{"id":226374,"date":"2025-10-07T10:00:15","date_gmt":"2025-10-07T17:00:15","guid":{"rendered":"https:\/\/www.insidephilanthropy.com\/?p=226374"},"modified":"2025-10-08T08:44:28","modified_gmt":"2025-10-08T15:44:28","slug":"as-the-u-s-dials-back-aids-relief-can-philanthropy-maintain-lifesaving-services","status":"publish","type":"post","link":"https:\/\/www.insidephilanthropy.com\/home\/as-the-u-s-dials-back-aids-relief-can-philanthropy-maintain-lifesaving-services","title":{"rendered":"As the U.S. Dials Back AIDS Relief, Can Philanthropy Maintain Lifesaving Services?"},"content":{"rendered":"\n
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Back in 2003, at the peak of the global AIDS epidemic, President George W. Bush launched PEPFAR \u2014 the President’s Emergency Plan for AIDS Relief \u2014 giving people in lower-income nations access to an effective new class of antiretroviral drugs, as well as related HIV services such as testing and prevention. The program has been a humanitarian success, saving an estimated 26 million lives in 55 countries over the course of its 20-plus years in operation. PEPFAR was also a wise strategic move for the U.S., it has been argued, helping to maintain political order and American influence in nations that might otherwise have destabilized and bred extremism under the added strains of AIDS. <\/p>\n\n\n\n

Every year since PEPFAR’s establishment, Congress has voted to continue U.S. funding for the program. But as the beginning of 2025 saw the second Trump administration hollow out USAID funding and other foreign assistance, HIV\/AIDS advocates and funders feared for the future of PEPFAR and the people it protected. <\/p>\n\n\n\n

So it came as some relief to HIV\/AIDS care advocates when Congress voted in July to maintain funding for PEPFAR, despite the administration’s attempts to rescind the money. But PEPFAR’s immediate and long-term future is far from certain: The White House Office of Management and Budget has released only about half of the $6 billion Congress appropriated for PEPFAR’s fiscal year 2025 operations. That has led to significant cuts to PEPFAR programs. For many people with HIV, that has turned a manageable health condition into a fatal disease: Over 93,000 adults and 9,000 children have died since January because of PEPFAR-related service disruptions, according to Masen Davis, executive director of Funders Concerned About AIDS, an organization that works to coordinate philanthropic efforts to end AIDS.<\/p>\n\n\n\n

“These funding cuts are much more than lines in a budget \u2014 they impact real people,” Davis said. “We saw that firsthand earlier this year during the foreign aid freeze.” It remains to be seen how future cuts or executive actions will impact PEPFAR service delivery, while the broader dismantling of foreign aid and public health infrastructure will likely make it harder for HIV services to reach those who need them most, he added. <\/p>\n\n\n\n

The Trump administration has placed PEPFAR under the control of the State Department and has limited the program’s HIV prevention services to pregnant and nursing women, leaving countless people who don’t fit those criteria facing loss of access to care and more vulnerable to HIV infections. Although PEPFAR was launched by the U.S., which has been its largest funder, other nations have also contributed to the program’s work; some governments are increasing their participation in PEPFAR to make up for the drop in U.S. support. <\/p>\n\n\n\n

This year’s news hasn’t been completely bleak. The FDA recently approved a new HIV pre-exposure prophylaxis drug, lenacapavir, developed by Gilead Sciences. The medicine has been shown to prevent 99.9% of HIV infections with just twice-yearly injections \u2014 a significant convenience over existing PReP drugs, which require daily pills or bimonthly injections, making it harder for people who should be taking them to adhere to treatment. Because of its simpler, twice-yearly shots, the new drug offers the possibility of more widespread use and is hailed by the HIV care community as potentially transformative in the fight against AIDS \u2014 if the people who need the drug can get it. PEPFAR has recently committed to distributing lenacapavir within countries with high HIV rates, which is good news, but is limiting that distribution to pregnant and breastfeeding women.<\/p>\n\n\n\n

Experts warn against restricting access in this way. “If the U.S. says that only pregnant and breastfeeding women can get lenacapavir, that will not curb the pandemic,” said Jennifer Sherwood, the director of research and public policy at amfAR, the Foundation for AIDS Research. “If they were really serious about the pandemic, they would buy lenacapavir and give it to those most at risk, not just restrict it to certain populations.”<\/p>\n\n\n\n

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