US State Department grants waiver on aid freeze for ‘life-saving humanitarian’ assistance

By Tamsin Metelerkamp and Victoria O’Regan

29 Jan 2025

US Secretary of State Marco Rubio has backpedalled on the near-total freeze of US foreign aid, stating that ‘life-saving humanitarian assistance’ would be continued during the 90-day review period. There is widespread uncertainty about which programmes fall under the new waiver among global and South African health organisations.

US Secretary of State Marco Rubio has waived the 90-day freeze on American foreign aid for providers of “life-saving humanitarian assistance”, as Washington’s sweeping review of all foreign aid continues to send shockwaves through the global community.

Rubio, who previously exempted only emergency food assistance and military support to Israel and Egypt, approved an additional waiver on Tuesday, 28 January 2025.

Read more: ‘I’m breaching my Hippocratic oath’ — Trump’s foreign aid freeze halts key HIV programmes

“Implementers of existing life-saving humanitarian assistance programs should continue or resume work if they have stopped, subject to the following directions. This resumption is temporary in nature, and except by separate waiver or as required to carry out this waiver, no new contracts shall be entered into,” read the memo seen by Daily Maverick.

In the memo, Rubio defined humanitarian assistance as “core to life-saving medicine, medical services, food, shelter, and subsistence assistance, as well as supplies and reasonable administrative costs as necessary to deliver such assistance”.

He said the waiver did not apply to programmes that involved “abortions, family planning conferences… gender or DEl (diversity, equity and inclusion) ideology programs, transgender surgeries, or other non-life-saving assistance”.

Widespread uncertainty

There is widespread uncertainty over which programmes and activities fall under the scope of “life-saving” assistance. The extent to which the waiver covers the US President’s Emergency Plan for Aids Relief (Pepfar) was not immediately clear.

Anele Yawa, the general secretary of the HIV/Aids activist organisation Treatment Action Campaign (TAC), told Daily Maverick: “We welcome this announcement in terms of issues related to life-saving medication, based on the fact that already, over the past couple of days, we we have seen some of the challenges on the ground with regards to access to treatment. But we do not know, as it stands, what the details of this waiver are.

“We are unsure of what it will entail and... who it involves, and who is excluded in terms of this waiver and what services will be provided in terms of life-saving medication, because when you’re talking about life-saving medication in response to HIV, you cannot leave prevention out of that.”

Lynne Wilkinson, a Gauteng-based public health specialist in the HIV/Aids sector, said there was “a lot of confusion” around the waiver in the South African health sector. While there was some confidence that US-funded antiretroviral therapy service delivery would resume, the impacts on HIV testing, prevention and community-led monitoring by local organisations like Ritshidze were less certain, she said.

“My opinion is that HIV programmes should fall under life-saving humanitarian assistance. People living with HIV will get sick and die, with an increase in transmission and incidence,” she said.

US President Donald Trump last week ordered a 90-day suspension of all US foreign assistance to review if it was aligned with his foreign policy priorities. The freeze included Pepfar, an HIV/Aids treatment and support programme overseen by the US State Department.

The programme has saved millions of lives since its inception in 2003. According to data from the Andelson Office of Public Policy at the Foundation for Aids Research, Pepfar was supporting more than 20 million people on antiretroviral treatment worldwide.

For the US financial year spanning October 2024 to September 2025, South Africa received about $440-million from Pepfar, which funds services that include HIV counselling and testing; HIV treatment programmes; TB screening, preventive therapy and treatment; support for orphans and vulnerable children affected by HIV/Aids; and support for survivors of gender-based violence.

On Friday, 24 January 2025, the State Department issued a stop work order worldwide even for existing assistance, according to a Reuters report.

Read more: Trump administration targets dozens of senior USAid staff after aid freeze

Mass disruption

Several South African health programmes announced a suspension of their services as a result of stop work orders issued by US funders earlier this week, including the Wits Reproductive, Health and HIV Institute’s (RHI) Key Populations Programme, and Engage Men’s Health in Johannesburg.

Professor Shabir Mahdi, the dean of the Faculty of Health Sciences at Wits University, said there had been a “stop order communication issued regarding some of the USAid-funded programmes being run by staff at Wits Health Consortium, primarily by (Wits RHI)”. He noted that there was ongoing communication with the programme leads about the implications of the stop order, while mitigation plans related to the impact on patient care were being “developed and deployed”.

Daily Maverick reached out to Mahdi on Wednesday about whether the waiver had allowed USAid-funded programmes run by Wits RHI to resume.

“There has not been any official reversal of the SWO (stop work order),” said Mahdi. “My understanding is (the waiver) refers to humanitarian crisis situations, and would not be any reversal of DEI-linked (diversity, equity, and inclusion) programmes.”

Yawa said that the stop work orders issued to Pepfar-funded organisations in South Africa had already affected the livelihoods of more than 13,815 health workers, including nurses, midwives, pharmacists, doctors and laboratory staff. Many had little to no warning that their work would be halted.

“One needs to remember Pepfar is supporting more than 20-million people living with HIV around the world, and if Pepfar just pulls out like that without preparing our governments, it therefore means it puts the lives of those people at risk... I think if our governments were prepared, they could have maybe managed to see how they were going to address the situation,” said Yawa.

Speaking at an ANC press conference on Tuesday afternoon, South African Health Minister Dr Aaron Motsoaledi said the department had started collecting data on the organisations that would be affected.

Motsoaledi said the world was “baffled” by Trump’s review.

South Africa is “running the world’s biggest HIV counselling and testing campaign at 5.5 million people who are on ARVs — no other country comes anywhere near that. The total amount spent in this campaign is R44.4-billion, and Pepfar contributes 17% of it,” said Motsoaledi.

The abrupt freeze on US foreign aid has widespread implications for South African health programmes, not only for the treatment of HIV/Aids, but also for tuberculosis (TB) care, and abortion and family planning services.

Speaking to Daily Maverick about the possible consequences of the loss in funding, SECTION27 executive director Sasha Stevenson said: “There’s a big impact on HIV and also TB (health services). We shouldn’t forget TB because of the way the HIV programme has been integrated into the health system and coupled with TB, which is difficult and important to manage.

“What this administration is doing is making the world less safe for all of us who are affected by the matters that affect global health, like, for example, Covid-19 and other global health disasters — essentially making the world less safe for everybody.”

Read more: The Trump 2.0 effect — how the barrage of executive orders could jeopardise SA’s wellbeing

Since taking office, Trump has reinstated a longstanding and controversial Republican anti-abortion policy known as the “Mexico City Policy” or the “global gag rule”, which restricts US foreign assistance to organisations providing, counselling or advocating for legal abortion services.

According to Stevenson, this means that health organisations will be cut off from US funding if they use any part of their budget for abortion-related services, even if the funds for these services are provided by non-US donors.

“The US will not support an organisation that is mentioning the word abortion, essentially… It’s making the world less safe for women by removing access to abortion in countries where the government has decided that it is lawful, such as the case in South Africa,” she said. DM

Categories:

Tags:

DM is much better if you are signed in...

South Africa

Widespread uncertainty

Mass disruption