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AVAC Advocates' Network Logo Februaray 7, 2025
Global Health Watch is a weekly newsletter breaking down critical developments in US policies and their impact on global health. Tailored for our partners in the US and around the world, this resource offers a concise analysis of the week’s events, supporting advocates to respond to threats, challenges and opportunities in this critical period of change in global health.

The sustained attacks on global health and the dismantling of critical infrastructure by the US government continued this week. Here is an overview of developments in US policies and their implications for the HIV response and global health equity.
New developments


** Humanitarian Aid, PEPFAR Freeze and HIV Prevention
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A pause on all US foreign assistance was announced January 20, leading to layoffs and halted delivery of life-saving medication and services, with severe consequences for communities. Last weekend, PEPFAR finally received a waiver for some treatment and programs for the prevention of mother-to-child transmission (PMTCT). However, guidance has been lacking as to which programs can resume. On Thursday, the US Department of State issued guidance ([link removed]) allowing for the continuation of HIV testing for all populations and HIV care and treatment for all people living with HIV. But primary prevention and key population programming was excluded, and the guidance goes so far as to state: “people other than pregnant and breastfeeding women who may be at high risk of HIV infection or were previously initiated on a PrEP option cannot be offered PEPFAR-funded PrEP during this pause of US Foreign Assistance or until further
notice". In the meantime, almost all USAID staff were put on administrative leave and all contract staff at PEPFAR were laid off on Wednesday. Advocates and implementers in dozens of countries are already reporting significant setbacks, including closed drop-in centers and halted PrEP distribution. In an attempt to fight back and advance HIV prevention as core in the global HIV response, the African Women Prevention Community Accountability Board issued a powerful Call to Action for Sustaining HIV Prevention Gains for Women and Girls in Africa ([link removed]) .

IMPLICATIONS: The situation remains deeply concerning and riddled with confusion: while some waivers are being granted, many implementing partners continue to face stop-work orders, stalling critical services. Most alarmingly, disallowing individuals already on life-saving PrEP from continuing these services threatens to reverse hard-won progress in controlling the HIV epidemic. As Kenneth Ngure explains in the New York Times ([link removed]) article on the USAID withdrawal’s impact on clinical trials: “Without regular [PrEP] injections or a carefully-managed discontinuation, the participants will not have enough cabotegravir to stop a new infection, but there will be enough in their systems that, if they were to contract the virus, it could easily mutate to become drug-resistant.”

READ:
* Abandoned in the Middle of Clinical Trials, Because of a Trump Order ([link removed]) – New York Times
* Too little, too late: What a PEPFAR waiver can’t do ([link removed]) – Bhekisisa
* The Status of President Trump’s Pause of Foreign Aid and Implications for PEPFAR and other Global Health Programs ([link removed]) – KFF


** USAID Shutdown and Dismantling ([link removed])
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The majority of USAID staff and contractors were fired or placed on administrative leave and locked out of their accounts and out of the building in Washington, DC. Most essential functions of the agency have been stopped. Many lawmakers on both the Democrat and Republican sides have opposed these orders ([link removed]) , but attempts to pass resolutions supporting USAID have been blocked in the Senate. Also, Secretary of State Marco Rubio informed lawmakers that he would also serve as Acting USAID Administrator and has given Peter Marocco, a political appointee at the State Department, additional responsibility at USAID. This allowed Marocco to start reviewing and possibly restructuring USAID’s programs. The State Department also began a review of USAID’s foreign aid activities, with the goal of potential reorganization. R
([link removed]) eports late on Thursday ([link removed]) were that USAID would have less than 300 staff left (down from over 10,000) and 800 awards and contracts were being canceled. Labor groups representing employees at USAID brought a lawsuit against the new administration over efforts to freeze foreign assistance and HIV advocates protested in Washington, DC ([link removed]) Thursday demanding that the administration fully restore PEPFAR funding. So much for a 90-day pause and review – all done in two weeks?

IMPLICATIONS: This dismantling includes efforts to completely dissolve USAID, raising significant concerns about the future of global health and development programs. Many argue that a shutdown of the agency undermines US power and global influence, especially as China and Russia look to fill in the foreign aid gaps. As we wrote last week ([link removed]) , contractors at USAID and the State Department Bureau of Global Health Security and Diplomacy (GHSD) are essential to the Bureau’s operations, and their expulsion paralyzes USAID, GHSD and PEPFAR.

READ:
* USAID may be reorganized, absorbed by the State Department, Rubio says ([link removed]) – Devex
* USAID Workforce Slashed From 10,000 to Under 300 as Elon Musk’s DOGE Decimates Agency ([link removed]) – Wired


** New Gender Policy ([link removed])
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The US CDC, NIH and other federal health agencies removed hundreds of HIV-related web pages on 8,000+ websites following executive orders targeting “gender ideology” and “DEI.” This week, many of the pages have been restored, but without reference to transgender individuals. The restored pages show a rushed revision to content on HIV, STIs and sexual and reproductive health and important information for key populations has been removed. This censorship is further exacerbated by instructions from the new administration demanding that scientists at the US Centers for Disease Control and Prevention (CDC) retract scientific articles that include “forbidden terms” such as gender, transgender, LGBT, or transsexual.

