The Pepfar programme keeps millions with HIV alive – a new push seeks to save it from Trump’s aid cuts

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The US Senate have moved to spare the world’s biggest HIV treatment and prevention programme –which funds drugs and research in more than 50 countries – from $400m (£298m) of aid cuts imposed by Donald Trump.

The proposed cuts to the President’s Emergency Plan for Aids Relief (Pepfar) were part of a wider request from Trump to Congress to claw back $9.4bn (£7bn) in funding already allocated to projects around the world. Eight billion dollars of that were from foreign aid.

Pepfar is estimated to have saved 26 million lives and prevented 7.8 million babies from being born with HIV infections.

The amendment passed by the Senate agreed $400m should effectively remain in Pepfar’s bank account rather than being sent back to the US Treasury. The bill will now go back to the House of Representatives – which passed a version of the bill allowing Pepfar to be cut – for a vote by the end of the week.

On taking office, Trump cut roughly 80 per cent of foreign aid spending virtually overnight, closing swathes of clinics and severing access to lifesaving medicines and tests. Thousands of lives are thought to have been lost already.

If the clawback – or rescissions – bill passes, this money will remain available to spend on the HIV programme, but it doesn’t guarantee any cancelled projects will be reinstated.

Dr Kenneth Ngure, the president-elect of the International Aids Society, said it was “very exciting news” which, if confirmed, meant “there will be more money available for the HIV response”. But he cautioned that there were still policies that had been put into Pepfar which, “don’t favour the HIV response, for example prevention or pre-exposure prophylaxis [PrEP] is currently only being provided for pregnant women,” he added, rather than to all high risk groups as before Trump launched his cuts.

Solianna Meaza, director of policy and advocacy at global health non-profit FHI 360 said: “It remains a concern for us that, at least right now, what we are allowed to do as the implementer of the Pepfar program is only administer certain prevention services to a more limited number of populations,” but she added she was “hopeful” that a greater emphasis could be put back on prevention.

Millions around the world are helped with Pepfar funding (AP)

It also remains to be seen how much money is allocated for the programme in future, with it facing possible cuts.

Dr Ngure said, “I would encourage that [the] HIV response is well-funded because we have made a lot of progress over the years. And we had reached a place where we are starting to see the end of HIV as a public health threat. So, we just needed a few more years of funding”.

The majority of the cuts to foreign spending, including $500m taken back from other global health programmes, remain in the bill. These are expected to fall on maternal health, TB and malaria programmes among other areas. They may also still hit some HIV programmes.

“A lot of this funding doesn’t just work in silos, they work hand in hand,” Ms Meaza said. The $500m pot “still did have HIV funding. So HIV still could be impacted… but it’s just hard to say without the details,” she added.

The amended bill is, “a double-edged sword,” she said.

“It’s definitely a big celebration that Pepfar funding has been protected,” Ms Meaza – before adding that she remained “concerned at the overall remaining proposed cuts”.

Mitchell Warren, executive director of HIV advocacy group, the Aids Vaccine Advocacy Coalition (AVAC) said: “Congress should still reject the full package of proposals subject to rescissions. If this package passes, this will establish a dangerous precedent for the administration and Congress to push at will, additional rescissions packages that could rescind and defund other programs across the government.

He added passing the cuts would, “codify [the Department of Government Effiency] DOGE’s unlawful cuts to USAID and foreign assistance overall, essentially giving the administration clearance to continue to operate without any accountability”.

This article is part of The Independent’s Rethinking Global Aid project