Consequences of suspending U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Generally speaking, effective foreign aid to fight infectious diseases is a kind of enlightened self interest, since infectious diseases that go around come around.  And drug-resistent versions evolve when a disease is unchecked anywhere in the world.   

Aid for fighting AIDS, now suspended, is no exception.

Here's an article from the Lancet: about the recent suspension by Executive Order of the operations of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Online first, February 07, 2025
PEPFAR under review: what's at stake for PEPFAR's future, by
Jirair Ratevosiana Jirair.Ratevosian@duke.edu ∙ Gregorio Millettb ∙ Brian Honermannb ∙ Sara Bennettc ∙ Catherine Connord ∙ Linda-Gail Bekkere ∙ Chris BeyreraShow less

 

"Over the past two decades, PEPFAR has been one of the most successful global health initiatives ever undertaken.3 By investing in HIV prevention, treatment, and care services, PEPFAR has saved about 26 million lives and strengthened health-care infrastructure across low-income and middle-income countries.4 However, the political landscape in the USA has become more polarised, creating challenges that threaten US global health financing and the PEPFAR programme's future sustainability. Following the Reevaluating and Realigning United States Foreign Aid Executive Order signed by Trump on Jan 20, 2025,5 the State Department issued a stop-work order for all foreign aid efforts, including PEPFAR, which took effect on Jan 24, 2025.
 

"PEPFAR's impact was highlighted in a recent analysis by amfAR, The Foundation for AIDS Research, of the effect of the 90-day order on health-care services.7 According to this analysis, PEPFAR operates in 54 countries, primarily across Africa, delivering life-saving care to millions of people through a network of more than 19 000 full-time clinical and support staff.7 Each day, over 222 000 people collect antiretroviral therapy (ART) to stay healthy; more than 224 000 HIV tests are done, diagnosing 4374 new HIV cases, including pregnant women in antenatal care; 17 695 orphans and vulnerable children affected by HIV receive support; 7163 cervical cancer screenings are performed; and 3618 women experiencing gender-based violence receive care and support.
 

"In the current context PEPFAR is facing both organisational and operational challenges. Many PEPFAR-funded clinics have faced closures, staff lay-offs, and disruptions in service delivery due to uncertainty surrounding the programme's future.8 On Feb 1, 2025, the US Government issued a limited waiver to restart essential HIV services during the foreign aid review period; the waiver's scope is narrowly focused on ART and the prevention of mother-to-child transmission, but it excludes other key activities.2,9 Programmes that focus on the prevention of HIV in key populations, HIV prevention services for adolescent girls and young women, voluntary male medical circumcision, and support for orphans and vulnerable children are still halted.2 Alarmingly, nearly all HIV prevention efforts under PEPFAR—aside from programmes for the prevention of mother-to-child transmission—are currently on hold.2 This is especially concerning since PEPFAR supports more than 90% of global pre-exposure prophylaxis (PrEP) initiations around the world."