The United States has suspended some funding for its flagship AIDS relief program, according to international organizations and members of Congress who warn the cuts are already hurting patients and halting critical projects globally.
The full extent of the budget cuts related to US-funded HIV/AIDS relief work is highly unclear, and Congress is still battling the White House’s proposed budget clawbacks and withholding of billions of dollars in funding.
PEPFAR, formally called the US President’s Emergency Plan for AIDS Relief, is credited with saving more than 26 million lives over the past two decades and preventing millions of HIV infections, particularly in Africa.
Last year alone, government figures show that PEPFAR provided 20.6 million people with life-saving HIV medicines, called antiretroviral therapy. It also supported more than 342,000 health workers to deliver HIV treatments, prevention care and support services, bolstering healthcare systems in more than 50 countries.
Funding for the landmark program – established in 2003 by the Bush administration – was primarily implemented by USAID, which US President Donald Trump dismantled earlier this year after a freeze on foreign aid. The US State Department later issued a waiver to exempt life-saving services from that freeze, including those of PEPFAR, and moved operations to the State Department’s remit.
But nonprofits are sounding the alarm that HIV/AIDS projects have been terminated regardless. And without USAID, implementation of many planned initiatives has also stalled. Such cuts are severely disrupting patients’ medical care across Africa, Asia and Latin America, threatening the global fight against the disease, they say.
An aerial view of Migosi Sub-county Hospital in Kisumu, Kenya, where the continuity of services for thousands of HIV patients has been threatened. – Michel Lunanga/Getty Images
How is HIV/AIDS relief work being impacted?
UNAIDS, the United Nations’ agency working to end AIDS, has cited examples around the world of medicine stockouts, staffing cuts at HIV/AIDS clinics, suspended community outreach services and “rising levels of stigma, discrimination and mortality rates” in the wake of the US funding cuts.
The suspensions have caused major disruptions to HIV responses in dozens of countries, including Uganda, the Philippines and Tanzania, the UN agency said.
People living with HIV are skipping and rationing doses of antiretroviral medications, creating conditions for drug-resistant HIV strains to emerge, according to the nonprofit Physicians for Human Rights, which compiled testimonies of healthcare disruptions from people in Tanzania and Uganda.
Doctors Without Borders has warned that “PEPFAR faces an uncertain future” and that project cancellations following the dismantling of USAID have already impacted humanitarian work.
“PEPFAR’s scope of work has already been dramatically reduced since January when the State Department restricted its work on key areas of HIV prevention, treatment, care, and support,” the Doctors Without Borders statement said, contradicting the US government’s repeated claims that lifesaving aid work is being preserved.
“Cuts are not just hitting program activities and medical stocks; they are crippling the logistical backbone of HIV care. Transport for distributing supplies has all but vanished,” said the organization’s representative in Zimbabwe, Zahra Zeggani-Bec.
Children play on a trampoline at the Nyumbani Children’s Home in Kenya, which cares for more than 100 children with HIV, whose parents died of the disease, while providing them with US-funded supplies of antiretroviral medicines. – Thomas Mukoya/Reuters
World Vision, an international Christian organization focusing on poverty and development, told CNN it had a large PEPFAR program in Kenya that had been terminated.
“That (program) had focused primarily on orphans and vulnerable children and prevention activities,” said Margaret Schuler, World Vision’s chief impact officer. Shuler said it was surprising that “what would have been considered ‘lifesaving programs’ were terminated,” including other World Vision programs related to health care and disease control.
Full extent of impact is unknown
PEPFAR reporting data has been publicly unavailable for months, meaning there’s little clarity on the program’s ongoing activities. A message on the government website says it is “undergoing updates.” The release dates for 2025 PEPFAR data reports are all listed as “TBD.”
A State Department spokesperson told CNN that “data collection is ongoing to capture recent updates to programming.”
UNAIDS said in a report in April that, among 70 of its country offices, 28 (40%) had witnessed an end to community-led services due to the US funding cuts. Meanwhile, 21 (30%) reported that services by international NGOs had been stopped.
