When Donald Trump signed a $51.4 billon (£37.8bn) foreign aid package earlier this month, including nearly $6bn for the global HIV response, the announcement was framed as a restoration of the key programmes that the US president had slashed when he came back into office at the start of 2025. Congress had rejected proposed cuts and compelled the White House to release funding for programmes that underpin treatment for millions of people.
The Joint UN Programme on HIV/AIDS (UNAIDS) has spoken of the “real bright lights we are starting to see” over the ch and the figures looked familiar, with around $9.4bn for global health overall, covering HIV treatment and prevention; tuberculosis and malaria programmes; maternal and child health services and vaccine support – alongside humanitarian assistance.
Any increase in funding for such health projects is a good thing, but it is not a full restoration. Analysis from the Kaiser Family Foundation (KFF) shows that the global health budget now pledged by the US for the financial year 2026 is around 6 per cent lower than the previous year, with some HIV and multilateral funding reduced and other programmes simply held flat. Congress prevented a far steeper cut, yet the system that existed before has not been completely replenished.
For more than two decades, US global health aid followed a predictable model in which Congress annually appropriated funds, large international partners handled procurement and delivery, and multi-year planning tied budgets to targets such as patients treated, infections prevented and clinics expanded. That architecture fractured when the Trump administration froze global health funding and terminated many awards. Programmes stalled not because Congress removed money but because the channels that turned money into services disappeared.
Across parts of Africa and Asia, clinics and aid groups now describe something closer to suspension. Clinics are keeping existing HIV patients alive, yet the outreach that brings new people into care is fading because organisations cannot plan for future outreach. “We don’t yet know what the final interventions are going to be, says Catherine Connor, of the Elizabeth Glaser Pediatric AIDS Foundation. “We’re waiting to understand how this will manifest on the ground.”
Much depends on the way the Trump administration moves forward.
“The [previously-provided] funding provided by Congress was still there. It just wasn’t being obligated or disbursed,” Adam Wexler, associate director of Global and Public Health Policy at KFF, says.
Stephen Morrison of the Centre for Strategic and International Studies (CSIS) think tank, tells The Independent that the shift reflects a deeper divide in Washington: “The sentiment inside the [Trump] administration is that there’s too much money flowing into these [aid] accounts. They want to scale things down. What looks like restoration in Congress is different from the vision emerging within the administration.”
The February spending bill signed by Trump recently has forced funds to move again, close to previous levels but a different system. Much of the old contracting infrastructure has gone and the administration is negotiating directly with governments rather than through NGOs and implementing partners.
Morrison adds that inside the White House, the emphasis is on transition. The administration’s “America First” approach relies on bilateral deals directly between the US and other countries, rather than funding being distributed by bodies such as the UN. Morrison says there is now a gap between what lawmakers fund and what the administration ultimately intends programmes to become.
Morrison also points towards the withdrawal from the World Health Organisation and the US exploring alternative alliances tied more closely to national security priorities. The aim is not “total disengagement from Africa”, he says, but less focus on HIV and more on security and geopolitical competition elsewhere. The policy is not a collapse of aid but a pivot, smaller and more conditional, and, he says, it has already damaged confidence in US reliability.
Connor, of the Elizabeth Glaser Pediatric AIDS Foundation, says programmes are now caught between two systems. She describes a moment of “risk and reward” in which the US is “rolling the dice” on a new model. Congress still wants to fight death and disease globally, but decisions are now worked out directly between Washington and governments rather than the wider network of partners that once ran programmes, she explains.
For years funding came with clear targets such as expanding treatment, preventing mother-to-child transmission and finding undiagnosed cases. Now programmes do not know whether they are meant to grow or simply hold the line.
Sarah Shaw, MSI Reproductive Choices’ associate director of advocacy, tells The Independent the funding that is returning “hasn’t made everything alright.” She said organisations are seeing lower amounts negotiated through new government agreements with “incredible conditionality”.
