Latest news on US crisis (24 July): Plans to end PEPFAR

29 July 2025. Related: Treatment access, Activism & advocacy.

Paul Clift for CHANGE and EATG

The following notes are based on the weekly activist webinar organised by the CHANGE network on 3 July 2025.

• Email: contact.change.2025@gmail.com
• pepfarwatch.org/pepfar-funding-freeze

Detailed news is also covered in the latest issue of AVAC’s Global Health Watch:
avac.org

CHANGE 24th July 2025

Pretty much back to normal after Kigali. As ever I am summarising under bullet points with a few added comments of my own [in square brackets].

As is usual in these meetings we were shown a number of slides. I am not yet confident that we have permission to copy and share these so I’ve summarised where appropriate.

1. NY Times article on US Government quietly drafting a plan to end PEPFAR.

Article is here but behind a paywall but the US Govt is using the term ‘transition’ but in practice this means ‘termination’.

Marco Rubio and colleagues are saying ‘we need to wind down the program’ [which is another reminder that we need to be ultra-cautious about any US Govt public statements regarding the future of US funding programs]

PEPFAR Transition Strategy

We were shown text from official documents outlining the ‘transition’ strategy.

This is a short summary:

PEPFAR’s goal is responsible transition of successful HIV response efforts in PEPFAR-supported countries. Transition is complete when PEPFAR no longer provides bilateral financing for HIV programming in a host country. After transition the US Government’s health relationship with the host country will shift primarily to a peer-peer relationship outside of any remaining funding for other health programs. This redefined mission will be centered on protecting the US homeland from disease threats and promoting US commercial interests in the health space.

Transition will be challenging. No global health program in history has transitioned at this scale and HIV is a uniquely challenging disease to control without a cure or vaccine. However PEPFAR has unprecedented accomplishments from the last 22 years which have laid the groundwork for ongoing success. The current global and US political context presents a major opportunity to advance transition through substantially greater efficiency in PEPFAR-supported HIV control programming and through new binding agreements with partner countries.

PEPFAR is developing detailed transition guidance inclusive of a co-investment policy for release in October 2025. Consultation with key stakeholders including Chiefs of Mission will occur prior to finalisation of the plan. Transition actions for Tier 1 will begin immediately with a focus on rapid close-out of US funded activities. PEPFAR’s proposed plan includes six concrete strategies to deliver a robust transition:

1. Establish co-investment agreements for countries to incentivise them to mobilise domestic financing and resources for core HIV services.
2. Reduce the scope and number of US Government PEPFAR implementing agencies across all US global health programs by shifting to lower-cost simplified implementation models.
3. Coordinate closely with and leverage the Global Fund to drive efficiency funding and transition goals.[This is just an outline – we were not given the full picture e.g. I don’t have strategies 4 to 6.

A number of participants noted their alarm at the outline plan.

Congress appears to be poised to say they reject the cuts [but no confirmation of this]

2. The rescission package was passed.

No further details at this stage.

3. Representative Ansari introduces HIV Medication Act to expand access to prevention treatments:

WASHINGTON – Today Representative Yassamin Ansari (AZ-03) introduced the HIV Medication Act to Expand Access to amend the Foreign Assistance Act of 1961 to ensure that all at-risk populations receive HIV prevention treatments through the President’s Emergency Plan for AIDS Relief (PEPFAR) and reverse the Trump Administration’s ideological restrictions that limits the program’s effectiveness.

“We’re never going to eradicate HIV by limiting who we treat for ideological reasons. That’s why I am so proud to introduce the HIV Medication Access Act. This bill would prevent the Trump Administration’s ideological attacks on PEPFAR and resume its full spectrum of services” said Rep. Yassamin Ansari (AZ-03).

Article and fuller details here.

4. Lengthy discussion of tactics and strategies…

…for affecting political process and the Trump administration lying but this is really for our US colleagues to work on. [In fact this was the main item in the meeting. It is of central importance of course but it’s one that is outside our control or sphere of influence as Europeans based in Europe.]

5. Regarding the cuts overall

One researcher commented that:’various papers have been published on the harm that could be caused by these cuts for example one in The Lancet looking at USAID cuts predicting 14 million deaths overall.

Another paper on TB predicts a million deaths UNAIDS estimates of 4 million deaths from HIV. Is this being heard? Do people in Congress understand the impact and scale of these cuts? Six million people died in the Holocaust – this is twice that for which Donald Trump is ultimately responsible.

These predictions are published in peer-reviewed medical journals but are they read are they trusted by people in Congress?’Response: “a high proportion of US Congresspeople are, like members of the current administration, walking moral vacuums who have zero concern about the deaths of millions of people around the world”

6. South Africa’s Key Population space

We’re seeing growing fear and silence in South Africa’s Key Population space.

Some key organisationss funded by PEPFAR are being pressured not to speak out with the risk of being excluded from future PEPFAR funding.

This creates a climate where data is hidden and the most affected communities are left out. We really need safe channels for truth-telling and a commitment that inclusion won’t be based on compliance but on community impact.