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Trump’s freeze on HIV/Aids foreign aid is troubling news for the US — here’s why

Trump’s freeze on HIV/Aids foreign aid is troubling news for the US — here’s why
Tamsin Metelerkamp
By Tamsin Metelerkamp
5 Feb 2025
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Does America stand to lose anything if Pepfar disappears? What lies ahead for the US Agency for International Development? Are Trump’s executive orders even legal? Daily Maverick tackles key questions about the 90-day pause on US foreign aid.

Since President Donald Trump signed an executive order on 20 January suspending all foreign development assistance for 90 days, pending a review to determine whether they were “fully aligned” with US foreign policy, Daily Maverick had been tracking the impact of the freeze on the US President’s Emergency Plan for Aids Relief (Pepfar).

On 28 January, US Secretary of State Marco Rubio issued an additional waiver on the 90-day freeze for “life-saving humanitarian assistance”, stating that implementers of existing life-saving programmes could continue or resume work. The waiver applies to a limited array of HIV services.

However, many Pepfar-funded programmes in South Africa and around the world have yet to receive instructions from funders that would allow them to resume their work. 

Trump is just putting America first – isn’t this the best course of action for the American people?


It is a mischaracterisation of Pepfar to see it as a purely altruistic programme on the part of the US. While it is a funding tool to aid other countries in combating the HIV/Aids epidemic, it also has benefits for the American public, ranging from disease control and research, to employment and diplomatic relations.

One expert in the American HIV/Aids sector, who chose to remain anonymous, described the suspension of Pepfar funding as “disastrous” for US relations.

“It’s showing the United States to not be a reliable partner with anyone, whether ally or adversary. I don’t know how this makes America a more reliable partner, a stronger partner to other countries, or more prosperous,” he said.

He added that the gap left by Pepfar could not be filled by smaller, private philanthropic organisations, since tackling the whole of the HIV epidemic required a coordinated, specific strategy that cut across a range of areas.

“It doesn’t work without the amount of money, the amount of centralised funding… that exists in Pepfar and the Global Fund and all those sorts of entities,” he said.

“We have built these programmes over 20 years of coordinated, planned, careful discussions about who’s funding what this year, so that everybody is in alignment… The pieces of the system are being funded by different partners in different ways to ensure the whole of the system is functional.”

Since the announcement of the freeze on US aid, a Pepfar impact tracker has been launched by Brooke Nichols, an associate professor in the Department of Global Health at the Boston University School of Public Health. The tracker lays out the benefits of Pepfar for America’s wellbeing, including:

  • Global health security and the reduction of the risk of new variants, protecting Americans from potential health threats;

  • Economic benefits, as healthier global populations mean stronger economies and better trading partners for the US;

  • Diplomatic soft power, in that Pepfar enhances America’s global reputation and influence;

  • Scientific advancements, as research funded by Pepfar contributes to broader medical discoveries that benefit Americans;

  • Job creation, as Pepfar supports American jobs in healthcare, research and international development sectors; and

  • Domestic manufacturing, since Pepfar’s demand for medical supplies and pharmaceuticals stimulates US manufacturing, creates jobs and fosters innovation in the healthcare industry.


According to the tracker, an estimated 35,531 premature deaths occurred between 27 January and 10am today, due to the funding gap caused by Pepfar’s suspension. The death count goes up every 21 seconds.

A media release from the US State Department on 29 January said the 90-day pause and review of foreign aid was allowing the government to “root out waste” and block “woke programmes”. It stated that the US was spending about $40-billion in foreign aid annually, not including support for Ukraine.

“In just a few days, the Department received billions of dollars in waiver requests. Many of those requests are still under a merit-based review as they are not considered emergency or life threatening; however, even at this early stage, over $1,000,000,000 in spending not aligned with an America First agenda has been prevented,” the department said.

Is the Pepfar system corrupt or mismanaged?


Lynne Wilkinson, a Gauteng-based public health specialist in the HIV/Aids sector, noted that the checks and balances for ensuring that Pepfar funds were used as intended by South African organisations were effective, “to the point of it being extremely painful”.

