On the 20th of January 2025, President Donald Trump signed an executive order that initiated a freeze on foreign aid, including the President’s Emergency Plan for AIDS Relief (PEPFAR). This abrupt suspension of funding has triggered a global health crisis, undermining decades of progress in combating HIV/AIDS and endangering millions of lives across the globe.

PEPFAR and its global success

Launched in 2003 under President George W. Bush, PEPFAR has saved 26 million lives by providing HIV prevention, treatment, care, and support services in 54 countries. The DREAMS initiative (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) successfully reduced new HIV infections among adolescent girls and young women through education programs empowering them about their reproductive health rights and access to services.

PEPFAR has been instrumental in preventing mother-to-child transmission of HIV, strengthening overall health care infrastructure, and training thousands of health care workers in regions most affected by the epidemic.

Despite these successes, PEPFAR has always been vulnerable to U.S. political shifts. The Trump administration’s decision to freeze foreign aid funding, including support for HIV/AIDS programs, threatens to reverse years of progress in HIV prevention and treatment.

Immediate consequences of the funding freeze

The impact of this decision has been swift and devastating, particularly in low- and middle-income countries that rely on PEPFAR funding:

• HIV/AIDS treatment access has been abruptly cut off in clinics across sub-Saharan Africa. In South Africa, clinics that heavily depend on this support have faced closures and left thousands of patients without life-saving antiretroviral medications.
• In Mozambique, over 20,000 health care providers received stop-work orders, effectively halting HIV/AIDS treatment programs overnight.
• The supply of preventive tools—such as pre-exposure prophylaxis (PrEP), condoms, and public health education campaigns—has been disrupted, increasing the risk of new HIV infections.

Health experts warn of a surge in new cases, especially among vulnerable populations such as young women, sex workers, and men who have sex with men.

Long-term implications for global health

The suspension of PEPFAR and other HIV/AIDS programs will lead to long-term consequences that extend beyond immediate service disruptions. These include:

• Treatment interruptions put people living with HIV at a higher risk of developing AIDS and transmitting the virus to others.
• Gaps in treatment increase the likelihood of drug-resistant HIV strains emerging, threatening global epidemic control.
• Many PEPFAR countries have fragile health care systems. The sudden withdrawal of U.S. funding places additional strain on these systems, potentially leading to higher mortality rates not only from HIV/AIDS but also from related conditions such as tuberculosis and opportunistic infections.

The freeze on HIV/AIDS funding also damages the reputation of the U.S. as a global leader in health and humanitarian assistance. PEPFAR has long been a symbol of America’s commitment to fighting global epidemics, and its suspension signals a retreat from international cooperation.

The disproportionate impact on vulnerable populations

Not all communities bear the consequences of this funding freeze equally. Women and children in sub-Saharan Africa are most at risk. Women aged 15–49 years form 61.9 percent of new HIV infections. The loss of PEPFAR-supported clinics and outreach programs will exacerbate maternal health risks, teen pregnancies, and barriers to reproductive care.

LGBTQ+ communities and sex workers will suffer as clinics and outreach programs disappear. These individuals already face significant stigma and barriers to health care. These populations often rely on community-based health organizations funded through PEPFAR, which provide medical care along with support services to fight discrimination and violence.

Next steps: Mitigating the damage

While the uncertainty of the future of PEPFAR looms, advocacy and action taken by global health organizations and policymakers has put pressure on the U.S. administration to reverse this policy. Advocacy efforts should emphasize not only the humanitarian impact but also the long-term cost-effectiveness of continued investment in HIV/AIDS prevention and treatment.

Additionally, alternative funding sources must be explored. While PEPFAR has been the cornerstone of the global HIV/AIDS efforts, there’s an urgent need for other nations and private donors to step up in filling the financial void created by the U.S. government’s retreat. Organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has declared its intention to continue distributing anti-HIV jabs for poorer countries, show the commitment the world needs in these dire times. The European Union and other philanthropic organizations can play a critical role in sustaining HIV/AIDS programs until a policy reversal is achieved.

Conclusion

The foreign aid freeze is a major setback in the fight against HIV/AIDS. This policy not only endangers millions of lives but also reverses decades of progress made in reducing infections and expanding treatment access. The international community must act swiftly to mitigate the damage, advocating for policy changes and exploring alternative funding sources. This will ensure that those in need continue to receive life-saving treatment.

Now is not the time for complacency. The fight against HIV/AIDS has always required political will, global cooperation, and sustained funding. The Trump administration must recognize the catastrophic consequences of this decision and restore its commitment to one of the most successful global health initiatives in history. Lives depend on it.

Koketso Masenya is a graduate student.