“The UN warns millions will die by 2029 if US funding for HIV programs isn’t replaced” – so warned Scripps News regarding the cut of $4B (US) to PEPFAR earlier this year.
There’s no official death toll. Not yet. But the Trump administration’s so-called 90-day pause in PEPFAR funding quietly stretched into more than six months — long enough to shutter clinics, sever treatment, and endanger over 100,000 lives in sub-Saharan Africa. Meanwhile, the PEPFAR Impact Portal estimates that 89,825 adults and 9,562 children have died between 24 January and today, with a new death every few minutes.
A Pause That Became a Collapse
For two decades, PEPFAR was more than a program — it was infrastructure, dignity, and survival. It saved 26 million lives, enabled 5.5 million HIV-free births, supported 20 million people on antiretrovirals, trained 327,000 health workers, and provided care for 7 million vulnerable children. It prevented HIV in men and boys through 32.5 million voluntary circumcisions.
Then came the rescission announced on 22 January 2025 by Trump and Musk: a cut that closed clinics, halted treatments, replaced health and hope with anxiety and despair, and erased decades of progress.
Forbes concluded that 60% of PEPFAR’s $4.8B allocation was withheld. USAID (the main agency delivering PEPFAR) lost 86% of its funding, and the future budget request is down to $2.9B.
Although the Trump administration claimed that 85% of PEPFAR’s services remained operational, critics — including lawmakers and former program staff — challenged that figure as unverifiable and misleading.. “It’s the most successful, bipartisan, highly efficient life-saving thing that the United States has ever done, and Elon Musk went in and trashed it,” noted Hawaii Senator Brian Schatz.
Despite a revision by the Trump Administration allowing for some marginal “life saving humanitarian assistance”, others continued to call for accountability, urging a deeper moral reckoning beyond political metrics.
“A 90-day PEPFAR funding pause and associated service disruptions could result in over 100,000 excess HIV-related deaths over a year in sub-Saharan Africa.”
— Kaiser Family Foundation
“What was once a global lifeline has become a disappearing act. The reversal of PEPFAR is not policy—it’s abandonment.” — Adapted from AP News Reporting
Counting the Cost
In reality, the damage was swift and widespread. According to the Associated Press, abrupt U.S. aid cuts “destabilized supply chains, led to the closure of health facilities, left thousands of health clinics without staff, set back prevention programs, disrupted HIV testing efforts and forced many community organizations to reduce or halt their HIV activities” (Anna, 2025). In South Africa alone, 12 specialized HIV clinics closed and over 8,000 health workers lost their jobs. Health officials warned of a return to the early days of the AIDS pandemic, when clinics were filled with the dying and medication was scarce. Clinics in South Africa, Mozambique, and Cameroon closed their doors. In Mozambique, one closure followed a false claim by the Trump administration that it had halted “$50 million in condoms for Hamas”—a grant that was actually for paediatric HIV care in Gaza Province of Mozambique. In Nigeria, over 500 ARV sites faced collapse. In Uganda, all dedicated HIV clinics shut down. ‘These services are no more,’ said one staffer.” Outreach teams in Haiti and South Sudan disbanded, leaving survivors of sexual violence without post-rape care or emergency nutrition.
Maternal health services collapsed in Afghanistan and Syria, while ambulance networks in Yemen ceased operations. In Guatemala, psychological support for trauma survivors vanished overnight.
These disruptions weren’t hypothetical—they were documented across multiple reports. According to Scripps News, the funding losses “destabilized supply chains, led to the closure of health facilities, left thousands of health clinics without staff.” UNAIDS tracked the loss of thousands of HIV health workers and the collapse of outreach services in at least ten countries via its Impact Portal. The Kaiser Family Foundation confirmed that a 90-day pause could result in over 100,000 excess deaths, with service disruptions already affecting diagnostics, treatment, and supply chains.
The pause — initially framed as a 90-day review — stretched into more than six months. During that time, over 100,000 lives were placed at risk. Staff were laid off. Medications expired. Patients were turned away. Entire communities lost access to care.
Survival Is Not Success
But advocacy worked. The HIV community mobilized. Lawmakers reversed course. On 18 July 2025, the US President signed a revised bill reducing the cuts. $400 Million was restored. “Advocacy works, and here is the undeniable proof,” amfAR Vice President and Director of Public Policy Greg Millett said.
However, this was not a total victory. It was a warning.
Thousands died before the reversal. Many more may suffer long-term consequences. PEPFAR survived—but only just. The broader humanitarian architecture did not.
We must not confuse survival with success. The blueprint for coordinated global action still exists. But it needs hands, not handouts.
PEPFAR was rescued, but only a fraction of what it was before. The broader humanitarian architecture did not. We must not confuse survival with success.
The blueprint for coordinated global action still exists. But it needs hands, not handouts.
This is our moment to rebuild—not just what was lost, but what was never fully delivered.
Join the call. Share the truth. Demand accountability.
Because lives were lost. And silence is complicity.
What you can do:
1.Direct Advocacy
Write to your representatives. Demand full restoration of PEPFAR and USAID funding. Ask for transparency, accountability, and protection of global health infrastructure.
Contact your MP (Australia)
Contact Congress (US)
2. Support Frontline Organizations
Donate to or amplify groups still doing the work. Organizations like amfAR, EGPAF, and UNAIDS are fighting to keep services alive.
3. Support Local People on the Ground
Please contact me if you would like to donate directly – person to person – with gay men, mothers with children or babies, or others in Africa who desperately need help to survive.
REFERENCES AND FURTHER READING:
Timileyin Akinmoyeje, 2025. “Trump’s PEPFAR Fund Cut Exposes Nigeria to Annual $390m HIV Bill FG Failed to Take Up”, Foundation for Investigative Journalism, 28 January.
amfAR, 2025. “amfAR Applauds Advocate-Led Efforts to Save PEPFAR from Federal Cuts,” Press Release, 17 July.
Anna Cara, 2025. “PEPFAR keeps millions of people with HIV alive and may be spared from Trump spending cuts,” Associated Press, 16 July.
Joshua Cohen, 2025. “USAID and PEPFAR Cuts Could Lead to Massive Loss of Life Overseas,” Forbes, 6 August.
Phoebe Davis, 2025. “Uganda HIV clinics to close after USAID funding cuts”, Tortoise Media Uganda, 12 February.
Kaiser Family Foundation (2025). “The Trump Administration’s Foreign Aid Review: Status of PEPFAR,” KFF Global Health Policy
PEPFAR Impact Counter (2025). “Real-time estimates of lives lost due to funding cuts.” Impact Portal.
Alison Prang, 2025. “Trump’s aid cuts cause thousands of deaths around the world”, National Catholic Reporter, 6 June.
UNAIDS (2025). “About the impact of US funding cuts on the global HIV response,” UNAIDS Impact Portal, UNAIDS.
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©2025 Geoff Allshorn. I show my respect for Elders past and present and acknowledge the Wurundjeri-Willam people, the Traditional Custodians of the Land on which this blog was prepared.
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