The Trump administration has destroyed one of the most successful programs in the history of the U.S. federal government: the President’s Emergency Plan for AIDS Relief.
PEPFAR, a U.S. government initiative to combat the global HIV/AIDS pandemic, was launched in 2003 by President George W. Bush. Every president until Trump has supported and enhanced PEPFAR. Every U.S. Congress, with bipartisan support, has voted to fund PEPFAR until Trump. PEPFAR and all of its sub-programs are run by the United States Agency for International Development (USAID).
PEPFAR has funded AIDS research, prevention, treatment, care and health-systems strengthening in over 50 countries worldwide. Its focal areas of activity have been in Africa, the Caribbean, Central and South America, Eastern Europe and Asia.
PEPFAR programs have been successful. For example, PEPFAR has saved or directly improved the lives of over 10 million children worldwide since its founding: 5.5 million children born HIV-free; 1.6 million children currently on treatment; 7 million+ orphans and vulnerable children assisted with support programs.
On Jan. 20, the very day Donald Joseph Trump was inaugurated for his second term as President of the United States, Trump signed Executive Order 14169, which imposed an immediate 90-day freeze on all new foreign aid obligations and disbursements. All funds for USAID were effectively frozen. Waivers were issued allowing “life-saving humanitarian aid” to resume, including antiretroviral therapy (ART) for HIV. But implementation was sketchy, and most programs stayed frozen.
On Feb. 2, Elon Musk wrote on X that USAID is a criminal organization that must be destroyed. On the morning of Feb. 03, the USAID website went down. DOGE, the Department of Government Efficiency, created by President Trump and run by Elon Musk, terminated most USAID programs, immediately curtailing access to the services of PEPFAR.
On March 10, Secretary of State Marco Rubio announced that approximately 83% of USAID’s programs would be canceled, and the remaining ones would be moved to the jurisdiction of the U.S. State Department.
AIDS programs continued to fall apart and disintegrate. People started to die.
For two decades, PEPFAR has been the primary support system of the HIV response in many African countries, credited with enabling roughly 26 million persons to survive and thrive with supportive treatment and services.
These are the populations targeted for PEPFAR AIDS services in Africa: peopleliving with HIV, pregnant women and newborns; adolescent girls and youngwomen (ages 15–24) andorphans and vulnerable children. PEPFAR funds care and support programs that provide health, education, and psychosocial services for children affected by HIV/AIDS.
In a June America Magazine article, Russell Pollitt documents the deadly impact of the PEPFAR freeze on the care for orphans in Eswatini (formerly Swaziland) where around 42% of the people were HIV positive when PEPFAR began operations.
Other targeted key populations at higher risk of infection: men who have sex with men, sex workers, people who inject drugs, and transgender persons.
These groups often face social stigma, ostracism, criminalization, vicious physical attacks, and limited access to health services, but they are central to halting HIV transmission.
For an excellent overall view of the achievements of PEPFAR programs in Africa, see Harvard Public Health journal May 2023.
Unfortunately, our federal courts have permitted the Trump administration to continue the freeze pending further litigation even though the US Congress has voted the funds. The freeze has already reversed a generation of gains. An entire future generation has been put at risk.
Sadly, many Christian groups and organizations have applauded the demise of PEPFAR, falsely claiming that these programs promote immoral sexual activities, abortions and LGBTQ+ lifestyles. A group of 350 African church leaders called the claim “unfounded and grossly unfortunate.”
Nonetheless, because the truth and facts no longer matter in our political discourse, this type of political interference devastated AIDS care programs especially for key populations such as LGBTQ+ peoples who already face criminalization and stigma, because partners became risk-averse about outreach, communications and referrals. This “policy chill” compounds the bureaucratic funding freeze, further isolating communities with the highest incidence.
The funding freeze had immediate effects on antiretroviral therapy, which increases mortality and fuels drug resistance. The United Nations AIDS agency tracked program impacts, documenting clinic closures, reduced outreach and shortages of essential medications.
PEPFAR’s signature success has been building national lab capacities: platforms for early infant diagnosis and viral-load monitoring, and disease surveillance systems that serve HIV and broader health security. Setbacks in lab networks don’t just affect HIV, they weaken tuberculosis co-infection management and the ability to detect outbreaks such as Ebola and COVID-19.
While some targeted rescissions were walked back under pressure, the larger freeze left USAID gutted and crippled and PEPFAR exposed to stop-start financing—anathema to clinical continuity. The bottom line: Even when line-items survive on paper, an ongoing freeze functions like a cut on the ground.
PEPFAR’s record is one of rare, measurable successes in global health. The 2025 freeze and cuts—framed within the administration’s broader DOGE agenda—have already disrupted services, endangered prevention gains, and stalled the learning engine that made the program so effective. Courts may yet revisit the legality of withholding congressionally appropriated funds, but the epidemiology won’t wait. Interrupted treatment and prevention today will echo in avoidable infections, deaths, and costs tomorrow.
Restoring predictable financing and depoliticizing program operations are immediate imperatives if the world is to avoid surrendering two decades of hard-won progress.
Write your U.S. Congressperson to restore full funding to PEPFAR one of the most effective humanitarian programs in history.
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August 2025 © nicholas.patricca@gmail.com
Nick Patricca is professor emeritus at Loyola University Chicago, a member of PEN International San Miguel Center, and a member of the TOSOS theatre ensemble NYC.
ChatbotGPT5 was used to document and confirm the facts cited in this article.