The Trump administration has terminated the contracts of nearly 10,000 global health projects funded by the US Agency for International Development (USAID) or the US State Department  – including projects to provide vital diagnosis and treatment for HIV, tuberculosis, and malaria, as well as humanitarian aid projects providing nutrition and water and sanitation services.

Grants to hundreds of African HIV organisations providing life-saving services have been terminated with immediate effect via letters received on Thursday morning.  Globally, the terminated awards include 5,800 grants administered by the USAID and 4,100 grants for projects managed directly by the State Department. Some of the terminated programmes had previously been granted temporary waivers, due to their roles in providing lifesaving health or humanitarian aid.

The Trump administration also announced Thursday that it was halting US funding to the Joint UN Programme on HIV/AIDS (UNAIDS), which is headquartered in Geneva, just across from the World Health Organization.

“All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated,” said Dr Atul Gawande, USAID’s former assistant administrator under the Biden administration.

Terminated, too, are all global tuberculosis programmes, all US-made food aid programmes, which manufacture specially enriched foods aimed at malnourished women and children, and around 1000 food kitchens serving displaced people in countries such as war-torn Sudan.

“This is one of the worst days of my professional life,” said Dr Kate Rees of Anova Health Institute in South Africa, which delivers HIV services to hard-to-reach groups. “Tomorrow, we are letting go 2,800 people who are mainly peer educators and data capturers.”

Prof Linda-Gail Bekker, CEO of the South African Desmond Tutu HIV Foundation, said that the US termination would cost 500,000 South African lives over the next 10 years and result in around half a million new HIV infections, according to recent modelling.

“As an activist, as a person living openly with HIV, I’m very hurt,” said  Sibongile Tshabalala, chairperson of the Treatment Action Campaign. “How am I going to survive? Will the public health care system be able to cater for us? Will be able to cover all the gaps that we are facing with all the challenges that the public healthcare system has?”

South Africa has the highest burden of HIV in the world with eight million people living with the virus (over 16% of the adult population).

All 44 South African HIV programmes that receive money from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID have seen their aid terminated. Projects affected range from mother-to-child transmission programmes and hospices to research groups. Many focus on “key populations”, groups that are the most vulnerable to HIV but often shun health centres in fear of discrimination.

“I’ve been having a sleepless night trying to think how best we can save our communities because we know that some of the government healthy facilities are very discriminatory,” said Kholi Buthelezi, national coordinator of the sex worker organisation, Sisonke.

HIV programmes devastated across Africa

HIV programmes across the continent have also been devastated. The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) was told to close programmes in Lesotho, Eswatini and Tanzania that cover HIV treatment for 350,000 people including almost 10,000 children.

Late yesterday, we received award termination notices for three of our primary USAID agreements.

Read our full statement. https://t.co/VpBNduu036 pic.twitter.com/0hAP17JqxG

— Elizabeth Glaser Pediatric AIDS Foundation (@EGPAF) February 27, 2025

In Uganda, for example, the Baylor College of Medicine Children’s Foundation’s HIV and TB programmes, that strengthens district health systems to better deliver HIV, TB and maternal and child services, has been terminated.

The termination letters all state that US Secretary of State Marco Rubio, in his capacity as acting administrator for USAID and Peter Marocco, USAID acting deputy administrator, “have determined your award is not aligned with agency priorities and made a determination that continuing this program is not in the national interest”.

‘Chaos and disaster’

The terminations have caused “chaos” and “disaster”, said emotional South African leaders of the HIV sector who urged their government to step in to save their programmes.

Fatima Hassan, head of the Health Justice Initiative, urged the South African government to issue compulsory licenses to reduce the price of antiretroviral medicine as the US has already “done the worst to us”.

“US Congress approved the funds, and that is what has been stopped. So we do believe that it’s an illegal grab. It’s an illegal halt of services and programs. It’s not following due process,” Hassan added.

The terminations will decimate South Africa’s HIV testing, data collection and HIV and TB literacy, said public health expert Dr Lynne Wilkinson, who added that USAID funds also assisted groups combating gender-based violence.

However, South Africa is luckier than many other African countries as it derives around 17% of its HIV budget from PEPFAR. The Democratic Republic of Congo (DRC) gets 89% of its HIV budget from PEPFAR, while Mozambique and Tanzania get 60% of their HIV budget from the US.

‘Blanket freeze is illegal’

Mitchell Warren, head of the US-based HIV programme AVAC, described the blanket termination of USAID grants as “unlawful”.

“The US government’s in a very strong position with any cooperative agreement or grant or contract. They’re allowed to cancel agreements or amend them. They’re in a very strong position generally, but the blanket freeze is illegal,” said Warren, whose organisation has resorted to the courts to prevent the cutting of lifesaving aid.

“We have been now in a federal court for several weeks, and a temporary restraining order was provided two weeks ago by the Court that said that things had to go back. The tap had to be put back on until this 90 day review actually took place in a comprehensive way,” he added.

“We now have evidence entered into the public record in the courts that show the intentionality at USAID and the State Department to dismantle everything but the government has simply thrown up additional legal delays, as is their want,” said Warren.

A federal judge had set Wednesday at midnight as the deadline for USAID to release some $1,5 billion funds for the foreign aid work already completed, but the US Supreme Court granted the government a stay on the release of funds until the court could apply itself more thoroughly to the issue.

“We expect a hearing next week in Washington,” said Warren.

“This is not about PEPFAR. This is not about the HIV response. This is not about USAID. This is about the rule of law.  The United States Congress has the power of the purse. They decide what gets spent. The executive branch is there to execute, and that’s the basis of this legal argument.

“But as of [Wednesday] night, they began to basically massacre every possible implementing agency to deliver on this work. This court case, as important as it is, is not going to change that overnight. That’s why working in partnership with each other and with national governments is essential because the United States is not a partner that is trustworthy  right now,” Warren concluded.

Image Credits: Reuters Youtube, Gandhi A, et al, Annals of Internal Medicine, 11 Feb. 2025, UNAIDS.