Despite Waiver, Many US-Funded HIV Programmes Remain Paralysed; Trump Orders Face Protests, Lawsuits
HIV and AIDS 05/02/2025 •
At the ‘Build the resistance” protest in Washington DC, people protest against the disbanding of USAID.

Many HIV programmes worldwide remain paralysed despite being exempted from the United States’ 90-day freeze on foreign aid and “stop work order”.

This is largely because the axe Elon Musk has taken to US agencies has resulted in there being too few staff members left to support their work, including processing payments and ensuring that supplies reach projects.

On 1 February, a waiver notice was sent to implementing agencies and country coordinators of the President’s Emergency Plan for AIDS Relief (PEPFAR) clarifying which “life-saving” HIV activities could be resumed.

These include “life-saving HIV care and treatment services” including HIV testing and counselling; prevention and treatment of opportunistic infections including TB, laboratory services; procurement and supply of medicines, and prevention of mother-to-child transmission services.

But the US Agency for International Development (USAID) is being dismantled with all staff except those with essential functions being placed on leave from this Friday.

US President Donald Trump’s administration has also taken PEPFAR databases offline, raising suspicions that it plans to close the programme credited with saving 26 million lives and supporting over 20 million people on antiretroviral treatment.

However, US Secretary of State Marco Rubio blamed organisations for being “too incompetent” or deliberately sabotaging their work to make a “political point”, when asked by The Washington Post why many lifesaving projects were not functioning.

Meanwhile, thousands of people took part in protests against Trump’s actions across the US on Wednesday under the banner, “Build the resistance“. The decentralised movement organised 50 marches in 50 cities with Washington DC march reported to have attracted  thousands of people.

Setbacks for African HIV services 

The Joint UN Agency on HIV/AIDS (UNAIDS) said in a statement on Wednesday that the permanent dismantling of PEPFAR would lead to “an estimated additional 6.3 million AIDS-related deaths, 3.4 million AIDS orphans, 350,000 new HIV infections among children and an additional 8.7 million adult new infections by 2029”.

In Ethiopia, the US funding freeze “has caused critical delays in the supply of essential HIV services, including testing kits and other resources”, according to UNAIDS.

The country is running short of reagents for viral load tests and babies’ HIV tests, that are procured by PEPFAR.

In addition, Ethiopia’s Ministry of Health has terminated the contracts of around 5,000 public health workers and 10,000 data clerks working in the HIV program who were funded by the US. 

A meeting of civil society organisations providing HIV services in Uganda this week noted that crucial work is under threat, including mother-to-child HIV transmission.

“We were on the verge of eliminating mother-to-child transmission,” said Mwehonge, Executive Director of the Coalition for Health Promotion and Social Development. “Without urgent intervention, at least 41 children will face new HIV infections daily.”

The Centre for Human Rights and Development (CEHURD) in Uganda reported on a meeting of Ugandans living with HIV this week:

“For the past 22 years, the US government has been a major supporter of HIV funding, contributing about 80% of the total [Ugandan HIV] budget. Cutting off this support is essentially a death sentence for the 1.3 million people currently on antiretroviral treatment,” CEHURD notes. 


Meanwhile, South African civil society organisations wrote to their government on Wednesday, urging it to develop an emergency plan and increased budget to address the PEPFAR freeze. PEPFAR funds cover around 17% of South Africa’s HIV budget. 

HIV activist organisations that have been at the forefront of fighting the virus for decades – ActUp, HealthGap and Treatment Action Group – have organised a protest outside the US State Department in Washington DC on Thursday morning.

“Trump’s global freeze on foreign aid is an attack on millions of people around the world with HIV and people at greatest risk of acquiring HIV,” according to the groups, which described the waiver announced by US Secretary of State Marco Rubio as “too little, too late”.  

Journals ‘forbidden’ to ‘bow to political censorship

BMJ’s editor-in-chief Kamran Abbasi and international editor Jocalyn Clark have appealed to medical journal editors to “resist CDC order and anti-gender ideology” after the Trump administration instructed CDC scientists to withdraw or retract articles from medical and science journals that include terms such as “gender, transgender, LGBT, or transsexual”.

Describing the instruction as “sinister and ludicrous”, the editors stressed “this is not how it works”.

Medically relevant terminology follows “evidence-based reporting standards” not “political orders”.

In addition, co-authors “cannot simply scrub themselves from articles,” they note. “If authors wish to withdraw submissions under review at a journal, this process is feasible should all of their co-authors agree. However, if somebody who merits inclusion in the authorship group of an article requests to be removed, even with the approval of the co-authors, this is a breach of publication ethics.”

“The US was considered a world leader in public health and research. With one repressive stroke that reputation risks being shattered and broken. If anything is forbidden now, it is that medical and science journals, whose duty is to stand for integrity and equity, should bow to political or ideological censorship,” they conclude.

Doctors file lawsuit

On Tuesday, Doctors for America filed a lawsuit against the Office of Personnel Management (OPM), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Department of Health & Human Services (HHS) challenging the removal of health-related data and other information used by health professionals and researchers from publicly accessible government websites.

The CDC website was still offline on Wednesday.

“The removal of the webpages and datasets creates a dangerous gap in the scientific data available to monitor and respond to disease outbreaks, deprives physicians of resources that guide clinical practice, and takes away key resources for communicating and engaging with patients,” according to court papers. 

“Like many of my colleagues, I am both a doctor who takes care of patients and a researcher. Removing critical clinical information and datasets from the websites of CDC, FDA, and HHS not only puts the health of our patients at risk, but also endangers research that improves the health and health care of the American public,” said Dr Reshma Ramachandran, a Doctors for America board member, physician and Yale professor “Federal public health agencies must reinstate these resources in full to protect our patients.”

More lawsuits?

So far, the Trump administration is facing 33 lawsuits and many more are likely in the coming days, particularly as many legal experts assert that the abolition of USAID is illegal.

The Foreign Affairs Reform and Restructuring Act of 1998 restricts the president’s ability to abolish the agency unilaterally. 

“USAID is an independent agency with authorities legislated by Congress. Its history is complex but its status is clear: Congress intended for US foreign aid functions to operate with independence. The President does not have the legal authority to abolish it or move it under the State Department unilaterally,” writes Dr Matthew Kavanagh, Director of Georgetown University’s Center for Global Health Policy and Politics.

“There is a new, dangerous outbreak of Ebola Virus in the Democratic Republic of Congo and Uganda, Marburg virus in Tanzania, and the extremely rare Chapare Hemorrhagic Fever in Bolivia,” added Kavanagh.

“For each of these, USAID is a key responder – moving money and commodities from its congressionally authorized emergency response fund to stop these viruses before they move. Suggesting the State Department, which deals in policy, can morph into an effective operational humanitarian and aid agency is absurd.  

“Imagining it can do so overnight via executive order is reckless. Believing that other governments will cooperate the same way with the department responsible for US political manoeuvring and diplomacy as they do to a humanitarian aid agency is nonsensical.”

 Dr Nina Schwalbe, Senior Scholar at Georgetown Center, described the closure as “an act of violence and targeted creation of chaos”, warning that it would take decades to rebuild the trust this has broken. 

“Destroying USAID through a rash and rushed order, firing most of the staff, and putting an immediate freeze on resources coupled with a stop work order to partners around the globe providing life-saving treatments and programs, will cause countless avoidable deaths,” said Schwalbe.

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