By Bunmi Yekini
The future of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is at a critical juncture as political shifts and funding uncertainty cast doubt over its continued operations. With its reauthorisation set to expire on March 25, 2025, and a U.S. State Department-mandated 90-day review of foreign aid in progress, global health stakeholders are racing against time to secure reforms and sustain the program.
Since its inception in 2003, PEPFAR has been instrumental in combating HIV/AIDS worldwide, particularly in low-income and middle-income countries. According to amfAR, The Foundation for AIDS Research, the initiative has saved approximately 26 million lives and provides life-saving services in 54 countries through a vast network of healthcare workers and service providers. Each day, more than 222,000 people receive antiretroviral therapy (ART), while over 224,000 HIV tests are conducted. However, the program now faces one of its most challenging periods due to recent policy shifts under the administration of U.S. President Donald Trump.
The situation intensified following the issuance of the Reevaluating and Realigning United States Foreign Aid Executive Order on January 20, 2025. In its wake, the State Department imposed a stop-work order on all foreign aid, including PEPFAR, effective January 24. While a limited waiver was granted on February 1 to allow the continuation of ART and mother-to-child transmission prevention, other crucial services—including HIV prevention for key populations, support for orphans, and voluntary medical circumcision—remain halted.
“The uncertainty is devastating,” said Dr. John Nkengasong, U.S. Global AIDS Coordinator. “We are talking about millions of lives depending on these services, and disruptions put global HIV control efforts at serious risk.”
Health advocates warn that the current funding freeze could reverse decades of progress. Many PEPFAR-supported clinics have been forced to close or scale back operations, leaving vulnerable communities without essential care. Moreover, concerns are mounting over potential drug resistance and treatment interruptions due to these disruptions.
“The halt in funding means we are seeing HIV patients lost to follow-up, missed opportunities for prevention, and rising cases of mother-to-child transmission,” said Winnie Byanyima, Executive Director of UNAIDS. “This could be catastrophic.”
Beyond immediate service delivery concerns, broader questions remain about PEPFAR’s long-term viability. The Trump administration’s intent to restructure or eliminate USAID, which channels 60% of PEPFAR’s $4.76 billion annual budget, further exacerbates uncertainty surrounding the program’s future. Many experts stress the need for urgent reforms, including transitioning PEPFAR-supported HIV programs to country-led initiatives, reducing operational costs, and fostering private-sector partnerships.
“We need a sustainable plan that allows national governments to take greater ownership of HIV responses,” said Dr. Anthony Fauci, former head of the National Institute of Allergy and Infectious Diseases. “Cutting off funding without a proper transition strategy is not a solution—it’s a disaster in the making.”
Despite the challenges, stakeholders remain hopeful that bipartisan support in Congress can secure PEPFAR’s future. Advocacy groups are pushing for a five-year reauthorization, emphasizing the program’s global impact and its benefits to U.S. national interests.
“The U.S. has been a leader in the fight against HIV/AIDS for decades,” said former U.S. Secretary of State Condoleezza Rice. “Abandoning PEPFAR now would not only undermine that legacy but also put millions of lives at risk.”
With critical decisions looming in the coming months, the fate of PEPFAR hangs in the balance. As the foreign aid review continues, health advocates stress that maintaining bipartisan commitment and securing long-term funding is imperative to ensuring the program’s continued success in combating the global HIV/AIDS epidemic.