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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tU.S. is taking a \u2018real risk\u2019 with hasty shift in efforts to fight HIV, experts say<\/p>\n
Last year, HIV advocates piled up hundred of mock coffins in front of the U.S. State Department. (Photo courtesy of Pink News \/ AFP \/ Getty)
\nDonald Trump\u2019s decision last year to shut down the U.S. Agency for International Development (USAID) and abandon the country\u2019s flagship anti-AIDS initiative PEPFAR continues to take its toll, even beyond the predicted millions of deaths those actions are expected to cause.
\nU.S. legislators were told that shutting down USAID will cost $19 billion and public health experts warned that the U.S. is running the risk of AIDS rebounding in nations where PEPFAR is being phased out in favor of a \u201cpatchwork of individual partnerships with each country, potentially driven by resource extraction.\u201d
\nBelow are more details about the situation, presented in edited excerpts from The Hill and The Guardian.<\/p>\n
The now-shuttered U.S. Agency for International Development (USAID) has told Congress it has $19 billion in funds to cover costs associated with closing out the programs it terminated last year, according to a notification sent late last month and obtained by The Hill.
\nThe notification acknowledges that the price of closing out the agency is likely to cost less than the multibillion-dollar number, but it\u2019s unclear where the leftover funds will go.
\nHumanitarian aid experts and Democrats are urging the administration to show some urgency in disbursing it for dire humanitarian needs.
\n\u201cIf I was an appropriator, I\u2019d be alarmed that the administration is withholding life-saving aid,\u201d Sam Vigersky, international affairs fellow with the Council on Foreign Relations, said. \u201cBetween the war with Iran and global funding cuts from the U.S. and others, needs are near record highs. We\u2019re in a moment where every dollar matters.\u201d
\nUSAID was fed \u201cinto the woodchipper,\u201d as described in February by tech billionaire Elon Musk, who took on the task of shutting down USAID with his so-called Department of Government Efficiency. It locked out staff members and took over the computer systems, terminating the majority of programs in the agency\u2019s roughly $40 billion annual budget.<\/p>\n
Researchers\u00a0estimated that more\u00a0than 500,000 children and more than 260,000 adults died as a result of the aid cuts.
\nOn April 20, a notification was sent to Congress from USAID detailing that it planned to use remaining funds to cover costs associated with the closeout of terminated foreign assistance awards. The notification\u00a0was first reported by Devex.
\n\u201cUnobligated and\/or unliquidated funds that remain after USAID has completed all closeout actions may be used for other foreign assistance programs, such as those currently managed by the Department of State,\u201d the notification reads.
\nThe \u201cresources available\u201d for closeout funding, the notification said, includes more than $625 million of unobligated funds from 2024 and $3.2 billion in unobligated funds related to global health and economic development programs from 2025. The notification also tallied more than $15 billion in \u201cunliquidated obligations on terminated awards for DOAGs.\u201d
\nDOAGs refer to development objective agreements, typically five-year grant agreements between the U.S. and a foreign country.
\nCloseout costs are listed as \u201ccovering final settlements, pending invoices, adjustments to negotiated indirect cost rate agreements, costs associated with disposition of assets and\/or other claims.\u201d
\nThe notification notes that the expected closeout costs are \u201canticipated to be substantially less than these total amounts.\u201d
\nOne former USAID official, who was granted anonymity to speak candidly, noted the remaining funds were almost half of the State Department\u2019s entire $50 billion foreign assistance budget this year. In 2024, the last year of total data for USAID, the budget was around $35 billion.
\n\u201cThe trend that this speaks to and that Congress should be very concerned about, is that the Trump administration is not spending the money they are appropriating for them,\u201d they said.
\nThe notification does not include any names of administration officials. Office of Management and Budget Director\u00a0Russell Vought\u00a0\u2014 whom\u00a0President Trump\u00a0has dubbed the \u201cgrim reaper\u201d \u2014 was assigned as acting USAID administrator last year and tasked with overseeing the agency\u2019s complete shutdown. Reuters reported in February that the White House was using $15 million of USAID funds for Vought\u2019s security.
