Trump’s Foreign Aid Freeze Threatens Millions of Lives
In early 2017, rumors spread through social media of President Donald Trump’s intentions to cut off all foreign aid, including HIV programs. Franklin Wanyama, a 29-year-old Kenyan living with HIV, was alarmed by this news. Desperate to secure his life-saving medication, he rushed to his HIV clinic for a six-month supply and a checkup, fearing that he might soon have to pay for it himself.
Wanyama’s concerns were soon realized. On January 20, 2017, Trump issued Executive Order 14169, "Reevaluating and Reorganizing U.S. Foreign Assistance," which immediately halted all foreign aid for 90 days. Affected programs would be reviewed during this period to determine their continuation, alteration, or termination, including the President’s Emergency Plan for AIDS Relief (PEPFAR).
PEPFAR, established in 2003, is the largest single-disease assistance program in history. It has provided over $110 billion to dozens of countries for HIV medication and support for HIV clinics and prevention programs, reaching over 20 million people living with HIV worldwide. Amfar estimates that over 220,000 people reliant on PEPFAR support collect their medication every day, including more than 7,000 children under 15.
"That’s the number of people who lose access to their drugs every single day if PEPFAR simply shutters," said Brian Honermann of Amfar.
In addition to PEPFAR, the Trump administration attempted to dismantle the entire U.S. Agency for International Development (USAID). USAID, with an annual budget of $40 billion, provides crucial development work across the globe. "The harm is almost immeasurable," said Jeremy Konyndyk, who worked for USAID under Presidents Obama and Biden and now leads the relief organization Refugees International.
"Studies on HIV vaccines and prevention in South Africa? Halted. Bed net distribution to prevent malaria in Uganda? Suspended. 1,000 staff at a diarrhea institute in Bangladesh? Laid off. Projects on clean water or protecting the rainforest? Frozen."
"USAID does some of the world’s most cost-effective work against neglected tropical diseases like schistosomiasis and river blindness," said Konyndyk. "And that’s all being shut down. People will die."
While exceptions are intended for life-saving medication, they have been slow or non-existent due to bureaucratic hurdles. Many facilities have been closed, and staff laid off.
In South Africa, where HIV medication is funded by the government, 17% of HIV/AIDS funding comes from PEPFAR. But even here, the aid freeze will have dire consequences. According to Médecins Sans Frontières, many PEPFAR-supported health facilities providing HIV testing, treatment, and PrEP have closed. Sibongile Tshabalala, an HIV activist, fears that the progress made in combating HIV will be lost. "We managed to stop our children from becoming infected with HIV," she said. "We can’t do that anymore."
"It’s a vast and complicated web of assistance that the global community has built up over decades—with massive support from the U.S.," said Honermann. "PEPFAR and USAID are woven deep into it. Many countries are trying to fill in the worst gaps with their own money or with other organizations. But without U.S. support, the web threatens to tear."
"Over time, this whole system will collapse," said Honermann.
"If millions of people with HIV no longer receive the drugs that keep the virus at bay, they are at immediate risk of dying. But it also carries the risk that they will then infect others," said Konyndyk. "We’re talking about triggering a second wave of a global HIV epidemic that had been largely brought under control."
"People will die," said Konyndyk. "The idea that this is just a review is laughable," he said, referring to the aid cutoff in Sudan, where U.S. aid workers are pulling out amid a famine and civil war. "If there’s a place in the world where you would want to keep humanitarian assistance right now, that would be it."
"It’s just gratuitous destruction," said Konyndyk.
In Sudan, the aid freeze is already being felt across the country. In the Nuba Mountains region, Johannes Plate of the South Kordofan Blue Nile Coordination Unit has had to lay off 57 of his 73 staff. "For many, this is very, very severe and represents a major cut in the family’s income," said Plate.
An estimated 60-70% of donor-funded programs are affected in the Nuba Mountains alone, including peacebuilding measures, delivery of relief supplies, and long-term projects to train refugees from urban areas to become farmers.
Over 25 million Sudanese are facing acute hunger. Hundreds of soup kitchens set up by Emergency Response Rooms (ERRs) are providing life-saving meals to almost two million people. But two-thirds of the money for these kitchens came from USAID, and most have now closed. "These people need to eat every day," said Hajooj Kuka, an ERR spokesperson. "It’s a daily struggle. What we have now will last for a week." Nominated for the Nobel Peace Prize for the second year in a row, the ERRs are desperately seeking new funding. "I don’t know if we can survive this," said Kuka.
"In the end, it damages the U.S. itself," said expert Judd Walson of the Johns Hopkins Bloomberg School of Public Health. "Global health work in particular is a manifestation of soft power—it helps build trust, share information, and foster a sense of partnership. I don’t think most people realize that when we pull back from that, we also walk away from the chance to be at the table and help shape the world in a way that aligns with our values and beliefs."
Franklin Wanyama has found a glimmer of hope. A court in Rhode Island has temporarily blocked the funding freeze, and Wanyama has been recalled to his clinic in Nairobi. His job is secure for now. But the clinic remains in a state of panic, he said. No one knows how long the reprieve will last.
Clinics elsewhere are still closed, and some programs cannot be easily restarted. While some aid workers are hopeful that funding will resume after 90 days, others have been told that this will not be the case. The Institute of HIV Research and Innovation in Bangkok received an informal phone call instructing them to permanently discontinue all activities related to transgender people. "It wasn’t in the written order, but we were told," said Nittaya Phanuphak, the institute’s director.
Despite the closure of their offices at the end of the month, Phanuphak is committed to keeping the clinic open. The institute had already begun diversifying its funding sources, with salaries now partially paid from non-USAID sources. "It will be a big challenge," she said.
