Update on the status of UNAIDS agreement with the U.S. Government / USAID

• On 20 January 2025, the President of the United States of America issued an Executive Order called "Reevaluating and Realigning U.S. Foreign AID" which ordered a 90-day freeze of all foreign aid pending a review of assistance efforts to ensure alignment with current U.S. foreign policy.
• As a recipient of U.S. foreign assistance, UNAIDS complied with the Executive Order and suspended contracts and activities under those awards.  
• On 27 February 2025, UNAIDS received a letter from the U.S. Government/USAID stating they are terminating their agreement with UNAIDS with immediate effect.
• This is a serious development, which impacts the entire HIV response including in the continuity of life-saving HIV services for people living with and affected by HIV, civil society and our partners.
• In the letter, the U.S. Government/USAID stated "detailed instructions will follow." UNAIDS has reached out formally to the U.S. Government for more information.

Impact of recent U.S. decision on the global HIV response - The global impact of PEPFAR to date

For more than two decades, the United States Government has been a steadfast leader in the global HIV response through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, TB and Malaria and through its support to the Joint United Nations Programme on HIV/AIDS (UNAIDS).  

The importance of the United States contribution to the global HIV response cannot be overstated. Since its creation in 2003, PEPFAR has saved more than 26 million lives by investing in critical HIV prevention, treatment, care and support programs in 55 countries. 

The United States Government has recently issued an immediate pause on U.S. foreign assistance for assessment of programmatic efficiencies and consistency with United States foreign policy. This pause has impacted PEPFAR’s ability to continue the programmes and services for millions of people living with and affected by HIV.   

UNAIDS is responding to ongoing developments by mobilizing partners, governments, and communities to assess and mitigate the impact of the pause on the continuity of essential HIV services. This portal exists to provide  real-time, ongoing updates to share the latest global and country information, data, guidance, and other resources related to the impact of these developments across 55 countries and on the global HIV response.   

UNAIDS will continue efforts to ensure that during the ongoing pause, all people living with or affected by HIV who are directly affected continue to access life-saving services. 

UNAIDS remains committed to advance our life-saving collaboration with  the U.S. government.  We are committed to sustain the unique, pivotal life-saving impact of U.S. leadership in the global HIV response. 

IMPORTANT UPDATE: U.S. Department of State provides details on the implementation of the waiver, confirming that urgent life-saving HIV treatment services may be continued / resumed during the 90-day pause.  

On 1 February 2025, the U.S. Department of State’s Bureau of Global Health Security and Diplomacy (GHSD), which oversees PEPFAR, issued a memo to PEPFAR Implementing Agencies and PEPFAR Country Coordinators on the ‘Implementation of Limited Waiver to Pause of U.S. Foreign Assistance for Life-Saving HIV Service Provision’. The memo confirms that the following activities may be resumed during the 90-day pause or until superseded by new guidance:  

1. Life-saving HIV care and treatment services, inclusive of HIV testing and counseling, prevention and treatment of opportunistic infections including TB, laboratory services, and procurement and supply chain for commodities/medicines. 
2. Prevention of mother-to-child transmission services, inclusive of commodities/test kits, medicines and PrEP for pregnant and breastfeeding women. 
3. Reasonable implementing agency and implementing partner administrative costs strictly necessary to deliver and provide oversight of this assistance, including related country-based data activities and portions of PEPFAR's central data platform used for clinical monitoring and program management.  

PEPFAR implementing agencies are also instructed to continue to pause foreign assistance for all other activities not covered by the waiver.

Timeline

On 20 January 2025, the U.S. Department of State announced an immediate 90-day pause for all U.S foreign assistance, including for activities supported by The United States President’s Emergency Plan for AIDS Relief (PEPFAR). The executive order announcing a “90-day pause in United States foreign development assistance for assessment of programmatic efficiencies and consistency with United States foreign policy” was one of the first major foreign policy decisions of the new U.S. administration.  

On 28 January 2025, the U.S. Secretary of State approved an “Emergency Humanitarian Waiver”, which allows people to continue accessing lifesaving HIV treatment funded by the United States of America. This waiver approves the continuation or resumption of “life-saving humanitarian assistance” which applies to essential medicines, medical services including comprehensive HIV treatment, as well as to necessary supplies and costs to facilitate these services.  This is an essential, life-saving development for more than 20 million people living with HIV, representing two-thirds of the 30.7 million people living with HIV receiving treatment globally, who are directly supported by PEPFAR, the world’s leading HIV initiative. 

On 1 February 2025, the U.S. Department of State’s Bureau of Global Health Security and Diplomacy (GHSD), which oversees PEPFAR, issued a memo to PEPFAR Implementing Agencies and PEPFAR Country Coordinators on the implementation of the waiver, confirming that only the following activities should be continued / resumed during the 90-day pause:

1. Life-saving HIV care and treatment services, inclusive of HIV testing and counseling, prevention and treatment of opportunistic infections including TB, laboratory services, and procurement and supply chain for commodities/medicines.
2. Prevention of mother-to-child transmission services, inclusive of commodities/test kits, medicines and PrEP for pregnant and breastfeeding women.
3. Reasonable implementing agency and implementing partner administrative costs strictly necessary to deliver and provide oversight of this assistance.

PEPFAR implementing agencies were also instructed to pause U.S. foreign assistance for all other activities not covered by the waiver.

The global impact of PEPFAR to date

Over the past two decades, PEPFAR has been a leader in the global HIV response, saving more than 26 million lives and averting almost 5 million children from acquiring HIV. 

As of December 2024, the United States Government was supporting more than 20 million people with life-saving antiretroviral treatment, including about 560,000 children (ages 0-14 years). 

The PEPFAR program operates in 55 countries, primarily in Africa, providing critical life-saving services for tens of millions of people living and affected by HIV.

Any sudden pause in US foreign aid for HIV will have an immediate impact on the delivery of life-saving HIV medicines and the provision of HIV prevention services to millions of people who depend on them.

If PEPFAR were permanently halted, UNAIDS estimates that there would be an estimated additional 6.3 million AIDS-related deaths, 3.4 million AIDS orphans, 350,000 new HIV infections among children and an additional 8.7 million adult new infections by 2029 – making ending AIDS as a public health threat by 2030 impossible.