\nSenate Democrats took specific exception with the notification holding back $3.2 billion in development and humanitarian assistance that was appropriated in fiscal 2025. They called it an \u201cunnecessary and illegal impoundment of funds.\u201d
\n\u201cWe write to demand that you reverse this proposal and put the funds to their intended use to save lives and advance U.S. interests as directed by Congress last year,\u201d Sen. Brian Schatz\u00a0(D-Hawaii) and 16 of his colleagues wrote in a letter sent April 24.
\nThey note that the $3.2 billion was signed into law by Trump in March 2025 and expires at the end of this September.
\nThe assistance is earmarked for $300 million for programs to combat HIV\/AIDS, $250 million for malaria programs, $320 million for maternal and child health programs, and $650 million for global health security.
\n\u201cThe Administration should immediately begin using these foreign assistance funds to deliver results for the American people. There is no reason for this FY25 funding to be withheld to cover the wasteful costs this Administration has incurred because it chose to dismantle USAID,\u201d the lawmakers wrote.
\nThe State Department, Senate Democrats and Republicans with oversight of State Department funds did not return multiple requests for comment from The Hill.
\nEmily Byers, managing director of global development policy with Save the Children, pointed to a single $69 million program in Niger to illustrate how much impact the remaining funds could stretch. The program was terminated in the USAID shutdown.
\nThe organization\u2019s maternal and child health program delivered life-saving health and medical services to 1.4 million women\u202fand 1.1 million children in Niger, she said. This included immunizations, malnutrition screening and treatment, disease outbreak prevention and treatment, diagnosis and treatment of childhood illnesses and antenatal and obstetric care.
\n\u201cCongress has shown continued leadership by appropriating critical funding for maternal and child health and humanitarian response; those investments reflect a bipartisan commitment to saving lives,\u201d she said. \u201cWe urge the administration to ensure those resources are swiftly and effectively used to protect children and families in crisis.\u201d<\/p>\n
In the past, HIV testing in Nigeria was made possible by PEPFAR. Now it\u2019s at risk or terminated.<\/p>\n
Experts fear losing ground to virus even as the end of the HIV epidemic is in sight, and say decline in infant testing is \u201cparticularly concerning.\u201d
\nThe US government released likely the last report from PEPFAR (President\u2019s Emergency Plan for Aids Relief) [in April] and the chief science officer announced his resignation days later as the US moves to a patchwork of individual partnerships with each country, potentially driven by resource extraction.
\nWhile more leadership with other countries has long been the goal with global HIV efforts, experts fear the US is moving too quickly without being able to monitor its efforts as well as it has done with PEPFAR for more than two decades. They fear losing ground to the virus even as the end of the HIV epidemic is in sight.
\n\u201cI worry that this administration probably doesn\u2019t have the same level of ambition for global health that previous [leaders] have,\u201d said Mike Reid, who recently announced that he was stepping down as chief scientific officer at Pepfar. \u201cThat\u2019s really too bad, because we have extraordinary scientific tools right now, like long-acting prevention tools like lenacapavir, and we should be raising our ambition, not narrowing it.\u201d
\nThe number of people remaining on HIV treatment globally has stayed relatively stable at 20.3 million people, according to the data from PEPFAR. But other areas, like testing and workforce capacity, have seen significant decreases, independent analyses of the data reveal.
\n\u201cThe number of people on treatment, while it looks stable, obscures a lot of changes that have been happening underneath,\u201d said Brian Honermann, deputy director of policy at amfAR, the Foundation for Aids Research. \u201cWhere we see the really large disruptions is in all of the wraparound services that get people diagnosed, get them initiated on treatment, and retain people in care.\u201d
\nThe total number of people on HIV treatment declined slightly by 0.3%, but HIV testing declined by 17%, according to a preprint analysis coauthored by Honermann. People going on PrEP (pre-exposure prophylaxis) to prevent HIV infection dropped by 33%, and the number of healthcare workers providing HIV services dropped by 24%, the report found.
\nThe amfAR report looked at two categories of facilities \u2013 those that reported data in all four quarters of 2025, perhaps because they maintained at least some of their PEPFAR funding throughout the year, and those that reported only in certain quarters, perhaps because their PEPFAR funding was disrupted. Infant testing fell by 6% at continuously reporting facilities and by 60% at intermittently reporting facilities, while infant diagnoses also fell by 12% and 31%, respectively.
