Global update: 90-day review ended early and cancelled 10,000 grants, millions of people will suffer

1 March 2025. Related: Special reports, Treatment access.

Simon Collins, HIV i-Base

A group of people hold up a large white banner which has a pink triangle on it. Black text across it, reads: Trump and Rubio killing people with AIDS worldwide.

US activists protest against closure of USAID

This special report summarises the last two weeks in the continued assault on global health.

Some of these events were reported by UK media but most only had limited coverage.

Since 20 January 2025, the Trump presidency has caused chaos by cancelling international US aid. This included a 90-day STOP-WORK review period to check whether America was being put first in every programme. [1]

Although a temporary waiver covered life-saving HIV treatment programmes, funding remained essentially frozen because the structures needed to distribute funding were effectively closed. USAID was closed overnight with more than 90% of the 10,000 staff fired or put on administrative leave. USAID usually distributes US$ >40 billion annually (roughly 60% of foreign aid), including HIV treatment and prevention under PEPFAR.

Since 14 February, USAID only paid US$28 million to contractors and for grants compared to US$567 million during the same period in 2024. [2]

Several legal challenges are ongoing but the results have not been encouraging. On 26 February, the Supreme Court ruled that the freeze on international funding could continue, at least temporarily. Most notable about the legal challenges however is that any ruling against the Trump administration has been ignored. This raises the constitutional issue that Trump might just ignore any legal ruling against his policies due to the lack of any authority to enforce this. [3, 4]

Also on 26 February, the US administration announced that the 90-day review was already completed. They announced that 5,800 USAID awards were now cancelled (around 500 will continue) and 4,100 State Department awards were cancelled (keeping about 2,700). Many of the HIV programmes included clinics and services for key populations that integrated community advocates in providing and monitoring services.

Details of more than 20 terminated grants covering HIV, polio, malaria, water and nutrition, Ebola, emergency shelter, tropical diseases and TB were detailed in an early report from the New York Times. This could include up to 18 million cases of malaria this year with 160,000 additional deaths. It could include 200,000 children being paralysed with polio with millions of new infections. One million children will have untreated severe malnutrition. [5]

An essential health surveillance project that tracked health outcomes including maternal health, infant mortality, HIV and other Sustainable Development Goals in 90 low- and middle-income countries has also been cancelled. This would be one of the few ways to track the harm caused from withdrawing US aid. [6]

In addition to legal challenges, resistance to the new policies include activist demonstrations in Washington DC, academic publications modelling the clinical impact, community calls for national governments to commit to continued care and global activist networks including CHANGE coordinating and reporting the impact of cancelled services. The CHANGE website already hosts dozens of activist information sheets, press statements and court documents. [7]

We also include links to information resources for people living with HIV whose clinic services are either closed or reduced. This includes information if you have to stop ART. [8]

A more detailed i-Base listing with more than 80 reports and links..

Summary timeline

20 Jan – Presidential executive order for 90-day freeze on international aid.

28 Jan – Waiver issued to partially unfreeze life-saving programmes.

Several court challenges over the next four weeks include orders to restore funding.

3 – 6 Feb – USAID offices closed and almost 10,000 staff fired overnight.

14 Feb – Public Citizen and AVAC issue legal challenge.

26 Feb – Supreme Court judgement rules the freeze can continue.

26 Feb – 90-day review ends after only a month: almost 10,000 contracts and grants are cancelled.

Recent NGO statements

WHO. Protecting key populations from abrupt disruptions to essential HIV services. [Feb 27]
https://www.who.int/news/item/27-02-2025-protecting-key-populations-from-abrupt-disruptions-to-essential-hiv-services
WHO reports on many essential evidence-based prevention services being stopped, especially for key populations. This includes the closure of HIV treatment and prevention clinics. WHO stresses the importance of access to uninterrupted ART for all populations.

UNAIDS. Update on impacts of US shifts on the global HIV response
www.unaids.org/en/resources/presscentre/featurestories/2025/february/20250218_weekly-update-impact-us-shift
Summary 6-page report from 39 PEPFAR countries with nearly all reporting disruptions in US-funded programmes.
All UNAIDS responses.

ICW. New Report Release: No More Business as Usual. A Gender-Transformative Response to the USAID Freeze Crisis is Urgent. [Feb 26]
https://www.wlhiv.org/post/no-more-business-as-usual-report
An 8-page rapid report on the funding freeze.
“All 11 USAID-funded ART clinics in the capital of Papua New Guinea have closed. Women living with HIV, who worked as Mentor Mothers providing adherence counseling and referrals for gender-based violence survivors, have lost their roles. HIV projects have stopped entirely, severely impacting mental health. Many of us can no longer support our children’s education, afford food, or access ART treatment.”

