Among the whirlwind of over 70 executive orders signed by Donald Trump as of February 20, 2025, one particularly alarming directive halted the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)—the largest investment by any single country to combat a disease. This suspension was implemented under Trump’s "Reevaluating and Realigning United States Foreign Aid" initiative, placing a 90-day freeze on all foreign assistance in alignment with his “America First” doctrine. Unlike other executive orders, Trump explicitly notified officials to immediately halt all PEPFAR-funded work globally or face consequences.

Established in 2003, PEPFAR serves 55 countries, has saved 26 million lives, and ensured 7.8 million babies were born HIV-free. It has transformed the trajectory of the HIV/AIDS epidemic, promoting health equity worldwide and taking weight off strained and under-funded healthcare systems abroad. However, with treatment access now disrupted, millions of lives are at risk, as viral loads of HIV can rebound within 2 weeks.

On February 1, PEPFAR applied for and was granted a limited waiver, allowing the continuation of “life-saving” treatments. These include antiretroviral therapy (ART), some laboratory services such as HIV and TB testing, and procedures to prevent mother-to-child transmission of HIV through PrEP or Pre-Exposure Prophylaxis, a medication regime to prevent contraction of HIV.

Does this mean the global community is in the clear?

Short answer: no.

The waiver restoration of  “life-saving treatment” is dangerously unclear. The waiver only permits PrEP for pregnant women and does not extend to other services like cervical cancer screenings or services for vulnerable children affected by HIV. While mother-to-child transmission of HIV is a major driver of HIV transmission, it is not the sole demographic of PrEP users. PEPFAR funds over 90% of PrEP initiatives worldwide, covering 2.5 million people, and has contributed to a 52% reduction in AIDS infections in PEPFAR-supported countries. Although preventative, PrEP is “life-saving” treatment for at-risk communities such as sex workers and transgender individuals. 

There is widespread uncertainty regarding which programs can continue, leaving global health officials in limbo. Trump has reportedly threatened USAID officials, warning that speaking out could lead to the shutdown of essential programs. Resultingly, officials have halted work on USAID-funded projects like PEPFAR, waiting for explicit clearance on what procedures are considered “life-saving” before proceeding.

Many of PEPFAR’s most impactful programs remain suspended. One such program is DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe), which has successfully reduced HIV infections by reaching secondary school students, promoting violence prevention among young women, and providing PrEP to 475,000 young women as of 2024.

PEPFAR has promoted health equity on a scale few other initiatives have achieved. PEPFAR contributes to a shared-delivery model, where private donor funded clinics in regions like sub-Saharan Africa are often the only places that serve sex workers or the LGBTQ+ community, providing further services like vaccinations, testing, psychological support, access to condoms, etc. For example, PEPFAR funds Drop-in Centers (DiCs) in Uganda, which serve as safe spaces for the LGBTQ+ community to receive care. However, the ban explicitly calls for an end to “gender or DEI ideology” leaving ambiguity as to whether these treatments will be affected. 

This suspension and manner in which it was enacted is not just a public health crisis but a human rights violation. It is clearly aligned with Trump’s broader anti-LGBTQ+ agenda, including his recent decision to reissue passports based on sex assigned at birth, stripping transgender individuals of their identity. HIV/AIDS disproportionately impacts transgender individuals and sex workers, and in regions like South Africa, access to care for these marginalized groups is scarce. Many rely on private donor-funded clinics, such as those supported by PEPFAR, for both treatment and preventative tools—resources now in jeopardy.

Without full reinstatement, the consequences of this executive order will be catastrophic, jeopardizing decades of progress in the fight against HIV/AIDS.

Sub-Saharan Africa faces the most severe consequences of this executive order. The U.S. PEPFAR program funds 20% of the annual $2.3 billion spent on HIV/AIDS prevention and treatment programs across Africa, with PEPFAR-supported PrEP treatment reaching 5.5 million Africans daily. While the granted waiver has allowed some clinics to resume antiviral treatment, many others remain severely disrupted by the abrupt pause. 

To call this executive order life-threatening would be an understatement. With Trump’s withdrawal from the WHO, it is clear that global health—let alone domestic health—is not a priority for this administration. At least 300 babies who could have been born without HIV have instead been infected due to the disruption in services and the ban on the PEPFAR program. In 2023 alone, 50,558 New Yorkers utilized PrEP. While PEPFAR primarily focuses on global HIV initiatives rather than domestic programs, its suspension could signal uncertainty for other federally funded efforts, such as the Ryan White Program, which delivers comprehensive care to low-income individuals living with HIV. PEPFAR is just one of many USAID programs indefinitely halted, leaving millions of vulnerable people without access to essential medical care and reinforcing global inequities.