Update on UNAIDS and US Government/USAID Agreement
On January 20, 2025, President of the United States signed an Executive Order titled “Re-evaluating and Re-aligning US Foreign Aid”, which froze all foreign assistance for 90 days pending a review of US foreign policy alignment. As a recipient of US foreign aid, UNAIDS adhered to the order and suspended its contracts and related activities.
On February 27, 2025, UNAIDS was notified by the US Government/USAID that their agreement with UNAIDS was being terminated immediately. This development has significant implications for the global HIV response, especially for the continuation of essential, life-saving HIV services for people living with HIV, civil society, and partners.
In the termination letter, the US Government/USAID mentioned that “detailed instructions will follow.” UNAIDS has officially reached out to the US Government for further clarification.
Impact of Recent US Decision on Global HIV Response: PEPFAR’s Role
The United States has been a global leader in addressing HIV for over two decades, notably through the US President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, TB, and Malaria, and UNAIDS.
Since its inception in 2003, PEPFAR has saved over 26 million lives by funding critical prevention, treatment, care, and support programs in 55 countries. However, the recent pause in US foreign aid is threatening PEPFAR’s ability to continue providing these essential services, impacting millions of people living with HIV.
UNAIDS is actively coordinating with global partners, governments, and communities to assess and mitigate the potential impact of this pause. The real-time updates portal has been set up to share the latest information, guidance, and data on the implications of this freeze for countries and the broader HIV response.
Despite the pause, UNAIDS is committed to ensuring that individuals living with or affected by HIV continue to receive life-saving services, while working to maintain collaboration with the US Government to protect the significant global impact of US leadership in HIV prevention and care.
Key Updates and Waivers for Life-Saving Services
On February 1, 2025, the US Department of State’s Bureau of Global Health Security and Diplomacy (GHSD), overseeing PEPFAR, issued a memo clarifying that certain life-saving HIV services may continue during the 90-day pause. These include:
- HIV care and treatment services, such as testing, counseling, and treatment for opportunistic infections like tuberculosis.
- Prevention of mother-to-child transmission services, including necessary medications and testing kits.
- Administrative costs essential for maintaining oversight of these services, including clinical monitoring and data management.
However, all other non-essential activities are to remain paused.
Timeline of Key Developments
- January 20, 2025: The US announced a 90-day pause on all foreign assistance for a review of programmatic efficiency and alignment with US foreign policy.
- January 28, 2025: An Emergency Humanitarian Waiver was approved, allowing the continuation of life-saving HIV services during the freeze.
- February 1, 2025: GHSD issued guidance confirming which services would continue during the 90-day pause.
PEPFAR’s Global Impact
PEPFAR has been critical in the fight against HIV, saving more than 26 million lives and preventing nearly 5 million children from acquiring HIV. As of December 2024, PEPFAR supported over 20 million people with life-saving antiretroviral treatment, including approximately 560,000 children.
The program operates in 55 countries, predominantly in Africa, providing essential services to millions. Any disruption in US foreign aid will directly impact the distribution of HIV medicines and prevention services, jeopardizing the health of those relying on these interventions.
UNAIDS’ recent analysis shows that a permanent halt to PEPFAR could result in an additional 4 million AIDS-related deaths and 6 million new HIV infections by 2029, making the goal of ending AIDS as a public health threat by 2030 unachievable.