\n See Also<\/p>\n
The decline in infant testing, diagnosis, and treatment is \u201cparticularly concerning\u201d because infants with HIV have incredibly high mortality rates, the report said. U.S. is taking a \u2018real risk\u2019 with hasty shift in efforts to fight HIV, experts say Last year, HIV advocates piled up hundred of mock coffins in front of the U.S. State Department. (Photo courtesy of Pink News \/ AFP \/ Getty) Donald Trump\u2019s decision last year to shut down the U.S. Agency for International …<\/p>\n","protected":false},"author":2,"featured_media":1235,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"rop_custom_images_group":[],"rop_custom_messages_group":[],"rop_publish_now":"initial","rop_publish_now_accounts":{"facebook_3659155457675267_172535249438148":""},"rop_publish_now_history":[],"rop_publish_now_status":"pending","footnotes":""},"categories":[2],"tags":[],"class_list":["post-1234","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-news"],"featured_image_urls":{"full":["https:\/\/xavieradioug.com\/news\/wp-content\/uploads\/2026\/06\/The-costs-of-Trumps-USAID-cuts-keep-rising.jpg",2560,1706,false],"thumbnail":["https:\/\/xavieradioug.com\/news\/wp-content\/uploads\/2026\/06\/The-costs-of-Trumps-USAID-cuts-keep-rising-150x150.jpg",150,150,true],"medium":["https:\/\/xavieradioug.com\/news\/wp-content\/uploads\/2026\/06\/The-costs-of-Trumps-USAID-cuts-keep-rising-300x200.jpg",300,200,true],"medium_large":["https:\/\/xavieradioug.com\/news\/wp-content\/uploads\/2026\/06\/The-costs-of-Trumps-USAID-cuts-keep-rising-768x512.jpg",618,412,true],"large":["https:\/\/xavieradioug.com\/news\/wp-content\/uploads\/2026\/06\/The-costs-of-Trumps-USAID-cuts-keep-rising-1024x682.jpg",618,412,true],"1536x1536":["https:\/\/xavieradioug.com\/news\/wp-content\/uploads\/2026\/06\/The-costs-of-Trumps-USAID-cuts-keep-rising-1536x1024.jpg",1536,1024,true],"2048x2048":["https:\/\/xavieradioug.com\/news\/wp-content\/uploads\/2026\/06\/The-costs-of-Trumps-USAID-cuts-keep-rising-2048x1365.jpg",2048,1365,true],"tie-small":["https:\/\/xavieradioug.com\/news\/wp-content\/uploads\/2026\/06\/The-costs-of-Trumps-USAID-cuts-keep-rising-110x75.jpg",110,75,true],"tie-medium":["https:\/\/xavieradioug.com\/news\/wp-content\/uploads\/2026\/06\/The-costs-of-Trumps-USAID-cuts-keep-rising-310x165.jpg",310,165,true],"tie-large":["https:\/\/xavieradioug.com\/news\/wp-content\/uploads\/2026\/06\/The-costs-of-Trumps-USAID-cuts-keep-rising-310x205.jpg",310,205,true],"slider":["https:\/\/xavieradioug.com\/news\/wp-content\/uploads\/2026\/06\/The-costs-of-Trumps-USAID-cuts-keep-rising-660x330.jpg",660,330,true],"big-slider":["https:\/\/xavieradioug.com\/news\/wp-content\/uploads\/2026\/06\/The-costs-of-Trumps-USAID-cuts-keep-rising-1050x525.jpg",1050,525,true]},"author_info":{"info":["Editor"]},"category_info":"News<\/a>","tag_info":"News","comment_count":"0","_links":{"self":[{"href":"https:\/\/xavieradioug.com\/news\/wp-json\/wp\/v2\/posts\/1234","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/xavieradioug.com\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/xavieradioug.com\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/xavieradioug.com\/news\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/xavieradioug.com\/news\/wp-json\/wp\/v2\/comments?post=1234"}],"version-history":[{"count":0,"href":"https:\/\/xavieradioug.com\/news\/wp-json\/wp\/v2\/posts\/1234\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/xavieradioug.com\/news\/wp-json\/wp\/v2\/media\/1235"}],"wp:attachment":[{"href":"https:\/\/xavieradioug.com\/news\/wp-json\/wp\/v2\/media?parent=1234"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/xavieradioug.com\/news\/wp-json\/wp\/v2\/categories?post=1234"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/xavieradioug.com\/news\/wp-json\/wp\/v2\/tags?post=1234"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nA statement from the state department (which erroneously states that 20.6, not 20.3, million people are receiving HIV treatment) highlighted dramatic decreases in pediatric HIV treatment and testing. HIV treatments for children dropped from 643,627 in 2022 to 508,703 in 2025, and testing fell from 1.7 million in 2022 to 1.1 million in 2025. The statement attributed the decline to the program\u2019s success \u2013 but it\u2019s not clear if that\u2019s a true decline, or if infections are going undetected.
