In January, the US Government paused all foreign assistance. The sudden pause had an immediate impact on the delivery of life-saving HIV medicines and the provision of HIV prevention services to millions of people whose lives depend on them.
UNAIDS has been monitoring the impact in countries, mobilizing partners, governments, and communities to assess and mitigate the impact of the pause on the continuity of essential HIV services.
This portal exists to provide real-time, ongoing country updates to share the latest global and country information, data, guidance, and other resources related to the impact of these developments across 55 countries and on the global HIV response.
UNAIDS IMPACT ANALYSIS
UNAIDS analysis suggests that the permanent discontinuation of HIV programmes previously supported by the US President's Emergency Plan for AIDS Relief (PEPFAR), including treatment and prevention, would, between 2025 and 2029, lead to:
- An additional 6.6 million new HIV Infections
- About 2300 additional new HIV infections per day
- A total of 5800 new infections per day today compared to 3500 in 2023
- 660 000 additional new HIV infections among children between 2025 and 2029.
- An additional 4.2 million AIDS-related deaths
- Over 600 additional AIDS-related deaths per day
- A total of 2400 deaths per day in 2025 compared to 1700 in 2023
- An additional 300 000 children will die of AIDS related causes between 2025 and 2029.
- 3 million additional children orphaned by AIDS, and
THE WAIVER
On 1 February 2025, the US Department of State’s Bureau of Global Health Security and Diplomacy (GHSD), which oversees PEPFAR, issued a memo to PEPFAR Implementing Agencies and PEPFAR Country Coordinators on the ‘Implementation of Limited Waiver to Pause of US Foreign Assistance for Life-Saving HIV Service Provision’. The memo confirms that the following activities may be resumed until superseded by new guidance:
- Life-saving HIV care and treatment services, inclusive of HIV testing and counselling, prevention and treatment of opportunistic infections including TB, laboratory services, and procurement and supply chain for commodities/medicines.
- Prevention of mother-to-child transmission services, inclusive of commodities/test kits, medicines and PrEP for pregnant and breastfeeding women.
- Reasonable implementing agency and implementing partner administrative costs strictly necessary to deliver and provide oversight of this assistance, including related country-based data activities and portions of PEPFAR's central data platform used for clinical monitoring and program management.
PEPFAR implementing agencies are also instructed to continue to pause foreign assistance for all other activities not covered by the waiver.
Additional information was provided on 6 February 2025.
THE TIMELINE
On 20 January 2025, the US Department of State announced an immediate 90-day pause for all US foreign assistance, including for activities supported by PEPFAR. The executive order announcing a “90-day pause in United States foreign development assistance for assessment of programmatic efficiencies and consistency with United States foreign policy” was one of the first major foreign policy decisions of the new US administration.
On 28 January 2025, the US Secretary of State approved an “Emergency Humanitarian Waiver”, which allows people to continue accessing lifesaving HIV treatment funded by the United States of America. This waiver approves the continuation or resumption of “life-saving humanitarian assistance” which applies to essential medicines, medical services including comprehensive HIV treatment, as well as to necessary supplies and costs to facilitate these services. This is an essential, life-saving development for more than 20 million people living with HIV, representing two-thirds of the 30.7 million people living with HIV receiving treatment globally, who are directly supported by PEPFAR, the world’s leading HIV initiative.
On 1 February 2025, GHSD, which oversees PEPFAR, issued a memo to PEPFAR Implementing Agencies and PEPFAR Country Coordinators on the implementation of the waiver.
6 February 2025, Additional information regarding the waiver was provided
27 February 2025, UNAIDS received a letter from the US Government/USAID stating they are terminating their agreement with UNAIDS with immediate effect.
28 March 2025, the administration notified Congress of its intent to permanently dissolve USAID and that any remaining USAID operations would be absorbed by the State Department with remaining global health activities to be integrated into GHSD.
TWO DECADES OF US LEADERSHIP IN THE GLOBAL AIDS RESPONSE
For more than two decades, the United States has been a steadfast leader in the global AIDS response through the PEPFAR, the Global Fund to Fight AIDS, TB and Malaria and through its support to UNAIDS.
The importance of the United States contribution to the global HIV response cannot be overstated. Since its creation in 2003, to 2024, PEPFAR saved more than 26 million lives and averted almost 5 million new HIV infections among by investing in critical HIV prevention, treatment, care and support programmes in 55 countries.
As of December 2024, the US Government was supporting more than 20 million people with life-saving antiretroviral treatment, including about 560 000 children.