Early Friday morning, Congress approved the administration’s rescission proposal for the Department of State, the U.S. Agency for International Development (USAID), and other foreign investment programs. The U.S. Senate reached agreement with the administration earlier this week on removing from the original proposal, a cut of $400 million from the $6 billion appropriated in fiscal year 2025 for the President’s Emergency Plan for AIDS Relief (PEPFAR). Still, approximately $9 billion of fiscal year 2025 funding will now be returned to the Treasury.
What this means
This decision reinvigorates the bipartisan nature of PEPFAR. When President George W. Bush announced the program in 2003, members of Congress recognized the urgency of the HIV/AIDS pandemic and worked alongside the administration to ensure taxpayer dollars made the greatest impact.
Those partnerships have continued, and PEPFAR has benefitted from four reauthorizations through eleven Congresses, largely by unanimous consent. Members and congressional staff across the aisle have traveled to PEPFAR sites to see the direct impact on families, communities, and entire countries. They have worked together to ensure the program continues to evolve and deliver results.
At the same time, PEPFAR, country governments, and partners must chart an aggressive course to reach the goal of ending HIV/AIDS as a public health threat by 2030. Just last week, the Joint-United Nations Program for HIV/AIDS (UNAIDS) released its latest data on the HIV/AIDS pandemic. The data shows that in 2024, 87% of all people living with HIV knew their status, 89% of those people had access to lifesaving antiretroviral treatment, and among people accessing treatment, 94% were virally suppressed, meaning that they could not transmit the virus to others. These statistics are monumental, showing that the world is incredibly close to reaching the 95-95-95 goals.
However, these statistics are not universal. Key findings in the George W. Bush Institute’s PEPFAR Beyond 2030 series show that even the countries that have made significant gains over the last 20 years may not be on track to sustain that progress into the future alone. Congress’s decision to remove PEPFAR from the rescission package helps demonstrate a commitment to PEPFAR’s lifesaving operations and resources until the job is done over the next few years. Otherwise, over 20 million people could lose access to lifesaving antiretroviral treatment.
On the ground, courageous healthcare workers have continued to ensure people have uninterrupted access to lifesaving HIV treatment – without pay from the U.S. or their national governments – as Emily Bass recently detailed in a piece on the impact of changes to PEPFAR programming in Uganda. Private, U.S.-supported clinics have closed as a result of interruptions in funding, leading to longer wait times and growing uncertainty among PEPFAR beneficiaries. The most vulnerable populations, including pregnant and breastfeeding women, have lost access to lifesaving antiretrovirals.
As PEPFAR partner countries face uncertainty, they may increasingly turn towards adversaries like China and Russia for HIV/AIDS support – which has rarely happened over the past two decades due to PEPFAR’s success. Leaving countries behind prematurely could negatively impact the United States’ presence in economic powerhouses across Africa – a region that will account for nearly a quarter of the world’s working age population by 2050. Over the past several weeks, HIV activists have called upon China, India, Brazil, and Thailand to address programming and funding gaps that the United States previously filled.
What’s next
This week’s decision hopefully reassures long-time partners that the United States will continue to work alongside them to end HIV/AIDS as a public health threat.
As Congress continues to debate the fiscal year 2026 appropriations for PEPFAR, it is critical that the program receives the resources needed to continue to transition programming to country ownership. PEPFAR must now work to strengthen the tools that have created so much success – including the use of data-driven programming, collaboration with civil society partners, and innovative public-private partnerships. With this, PEPFAR can achieve its goals and move countries toward self-sustainability.
