Foreign Aid — News & Analysis

PEPFAR freeze halts HIV treatment in 28+ countries; services collapse across Africa (April 20, 2025)

April 20, 2025 — The President's Emergency Plan for AIDS Relief (PEPFAR) — credited with saving more than 26 million lives over two decades, providing antiretroviral treatment to 20 million people, and ensuring 7 million babies were born HIV-free — was frozen on January 20 along with all other foreign assistance, then partially restored via waiver, then plunged into sustained disruption as the agencies implementing it were gutted. UNAIDS reported that by April, 28 of 70 country offices (40 percent) had witnessed community-led HIV services ending entirely due to U.S. funding cuts; 21 (30 percent) reported that services by international NGOs had stopped.

In South Africa, which carries the world's largest HIV burden, clinics reported patients being turned away mid-treatment cycle. In Uganda and Tanzania, HIV patients were denied antiretroviral medications as implementing organizations ran out of funds. In the Philippines, the nonprofit LoveYourself — which provided free HIV testing and treatment services — suspended operations entirely after losing $69.7 million in U.S. aid programs. Disease surveillance was also collapsing: the administration had effectively paralyzed PEPFAR's data collection, with the program's website reporting all data release dates as "TBD" and PEPFAR reporting "undergoing updates" for months.

Mathematical modeling published in eClinicalMedicine projected 60,000 to 74,000 excess HIV deaths in Africa by 2030 from the funding disruption, even under the most optimistic assumptions about service recovery. The Trump administration's FY2026 budget request simultaneously proposed cutting PEPFAR bilateral funding from $4.85 billion to $2.9 billion — a $1.9 billion (39 percent) reduction — and shifting the "responsibility" for funding HIV programs to recipient countries with no transition plan and no guarantee of alternative financing.