KIGALI – Relief swept through delegates at the International AIDS Society (IAS) conference in Kigali, Rwanda, as news broke that the US Senate had moved to shield the President’s Emergency Plan for AIDS Relief (PEPFAR) from proposed budget cuts.

Late Tuesday, the US Senate  agreed to exempt the flagship HIV program from a planned $400 million reduction, which had been included in a $9.4 billion rescission package put forward by President Donald Trump.

The rescission package seeks to claw back federal funds from various programs, including approximately $900 million in global health allocations.

While the full package still awaits a final vote in both chambers of Congress, and amendments may yet emerge, the bipartisan removal of the PEPFAR cut marks a significant policy reversal. Under US budget law, Congress had 45 days to reappropriate the allocations, and that window closes on Friday (18 July).

“This is the best news ever,” said Professor Linda-Gail Bekker, former IAS president and director of the Desmond Tutu HIV Centre in South Africa.

“I’ve said this before, and I’m going to say it again, PEPFAR is the most important and consequential contribution to public health, certainly in my lifetime, and probably ever. That it is not going away in its entirety is a victory for all who’ve advocated for it.”

Bekker also thanked “every single person who’s advocated for this, and every person who will ensure that we see it go through and that it does not end until we get to a point where we can safely transition to a sustainable plan”.

Since the US global funding freeze from 20 January when Trump assumed the presidency, disruptions in service delivery have been reported across globally, and most severely in Africa, including interruptions in HIV testing, treatment distribution, and prevention programs.

These disruptions have placed millions of lives at risk, particularly in countries heavily dependent on US-supported HIV infrastructure.

Carolyn Amole, Clinton Health Access Initiative vice-president for HIV, hepatitis and TB, said that the ripple effects of PEPFAR’s funding disruptions had extended to commodities procurement, and essential systems, such as human resources, supply chains, and data infrastructure, undermining service delivery and overall program performance.

Modeling estimates suggest that, without intervention, up to 11 million new HIV infections and three million additional deaths could occur globally in the next five years.

Questions about PEPFAR’s future still remains

While the Senate’s move was met with applause, experts cautioned that broader risks remain.

Jirair Ratevosian, PEPFAR’s chief-of-staff under President Joe Biden, told an IAS press briefing that the US administration had yet to justify the rationale for these cuts, raising concerns about the politicization of budgetary decisions.

The Trump administration had claimed that PEPFAR funds were being spent in Russia, an assertion that was disproved as no allocations have been made to Russia since 2012. This clarification was instrumental in building bipartisan support for PEPFAR’s protection.

Still, the future of the program remains uncertain. With PEPFAR now under the US State Department, decisions on implementation will be shaped by the PEPFAR Scientific Advisory Board and other external advisors. Updated frameworks are expected to guide how and where services are delivered, though details remain limited.

“Unfortunately, it’s not over,” Ratevosian said. “We have to take today’s victory, celebrate, and then wake up tomorrow ready to keep fighting.”

“Global advocacy played a crucial role in persuading US lawmakers to protect this vital programme, reminding them that decisions about PEPFAR shape the health and futures of people around the world,” said IAS President Beatriz Grinsztejn.

But Grinsztejn warned that “uncertainty remains, with ongoing threats to global health funding. We must stay vigilant.”

Ratevosian also viewed the crisis as a chance to rethink how countries prepare for shocks. “This wake-up call has forced us to build resilience and sustainability,” he said, urging governments to take ownership of their HIV responses and expand domestic funding mechanisms.

“We don’t know who will be in power next year. We can’t leave national health programs at the mercy of external political changes.”

He also called for greater transparency in transitions: “There must be a planned phase-out—not a chaotic drop-off. The uncertainty of this crisis was part of the harm.”

Despite the Senate’s decision, gaps remain, particularly in areas supported by National Insitutes of Health (NIH), Centers for Disease Control and Preventin (CDC), and other US agencies.

“The PEPFAR money will only cover certain things. There are still huge holes due to earlier account freezes. We must continue to push for full restoration, not just of PEPFAR, but of the broader global health apparatus.”

Bekker also called for change: “We can’t go back to how things were. We need to recalibrate based on what’s most effective now, country by country.”

IAS President-Elect Kenneth Ngure added that conversations on long-term sustainability must still continue:  “PEPFAR is a lifeline for communities across Africa. But we must also strengthen domestic investment and reduce dependence on donors.”

He warned that while PEPFAR may be protected for now, future rescission packages, delayed disbursements, or reprogrammed funds remain plausible threats. Advocacy, he stressed, must continue to be relentless and grounded in evidence. “We must showcase the science and the human impact—again and again.”

Image Credits: Jean Bizimana/ IAS, PEPFAR, UNAIDS.