News Release: The African-Led HIV Control Working Group Response To U.S Abrupt Cuts In HIV Support

On 20 January 2025, the US President issued an Executive Order to pause all foreign aid funding for 90 days, which was immediately applied to the United States Government (USG) funded President’s Emergency Plan for AIDS Relief (PEPFAR). Launched in 2004, PEPFAR has been critical in global health efforts, saving over 26 million lives and providing life-saving HIV treatment for over 20 million people around the world, particularly in African countries.

Halting funding to such a successful public health programme, without notice risks the lives of millions of people who depend on resources to manage HIV infections or prevent new transmissions, particularly amongst high-risk populations. The decision overlooks the interconnectedness of our global community, where solidarity is essential to reduce the global disease burden.

While we recognize the power and rights of Governments to make decisions regarding their foreign policies, decisions that impact the health of millions of people around the world must be made in the context of a clearly defined plan that fully considers all the life-threatening implications.  

Instead, the Executive Order has created confusion, panic, and uncertainty among the USG funding agencies, country implementing partners, and most critically, the millions of people living with HIV (PLHIV) who depend on the USG funded health services to survive. Although the most recent communication on the limited PEPFAR waiver provides more information, it has done little to quell the anxiety among stakeholders. Furthermore, the waiver does not include pre-exposure prophylaxis (PrEP) for those at high risk of new HIV acquisition, such as adolescent girls, young women, men who have sex with men, sex workers, and other priority populations.  

The impact of the Executive Order on PEPFAR-supported programs is like dropping a bombshell. This one event that has destroyed decades of trust and security among PLHIV and threatened fragile health systems built by PEPFAR that supported the response to COVID-19, Ebola, and recently the Mpox outbreak. The 90-day limbo for the future of HIV care and treatment programs is intolerable, with long-lasting consequences. 

While we unreservedly oppose the Executive Order, its cascading effects, including the ensuing stop-work orders, this also demonstrates the inherent risks of African countries’ over-reliance on donor support for HIV programs. African governments need to reevaluate the sustainability of their HIV programs and make bold decisions to sustain their HIV response. Now is the time, in the midst of an emergency, for African leaders to look inward for domestic solutions and funding to address this challenge. Increasing health investments through domestic resources and local solutions is imperative to securing the long-term health and wellbeing of millions of people across Africa. 

The African-led HIV Control Working Group (AHCWG) is a think tank of African HIV and policy experts, established to project an African voice on the efficiency and sustainability of the HIV response. The group is actively addressing the consequences of the Executive order and the actions required to respond to the unprecedented challenges.

In response to the Executive Order, the AHCWG calls for four immediate actions:  

Immediate and full reinstatement of all PEPFAR and other USG-funded programs that provide life-saving HIV programs globally from the 90-day pause for re-evaluation and realignment of foreign policy, and a more systematic and appropriately considered approach adopted for determining future funding. 

Clear communication on the future of funding for the HIV program after the conclusion of the re-evaluation and realignment of foreign policy. 

African governments to recognize that there are no secure commitments from external funders regarding health care services and take immediate action to ensure health security for their people. This includes defining what capacity is needed, and at what costs, to support testing, prevention, care, and treatment for PLHIV and those at risk. It further includes sourcing domestic funding to the largest extent possible to ensure health security.

Strategic collaboration between global stakeholders and African governments committed to building the necessary capacity for Africa’s health care independence.