A lifesaving global health program almost hit a dangerous pause—but a last-minute waiver is keeping the fight against HIV alive for millions.
The Trump administration has issued an emergency waiver to ensure that millions of people living with HIV across 55 countries continue receiving life-saving treatment, following concerns that a recent freeze on U.S. foreign aid could disrupt critical health services.
The waiver, announced Tuesday by Secretary of State Marco Rubio, allows funding from the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, to flow uninterrupted despite a broader 90-day suspension of foreign development assistance. PEPFAR, the largest global initiative targeting the HIV/AIDS epidemic, provides antiretroviral therapy to more than 20 million people worldwide.
The emergency measure comes in response to a January executive order that put a temporary hold on U.S. development aid while officials conduct a sweeping review of its effectiveness and alignment with American foreign policy interests. The pause had raised alarms among global health advocates, who warned that any disruption in HIV treatment could have deadly consequences.
“UNAIDS welcomes this waiver from the U.S. government, which ensures that millions of people living with HIV can continue to receive life-saving medication,” said Winnie Byanyima, executive director of UNAIDS, the United Nations agency focused on the HIV response. “This urgent decision recognizes PEPFAR’s critical role and restores hope to people living with HIV.”
PEPFAR, launched in 2003 by President George W. Bush, has long enjoyed bipartisan support in Washington. The program has played a key role in reversing the trajectory of the AIDS epidemic, particularly in sub-Saharan Africa, where it has helped prevent millions of deaths.
Despite its success, PEPFAR has faced political headwinds in recent years. Some conservative lawmakers have questioned its financial scope and whether some funds indirectly support abortion services, despite safeguards preventing such use. Last year, Congress approved a short-term extension of PEPFAR’s funding instead of a customary five-year renewal, leaving the program in a precarious position.
The funding pause had raised concerns not only among global health organizations but also within recipient countries, where U.S.-supported HIV treatment programs form the backbone of national healthcare strategies. UNAIDS, along with partner governments and advocacy groups, has been working to assess the full impact of the aid freeze and develop contingency plans to minimize service disruptions.
While the waiver ensures that essential HIV treatment will continue, it remains unclear how other U.S.-funded global health initiatives—including maternal health programs, tuberculosis prevention, and pandemic preparedness—will be affected by the aid review.
Global health leaders have urged the administration to reaffirm its commitment to U.S. leadership in the fight against AIDS, warning that any further instability in funding could undermine two decades of progress.
“We are at a critical moment,” Ms. Byanyima said. “Continued investment is essential to achieving the goal of ending AIDS as a public health threat by 2030.”
A Legacy Under Scrutiny
The emergency waiver highlights the continued influence of PEPFAR, which has spent over $110 billion fighting HIV/AIDS since its inception. The program has been credited with saving millions of lives and strengthening healthcare infrastructure in some of the world’s most vulnerable regions.
But the recent uncertainty surrounding its funding has reignited debates over the U.S. role in global health. Some analysts see the temporary aid suspension as part of a broader shift in American foreign policy, one that prioritizes strategic competition over long-term development investments.
For now, however, those relying on PEPFAR-funded treatment can breathe a sigh of relief.
“Interrupting HIV treatment, even for a short time, risks lives,” said a senior official at a major international health organization who spoke on condition of anonymity due to the sensitivity of the issue. “This waiver is a necessary stopgap—but long-term stability is what’s truly needed.”
As the U.S. government proceeds with its aid review, advocates say the fate of millions of people will depend on whether programs like PEPFAR continue to receive the unwavering support they have enjoyed for decades.