STOP TB Partnership. Impact of Funding Freeze on TB Response in High TB Burden Countries [Feb 16]
https://www.stoptb.org/news/impact-funding-freeze-tb-response-high-tb-burden-countries
Report on the impact of USAID on diagnosis and treatment of TB in 12 high-incidence countries. These include Bangladesh, Cambodia, Ethiopia, India, Kenya, Nigeria, Pakistan, Philippines, Tajikistan and Tanzania.

Research into the impact on global health

HIV and TB impact trackers: updated daily in real-time
HIV impact calculator
pepfarimpact.vercel.app/
TB impact tracker
https://tb.impactcounter.com/
These websites model PEPFAR and other data to calculate the impact of cancelled programmess. The mortality figures probably reflect what will happen in a few months. 

By executive order: The likely deadly consequences associated with a 90-day pause in PEPFAR funding. Tram KH et al. (2025), J Int AIDS Soc., 28:e26431.
https://doi.org/10.1002/jia2.26431

JIAS. Early impacts of the PEPFAR stop‐work order: a rapid assessment.
https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.26423
Community activist paper summarising the STOP-WORK order.

Latest news on legal challenges

A group of people at a protest hold up a large black banner which has white and pink text on it. The text reads: Trump's AIDS cuts kill.

US activists protest against closure of USAID

Reuters. US Supreme Court allows Trump’s freeze of foreign aid funding temporarily. [Feb 27]
https://www.reuters.com/legal/trump-administration-says-it-cannot-meet-court-deadline-foreign-aid-payments-2025-02-26/
Supreme Court ruling that the freeze can continue temporarily. This judgement overturned the earlier Federal Court ruling that aid needed to be paid by 26 February.

Associated Press. Judge gives Trump administration two days to release billions of dollars in blocked foreign aid.
https://apnews.com/article/funding-freeze-usaid-trump-d592d015249934827e023c65e644c51a

US judge orders Trump administration to temporarily restore foreign aid funding
euronews.com/2025/02/14/us-federal-judge-orders-trump-administration-to-restore-funding-for-foreign-aid-programmes
Second case with temporary ruling to restart funding by US District Judge Carl Nichols in Washington.

Mainstream media reports

NYT. US Terminates Funding for Polio HIV Malaria and Nutrition Programs Around the World
https://www.nytimes.com/2025/02/27/health/usaid-contract-terminations.html
Details of more than 20 terminated grants covering HIV, polio, malaria, water and nutrition, Ebola, emergency shelter, tropical diseases, TB and essential health surveillance.

NYT. Trump Administration Ends Global Health Research Program. [Feb 26]
https://www.nytimes.com/2025/02/26/health/usaid-global-health-surveys.html
Global health surveillance programmes have also been cancelled. These projects not only provided the only reliable information in many countries but would have been the only way to monitor the negative impact from cancelling other US international aid.

CNN. Short video on Instagram including people living with HIV in Uganda and Winnie Byanyima on why USAID .
instagram.com/reel/DFzKE1KP8I2/
USAID is a lifeline to millions. “I feel like the world is ending tomorrow … I don’t know if I will be alive or dead.” “USAID benefits US companies at home.”

South Africa

Bhekisisa. Trump orders USAID-funded HIV organisations in SA to shut down [Feb 27]
https://bhekisisa.org/health-news-south-africa/2025-02-27-breaking-trump-orders-usaid-funded-hiv-organisations-in-sa-to-shut-down/

Joint Statement by ARASA and Partners in East and Southern Africa
https://arasa.info/wp-content/uploads/2025/02/ARASA-Partners-joint-statement-impact-of-Trump-freeze-on-funding-15h23-final.pdf
Call to action by community organisations in East and Southern Africa.

GroundUp. HIV patients go weeks without medicines after US aid cut
groundup.org.za/article/arv-treatment-disrupted-by-us-funding-cuts/
Impact of stopping HIV and TB meds in South Africa.

Briefings and updates from CHANGE

CHANGE logo. Text reads: CHANGE. Coalition of health and HIV advocates navigating global emergencies.Community Health and HIV Advocates Navigating Global Emergencies (CHANGE) is one of the international networks of global HIV advocates launched after the first news about changes in US policy.
contact.change.2025@gmail.com

pepfarwatch.org/pepfar-funding-freeze/

Now linking more than 2000 activists, their website includes comprehensive updates and briefings.

Information for people living with HIV

The i-Base Q&A service is publishing non-technical resources with advocates from CHANGE (see above).

References

Links to other websites are current at date of posting but not maintained.