, along with 8.7 million new HIV transmissions and an additional. 3.4 million children rendered orphans, according to the Joint United Nations Programme on AIDS (UNAIDS).

What does the pause in U.S. foreign aid mean for Ethiopia’s HIV response? UNAIDS update: www.unaids.org/en/pepfar-im...

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— UNAIDS Global (@unaids.org) February 6, 2025 at 8:10 AM

If Trump’s orders to halt work were carried out, services to 679,936 pregnant women with HIV would be halted, reports amfAR, noting that the stoppage would impact numerous groups of health care workers, not just the pregnant women.

“We estimate that this would mean 135,987 babies acquiring HIV,” amfAR writes. “These babies, however, are highly likely to also go undiagnosed because infant HIV testing services are also being suspended due to the stop work order.” That is to say every day of work stoppage will result in 1,471 new HIV cases among infants.

Which PEPFAR programs have been restarted?

In a waiver issued February 6, the Department of State spelled out which PEPFAR services “should be resumed as soon as possible.” They include providing HIV testing, treatment and related care in addition to screening and treatment of cervical cancer and tuberculosis for people living with HIV.

Regarding HIV prevention, however, the waiver notes: “Pre-exposure prophylaxis (PrEP) should be offered only to pregnant and breastfeeding women.… [Other people] 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 U.S. Foreign Assistance or until further notice.” This means that young women and men who have sex with men—populations at higher risk for HIV—can no longer access PrEP through PEPFAR.

“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,” says our Executive Director Mitchell Warren.@cohenjon.bsky.social @jirairratevosian.bsky.social @linda-gailb.bsky.social www.science.org/content/arti...

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— AVAC (@hivpxresearch.bsky.social) February 7, 2025 at 4:31 PM

As AVAC, the global HIV prevention and health equity group, notes, the waiver’s PrEP restriction “appears to be less about public health and more about an ideological agenda that seeks to police morality rather than protect lives.… 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.”

With PEPFAR’s funding—along with other U.S. foreign aid—currently under review and its authorization set to expire in late March, PEPFAR will remain in the headlines and crosshairs. For a roundup of related articles in POZ, click #PEPFAR.