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Some Pepfar projects reinstated: a lifeline for HIV prevention as legal battle unfolds

Some Pepfar projects reinstated: a lifeline for HIV prevention as legal battle unfolds
Mia Malan
By Mia Malan
13 Feb 2025
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The original grants of President’s Emergency Plan For Aids Relief-funded (Pepfar) organisations that are funded through the Centres for Disease Control have been reinstated. This is because a federal judge enforced a temporary restraining order blocking US President Donald Trump’s administration from freezing federal grants.

The original grants of Pepfar-funded organisations that get funds through the Centres for Disease Control and Prevention (CDC) have been reinstated after a federal judge enforced a temporary restraining order blocking US President Donald Trump’s administration from freezing federal grants. 

As a result, they are restarting their original projects, and have permission to reinstate thousands of workers who had to be laid off and reopen clinics that had to close down — such as the handing out of anti-HIV preventive medication, voluntary medical male circumcision, projects for injecting drug users that provide clean needles and methadone — that were not allowed under waivers they had to apply for this week. 

The temporary restraining order was originally issued on 31 January 2025, but Trump ignored it. On 10 February, however, the District Court of Rhode Island enforced the order. As a result, at 3am on Wednesday, such organisations received notices on a portal of Grant Solutions, a grants management service that handles CDC grants on behalf of the agency. 

“In compliance with the temporary restraining order issued on 31 January 2025, in the United States District Court of Rhode Island, Notices of Award issued between 24 January and 11 February 2025, that instructed termination, ceasing, suspending, or limiting of activities under this award consistent with Administration Executive Orders are officially rescinded,” the notice said. “Activities under this award are no longer terminated, ceased or suspended. All other existing terms and conditions are still in effect.”

Health department spokesperson Foster Mohale said the department, which received Pepfar funding through the CDC, didn’t receive a notice. 

Yesterday afternoon, Bhekisisa sent the US Embassy and Consulate questions, including what would happen to projects receiving their funds through USAid, but they had not responded by the time of publication. We will update this story with their responses once received. 

What has happened so far


Pepfar, the President’s Emergency Plan for Aids Relief, is an Aids fund that the US launched in 2003 to help fight Aids in countries with high HIV infection rates, such as South Africa. The country has since received about $8-billion (about R145-billion) of which $439 537 828 (about R8.1-billion) was for the current US financial year, which stretches from 1 October 2024 to 30 September 2025. 

Pepfar funds are sent to organisations via federal agencies, mostly the CDC and US Agency for International Development, USAid. The CDC is situated within the Department of Health and Human Services. Roughly half of Pepfar funds in South Africa are distributed through the CDC to about 20 organisations. These include the Wits Reproductive Health Institute, Shout it Now, TB-HIV Care, Right to Care, the Aurum Institute, Human Sciences Research Council, the Broadreach Corporation, South African National Aids Council, South African Medical Research Council, Foundation for Professional Development and the national Health Department.  

The new Trump administration froze funding globally for all US-funded aid projects on 24 January. It then announced a limited waiver for some projects on 1 February. On 7 February, however, President Donald Trump signed an executive order that cancelled all funding from his government for South Africa for what he labels the “unjust and immoral practices” of South Africa that “harm our nation (the US)”. 

But on Monday the US Embassy and consulates in South Africa announced that Pepfar-funded projects could still apply for waivers with rules that only allowed activities that were directly related to “lifesaving treatment”. 

Gone are the waiver rules — but for how long? 


Now that those waivers no longer apply to organisations receiving their funds via the CDC they can continue with the original grants — but for how long is unclear. At the same time, this does not appear to be the case for Pepfar projects funded through USAid, as this funding comes through the US State Department and remains on an overall pause, with only some limited waivers. 

Trump appealed against the ruling on 11 February — and asked that the issue be resolved by 14 February. 

Nonetheless, Bhekisisa has spoken to six Pepfar-funded organisations whose funds get to them through the CDC, and they’re all adamant that they will restart their work this morning. One organisation, which has had to lay off 1,500 workers, is meeting with them this morning to tell them they’ve been reinstated. 

“We’re restarting services,” said the organisation’s director, who doesn’t want to be named, “and we’re of course scared that the US government will, once again, not stick to what it said it would, but we’re also thinking about the impact that closing down of our clinics and programmes had had on our clients, and we therefore think it’s important to restart them.”

A project director who works in the field of mental health, and whose project didn’t qualify for a waiver, and as such was stopped with 430 staff members, mostly health workers, being laid off, said: “We’re anxious, because we don’t know for how long this will carry on, but at least it gives us a while to plan for a proper transition, as opposed to the abrupt shutting down of projects, which is so disruptive — and cruel. 

“It’s a wake-up call for everyone involved.”

What happens to Pepfar after this year? 


Last year, warning signs emerged when the Congress authorised only one year of Pepfar funding as opposed to the normal five years. That meant projects could only be funded — and could only plan — for a year at a time. 

Most projects therefore have year-long budgets that end on 30 September 2025 (the end of the US financial year). Even in the case of multi-year grants, Pepfar grants currently have to be reconfirmed by the end of September.

The reauthorisation of Pepfar is needed by the end of March. The big question is: What happens after that? 

The Trump administration has said it is re-evaluating projects to see if they’re worthwhile funding. But the president of the US doesn’t have the power to end Pepfar — that authority lies with Congress members. 

On Monday, though, US State Secretary Marco Rubio said in an African Media Hub interview, a US government media service, that while he thought Pepfar should be phased out eventually, he currently supported it. 

“I’m a supporter of Pepfar. I have been in Congress… It’s a programme we want to continue. Obviously, we’re going to have questions about it… It’s a programme that should be getting smaller over time, not bigger, right? Because you’re preventing HIV, you’re preventing the spread of HIV, and so people aren’t testing positive because their viral load gets down, they’re not passing it on to their children. 

“So ideally, it’s a programme that over time shrinks, not expands, because less and less people are getting HIV or are transmitting it to their children.”  

Talk about phasing out Pepfar and getting local governments to take over the financial support have been taking place for a few years, but such plans were based on a gradual transition to make sure that projects were sustainable. 

“Pepfar has been a hugely successful long-term investment, but it was never meant to be a forever investment,” says Mitchell Warren, the executive director of the New York-based HIV advocacy organisation Avac. 

“The conversations among all partners over the past few years have been on designing strategic transitions. Now, even with the temporary return of CDC projects, we are all still dealing with chaos. We should be moving from an emergency response (in the original name) to a sustainable response. 

“Tragically, we are dealing with a crisis response.” DM 

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.

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