IMPLICATIONS: The recent removal of HIV- and LGBTQ-related content undermines public health and health equity. Key resources, including HIV PrEP guidance and transgender-focused materials, were deleted or revised, leaving significant gaps in data and care recommendations. Though some information has been restored, critical omissions jeopardize effective HIV prevention, care, and outreach, particularly for marginalized populations at higher risk of infection. In response to the censorship of scientific publications, at least the British Medical Journal editors stood up in their editorial: Medical journal editors must resist CDC order and anti-gender ideology ([link removed]) : “The US was considered a world leader in public health and research. With one repressive stroke that reputation risks being shattered and broken. If anything is forbidden now, it is that medical and science journals, whose duty is to stand for integrity and equity, should bow to political or
ideological censorship.”


** Robert F. Kennedy Jr. Confirmation Hearings ([link removed])
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The Senate Finance Committee voted to advance Robert F. Kennedy Jr.'s nomination for Secretary of Health and Human Services (HHS). His nomination now moves on to the full Senate after a 14-13 vote. Senator Bill Cassidy, a medical doctor and Republican from Louisiana, who voiced support for PEPFAR previously, ended up voting for Kennedy.

IMPLICATIONS: Despite concerns over Kennedy's vaccine skepticism, AIDS denialism and racist views of immunology, his confirmation appears likely with a full Senate vote imminent. As HHS Secretary, Kennedy would have control over the US CDC, NIH, FDA and other important health agencies, including how funding is spent, how programs are administered and how science is communicated.


**
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Seeking Visuals and Videos

Leading groups in Washington, DC are urgently trying to collect videos and photos of what's happening "on the ground" because of the freeze, such as clinic closures despite the waiver or videos of patients not having access to HIV medication. Non-professional phone videos and photos are welcome.
Contact [email protected] (mailto:[email protected]) for more
What we're reading

• Health Programs Shutter Around the World After Trump Pauses Foreign Aid ([link removed]) — New York Times
• Foreign Aid Freeze Leaves Millions Without H.I.V. Treatment ([link removed]) — New York Times
• NIH eases freeze on grant reviews imposed after Trump communications pause--Science ([link removed]) — Science
• Mind-boggling’: US CDC orders gender-related terms cut from scientific papers ([link removed]) — Nature
• Trump aid freeze disrupts global HIV/AIDS fight ([link removed]) — The Hill
• Musk and Trump Begin Shutting Down USAID ([link removed]) — The Telegraph
• ‘It’s tectonic’: U.S. foreign aid freeze deals a blow to research around the globe ([link removed]) — Science
Tracking the impact


**
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* Tracking the impact of the PEPFAR Freeze: ([link removed]) The PEPFAR Watch ([link removed]) coalition is running regular surveys throughout the 90-day period

* PEPFAR Impact Tracker ([link removed])
* Impact of USA government administration's directive to pause all foreign aid obligations, ([link removed]) AIDSFonds
* Global AID Freeze Tracker ([link removed]) documents the impact of the foreign aid stop work order

* USAID Stop-Work ([link removed]) , a resource tracking the impact of the stop-work order to USAID


RESOURCES
• The Status of President Trump’s Pause of Foreign Aid and Implications for PEPFAR and other Global Health Programs, KFF ([link removed])
• Join the CHANGE (Community Health Advocates Navigating Global Emergencies) WhatsApp community ([link removed]) for key updates and coordination
• Litigation Tracker ([link removed]) : A public resource tracking the legal challenges to the Trump administration's executive orders, Just Security
• Making Sense of the Madness | Understanding the Current Crisis & Opportunity in Global Public Health ([link removed]) , ITPC webinar recording
• PEPFAR & Global Fund Support for HIV Programs, ([link removed]) courtesy of Brooke Nichols

In other news, there was progress in HIV prevention: Gilead Sciences submitted lenacapavir for PrEP to the European Medicines Agencies ([link removed]) (EMA) for review, both to market in Europe as well as for an EU-Medicines for All (EU-M4all) application that would facilitate availability of LEN for PrEP in low- and lower-middle-income countries. This marks a big step toward ensuring i ([link removed]) njectable PrEP reaches those who need it most ([link removed]) , which was also highlighted in this week’s Lancet HIV editorial: Steps toward quick and
equitable roll-out of lenacapavir ([link removed](25)00007-4/fulltext) . This makes fighting to restart PEPFAR-supported PrEP programs all the more important, so the world can prepare for LEN introduction. If we can’t drive down new infections with all options, we can’t imagine a sustainable HIV response.

Stay strong and stay united.

Best,

AVAC
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AVAC Global Advocacy for HIV Prevention
+1 212 796 6423 [email protected] (mailto:[email protected]) www.avac.org ([link removed])
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