US issues temporary waiver to re-enable PEPFAR
29 January 2025. Related: Early access, Special reports, Treatment access.
Simon Collins, HIV i-Base
Within a few days, the new US administration issued immediate blocks on international aid programmes – including PEPFAR which currently supports more than 20 million people living with HIV to be on ART – and then issued a temporary waiver to reverse this action. [1, 2, 3]
The ban was to take immediate effect and to last for three months,
It included taking the PEPFAR database offline together with all related medical records and an order for all staff employed in the programme to stop work. Other directives include getting senior staff to taking immediate administrative leave. [4]
The initial blocks were made ‘in the name of the American people’ to ensure that every dollar would support the goals of the new administration ‘to put America first’.
Part of the community response included hundreds of global HIV activists joining daily zoom calls organised by HealthGAP with support from the IAS to work on how to overturn the ban and to determine its impact. Even following the waiver many questions are still unclear.
Following the waiver, UNAIDS and IAS issued new press statements, included below.
References
- Trump bans travel for US government scientists, presentations restricted, documents disappearing. HTB (23 January 2025).
i-base.info/htb/50084 - IAS statement: PEPFAR freeze threatens millions of lives. HTB (28 January 2025).
i-base.info/htb/50097 - US issues temporary waiver to re-enable PEPFAR. HTB (29 January 2025).
i-base.info/htb/50111 - Politico. Top USAID career staff placed on immediate leave, (27 January 2025),
www.politico.com/news/2025/01/27/top-usaid-career-staff-ordered-leave-00200854
IAS press statement: Restore access to all PEPFAR-supported HIV services immediately
https://www.iasociety.org/ias-statement/restore-access-all-pepfar-supported-hiv-services-immediately
29 January 2025 (Geneva, Switzerland) – IAS – the International AIDS Society – notes the decision to waive the suspension of “life-saving humanitarian assistance”, including “core life-saving medicine.” This should now ensure that HIV treatment disbursed by the US President’s Emergency Plan for AIDS Relief (PEPFAR) can continue across all PEPFAR-supported countries.
The Trump administration froze foreign aid funding, including to PEPFAR and, unexpectedly on 24 January, it imposed a stop-work order on existing operations. Clinic staff were sent home, distribution of ARVs bought with US funds was halted – cutting off HIV treatment for 20.6 million people. On 28 January, new US Secretary of State Marco Rubio issued a temporary waiver of aspects of this freeze.
“Since its bipartisan creation, PEPFAR has always been synonymous with saving lives and this waiver restores – in some part – that legacy. However, PEPFAR’s continued and uninterrupted support of all HIV treatment and prevention services must be fully restored,” IAS President Beatriz Grinsztejn said.
“PEPFAR has been and should continue to be an active contributor to changing the trajectory of the HIV epidemic. It is our hope that this waiver remains in place and will be expanded to all HIV services.”
For now, the emphasis should be on ensuring that, as a matter of urgency, PEPFAR implementers return to work to ensure that access to critical HIV services is not further interrupted and that communities most in need are able to get the care and treatment they need.
UNAIDS welcomes the decision by the US Secretary of State to continue life-saving HIV treatment and convenes partners to assess and mitigate impacts on HIV services
GENEVA 29 January 2025— The United States Secretary of State Marco Rubio has approved an “Emergency Humanitarian Waiver” which will allow people to continue accessing HIV treatment funded by the US across 55 countries worldwide. More than 20 million people living with HIV representing two-thirds of all people living with HIV receiving treatment globally are directly supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) – the world’s leading HIV initiative.
“UNAIDS welcomes this waiver from the US government which ensures that millions of people living with HIV can continue to receive life-saving HIV medication during the assessment of US foreign development assistance” said UNAIDS Executive Director Winnie Byanyima. “This urgent decision recognizes PEPFAR’s critical role in the AIDS response and restores hope to people living with HIV.”
In recent days the US Department of State announced an immediate 90-day funding pause for all foreign assistance including for funding and services supported by PEPFAR. The executive order announcing a “90-day pause in United States foreign development assistance for assessment of programmatic efficiencies and consistency with United States foreign policy” was one of the first major foreign policy decisions of the new administration. This waiver approves the continuation or resumption of “life-saving humanitarian assistance” which applies to core life-saving medicine and medical services including HIV treatment as well as to supplies necessary to deliver such assistance.
UNAIDS will continue efforts to ensure that all people living with or affected by HIV are served and that other key components of PEPFAR’s life-saving efforts including service delivery and services for HIV prevention care and support for orphans and vulnerable children are continued.
UNAIDS is serving in its essential role to mobilize and convene partners governments and communities across the globe at the country level to assess and mitigate the impact of the pause on the continuity of essential HIV services. UNAIDS has encouraged President Donald J. Trump to prioritize the U.S. Government’s leadership in the global HIV response to achieve the shared goal of ending AIDS.