\n\u201cWe anticipate that the numbers of people that are going to be diagnosed will go down over time, but it\u2019s important to put that in the context of whether the testing is happening in the first place,\u201d Honermann said.
\nAnother analysis by the health policy nonprofit KFF found that people newly enrolled in HIV treatment had dropped by 16%, one of the steepest drops in recent years. The number of people testing positive for HIV and receiving treatment during pregnancy dropped by 14%, the report found.
\nIt will probably get harder to access data on the US government\u2019s global HIV initiatives because the state department is moving away from PEPFAR\u2019s rigorous data collection and toward Memorandums of Understanding (MOUs) with each country.
\nThe state department has considered using HIV support as a tool to pressure Zambia into signing resource extraction agreements, the New York Times reported in March. While those conversations are classified, such a move would imperil progress on global health, Reid said.
\n\u201cI didn\u2019t want to work for an administration that potentially was predicating life-saving services on a minerals agreement, because I think we were slowing progress at exactly the moment when we need to accelerate it,\u201d said Reid, who is also an associate professor at UCSF School of Medicine and an HIV physician in San Francisco. \u201cI don\u2019t think these frameworks should serve the goal of economic or commercial prosperity.\u201d
\nMany countries in Africa, for example, have been squeezed by high fuel prices and other major expenses because of the Iran war.
\n\u201cAssuming that countries will be able to maintain care and treatment programs and sustain them at the levels that we have been able to is optimistic,\u201d Reid said.
\nThe new bilateral agreements have not brought in other key nongovernmental organizations, including the Global Fund, Reid said. And many of the US experts who would be able to support the transition to country leadership have been laid off or fired. The US Agency for International Development (USAID) was dismantled last year, and layoffs at the US Centers for Disease Control and Prevention (CDC) hit global health work particularly hard.
\nThe accountability structures that made PEPFAR effective are now being dismantled, Honermann said. \u201cThat puts us, as US taxpayers, in the position of, in order to do oversight of this programming, having to go ask permission to access data from a foreign government to do oversight of these tens of billions of US taxpayer dollars.\u201d
\nNo longer reporting detailed data will also make it harder to understand which programs are working well and which aren\u2019t, experts said.
\n\u201cFor our programs to be as effective and efficient as possible, we need more data than we\u2019re going to collect,\u201d Reid said.
\nHonermann added: \u201cWe\u2019re really concerned that we\u2019ve actually lost track of a large number of people.\u201d
\nPEPFAR, created by George W. Bush in 2003, has been credited with saving 26 million lives and changing the tide of the HIV epidemic. Within days of Trump taking office in January 2025, the entire program was temporarily halted, and it was only resumed with limitations, such as offering PrEP only for pregnant and breastfeeding women.
\n\u201cNot everything that has happened over the last 12 months, 18 months, has been bad,\u201d Reid cautioned, noting that it is \u201cremarkable\u201d how quickly the Trump administration has made progress on country transition, a longtime goal. And the countries have worked quickly to fill in gaps and create new leadership structures. But, Reid added, the administration has \u201cexposed the global HIV program to a massive shock.\u201d
\nAnd, he continued, \u201cit\u2019s not clear that we need to have moved this fast \u2026 the pace of the proposed transition, I think, has a real risk that will outstrip the systems needed to manage it safely.\u201d<\/p>\n\n
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