Some of that work may have resumed, but it’s impossible to determine how much, given the lack of data on the budget, contracted services and “what has actually been delivered,” said Charles Kenny, a senior fellow at the Center for Global Development, a think tank based in the US and UK.
He wrote in an analysis of the status of US aid operations that “right now, Congress and taxpayers have no visibility on what the foreign assistance system is trying to accomplish, let alone if that is happening.”
Antiretroviral medication is dispensed at TASO Mulago service center in Kampala, Uganda, on February 17, 2025. – Hajarah Nalwadda/Getty Images
Secretary of State Marco Rubio has stated PEPFAR is an important and life-saving program that will continue, a State Department spokesperson told CNN, adding that Rubio has “also said that PEPFAR, like all assistance programs, should be reduced over time as they are impactful in achieving their mission.”
Last week, the State Department announced a joint commitment with the Global Fund to purchase the drug lenacapavir, an HIV prevention injection that only has to be taken twice a year, from the American biopharmaceutical company Gilead Sciences. PEPFAR will distribute the drug in eight to 12 high-burden HIV countries in 2026, with a focus on reducing the number of new HIV infections in pregnant and breastfeeding mothers, according to a State Department statement.
What is happening with the Congressional budget battle?
The White House Office of Management and Budget (OMB) has released only about half ($2.9 billion) of the $6 billion appropriated by Congress for PEPFAR’s 2025 funding, according to budget documents on a nonprofit website that tracks the OMB.
A congressional aide raised concerns that the budget document listed billions of dollars of this year’s funds as part of fiscal year 2026, which the aide described as atypical.
A budget expert told CNN that the 2025 PEPFAR apportionment looks “weird” compared to previous years’ documents, which typically specify how much money is going to each government department involved in PEPFAR. For this year, the released funds are listed as “unallocated” and conditional on a spending plan that has to be agreed upon by OMB and the State Department. Those spending plans are not publicly available.
The source also said that placing the funds into fiscal year 2026 is at least an indication that OMB is not willing to spend the PEPFAR money now, and it could be an attempt to “slow walk” the funding.
Another congressional aide told CNN that Congress doesn’t have a clear picture because of a lag time in the information the White House must report to the public. It’s possible that 2025 funding could still be released in the coming weeks and months.
The picture of funding flows remains fuzzy, and it comes after the Trump administration already tried to claw back $400 million for PEPFAR. That proposal was canceled after bipartisan opposition in the Senate. Yet not all of those funds had been released, top Senate appropriator Susan Collins, a Republican from Maine, told CNN in a statement last week.
“OMB is blocking funding for PEPFAR, one of the most successful global health programs in history,” Collins said. “PEPFAR funds are simply not reaching those in need, as confirmed by those in the field.”
The ranking Democrat on the Senate Appropriations Committee, Senator Patty Murray of Washington, has called out OMB Director Russell Vought directly, saying that “even after promising Republican lawmakers that the program would be protected, he’s choked off a huge chunk of funding provided by Congress for PEPFAR.”
“The law is clear as day: the full funding Congress provided must be used for the work PEPFAR does day in and out. The more these funds are obstructed and delayed, the more people will die needlessly,” Murray told CNN in a statement.
CNN has reached out to OMB for comment but has not received a response.
Another fight brewing over foreign aid
Separately, last week, Trump notified Congress he was moving to cancel $4.9 billion in foreign aid already approved for this year, drawing criticism from lawmakers from both parties who questioned the legality of the move. The US Government Accountability Office says rescissions so late in the fiscal year are illegal.
Last Wednesday, a federal judge ruled that without congressional approval, the administration can’t decide to withhold federally budgeted foreign aid money that will expire at the end of this month.
But the White House is mounting a multi-front effort to do so both in the courts and on Capitol Hill, with Trump asking the Supreme Court on Monday to step back into the fight.
CNN’s Sarah Ferris, Jennifer Hansler and Katelyn Polantz contributed to this report.
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