Pepfar funds are distributed to South African organisations by the US Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC), according to Wilkinson.

“There’s very high checks and balances. These guys spend an inordinate amount of time accounting for every cent… There’s a lot of places where corruption happens in the health system, but definitely not the Pepfar funds,” she said.

“If the argument is that aid to the South African government is at risk of being lost due to corruption, it is important to understand that Pepfar funding doesn’t go directly to the South African government. It’s channelled in a parallel system directly to the South African NGOs, with stringent contracting, auditing and other checks and balances in place, all managed directly by USAID and CDC.”

Claims of fraud and mismanagement have been levelled against USAID by members of Trump’s administration in recent weeks.

According to a BBC report, Trump alleged, in a White House press briefing on 3 February, that USAID was run by “radical left lunatics” and was getting away with “tremendous fraud”. He did not provide names or details. 

One of his top advisers, billionaire Elon Musk, has also taken aim at the agency, posting on his social media site X on 2 February: “USAID is a criminal organisation. Time for it to die.”

The Trump administration is reportedly moving to merge USAID with the State Department – a move that democratic legislators have criticised as illegal and unconstitutional.

An announcement published on USAID’s website said all USAID direct hire personnel would be placed on administrative leave globally from Friday, 7 February at 11.59pm. The exceptions to this order are designated personnel responsible for mission-critical functions, core leadership and specially designated programmes.

“For USAID personnel currently posted outside the United States, the Agency, in coordination with missions and the Department of State, is currently preparing a plan, in accordance with all applicable requirements and laws, under which the Agency would arrange and pay for return travel to the United States within 30 days,” said the announcement.

“Thank you for your service.”

USAID’s workforce is made up of more than 10,000 people, with about two-thirds serving overseas, according to the Congressional Research Service. 

A memo released by the O’Neill Institute for National and Global Health Law at the Georgetown University Law Center in the US said that abolishing USAID or absorbing it into the State Department was not good policy.

“It will not make the United States safer or stronger. There are many reasons to demand reform at USAID, perhaps even radical reform. There are strong critiques from the left and the right… But aid money also saves lives. Halting it has shut down efforts to prevent children from dying of malaria, halted clinical trials, threatened a resurgence of HIV, and more – showing its crucial role,” it stated.

“Doing aid better, and with the outcomes-focus Secretary Rubio has pushed for, requires people, infrastructure, and political independence… Moving USAID into State would undermine its capacity to do high-quality contracting and aid transparency, not strengthen it, while making aid even more tied to geopolitics and confused with the day-to-day diplomacy of the US in the world.”

Are Trump’s executive orders legal?


Trump’s executive orders have seen him make sweeping changes to US policy. The impacts of his actions have been felt worldwide, but the question remains: are they legal?

In an article published by the International Bar Association, Trump’s executive orders were described as “pushing the legal boundaries of presidential authority”. Several of his orders almost immediately led to lawsuits.

On 28 January, US District Judge Loren AliKhan in Washington, DC paused the directive from Trump’s administration freezing federal grants, loans and other financial assistance pending review, according to a Reuters report. A temporary restraining order preventing the implementation of the directive was issued on 3 February.

The case against the freeze was brought by several coalitions of nonprofit organisations after Matthew Vaeth, acting director of the US Office of Management and Budget, issued a memorandum stating that federal agencies must temporarily pause all activities related to the obligation or disbursement of all federal financial assistance, including financial assistance for foreign aid, nongovernmental organisations, DEI [diversity, equity and inclusion], “woke gender ideology” and the Green New Deal.

In her ruling granting the temporary restraining order, AliKhan said that the plaintiffs had met their burden of showing that the funding freeze would cause “irreparable harm”.

“Each day that the pause continues to ripple across the country is an additional day that Americans are being denied access to programmes that heal them, house them, and feed them,” she said, adding that the funding freeze threatened “the lifeline that keeps countless organisations operational”.

It hasn’t been immediately clear what this decision means for the CDC or USAID funding for foreign aid. DM

Read Part 1 of this two-part explainer.

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