Trump administration disruptions to the U.S. government’s global HIV/AIDS program PEPFAR have caused severe harms – including previously unreported impacts on stigma, physical violence, and public trust – to people in Tanzania and Uganda, according to a new research brief published today by Physicians for Human Rights (PHR). Ahead of PEPFAR reauthorization negotiations in Congress later this month, PHR calls on U.S. policymakers to secure resources for this vital program and to prevent the reversal of decades of progress on global HIV prevention, treatment, and care.
“Adolescents forced to ration doses of life-saving medications. Pregnant women in fear of transmitting HIV to their babies. Rising violence against LGBTQ+ people, with assailants citing Trump. The accounts we documented in Tanzania and Uganda are harrowing,” said Emily Bass, global health expert and co-author of the brief. “While the damage to date has been acute, there is still a narrow window to salvage PEPFAR and save lives. Congress must act now to preserve what has been the most impactful global health program in history.”
Drawing on in-person interviews with 39 doctors, nurses, people living with HIV, service providers, and other experts in Tanzania and Uganda, “On the Brink of Catastrophe: U.S. Foreign Aid Disruption to HIV Services in Tanzania and Uganda” is the first large-scale narrative collection effort in these two countries and documents:
- Harms to individual physical and mental health through curtailed access to lifesaving medications for prevention and treatment, as well as from stigma and discrimination.
- Reduced public health programming for HIV as core components of effective services were discontinued.
- Damage to individuals’ outlook and trust in domestic government, U.S. foreign aid, and antiretroviral medications.
The research brief concludes that there is an opportunity for the U.S. Congress to act to secure resources to stabilize remaining services – and to prevent backsliding on decades of progress against HIV/AIDS. This is all the more urgent following revelations that the Trump administration Office of Management and Budget (OMB) is withholding half of PEPFAR’s appropriated funds for FY25.
“Services for people living with and at risk of HIV in Tanzania, Uganda, and beyond are on the brink of catastrophe,” said Thomas McHale, SM, director of public health at PHR and a brief co-author. “But U.S. policymakers can pull PEPFAR back from the edge. Despite the major disruptions to HIV prevention, treatment, and care programs earlier this year, our publication shows that not all is lost. Critical elements of the HIV service delivery infrastructure ecosystem can still be re-started to prevent further damage. PEPFAR has saved an estimated 26 million lives already – with Congressional action now, millions more can be saved in the future.”
The brief includes chilling testimonies and quotes from health professionals, peer counselors, and key population members that shed light on some of the consequences of the PEPFAR cuts and disruptions:
- People living with HIV skipping and rationing doses of antiretroviral medications, creating conditions for drug-resistant HIV strains to emerge and rendering prevention, management, and control much more difficult.
- Health workers going for months without pay in order to sustain some HIV services in their communities.
- One person reported having an unwanted abortion due to fear of transmitting HIV to her baby, because she may be unable to access the medication that prevents mother-to-child transmission.
- Rising violence and discrimination against LGBTQ+ community members that they attribute directly to the Trump administration’s rhetoric and policies, with one trans person noting “the fire has been fueled by Trump’s messaging. [Trump’s] messaging has become a weapon in [our] country.”
- Multiple interviewees expressed fears of a “dark” future with increased costs to access care, a resurgence of unproven remedies, and exacerbated HIV/AIDS stigma.
In January the U.S. government issued an immediate freeze on all new foreign aid funding and a 90-day review of existing foreign aid, much of which was subsequently terminated. PEPFAR, the U.S. government’s flagship program to combat HIV in low-income countries, received a limited waiver that halted all HIV prevention funding except for prevention for pregnant and lactating women. This excluded all key populations who are disproportionally burdened by incident HIV infections, such as men who have sex with men and sex workers.
Globally, millions of people lost access to HIV prevention through pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) clinics were unable to dispense medication purchased with U.S. resources. While PEPFAR’s unique structure, a Centers for Disease Control and Prevention (CDC)-specific court order, and partial waivers prevented a total collapse of PEPFAR, the U.S. foreign assistance ecosystem is tightly connected and the Trump administration’s dismantling of the U.S. Agency for International Development (USAID) devastated supply chains and service delivery around the world.
In Tanzania and Uganda, PEPFAR has historically provided over half of HIV response funding, making them especially vulnerable to aid interruptions. Both countries face severe and lasting HIV epidemics, have laws that criminalize groups at higher risk of HIV like the LGBTQ+ community and sex workers, and rely heavily on U.S. support for HIV treatment and prevention services. The 39 interviews that inform the brief were conducted across the two countries in April 2025.
In addition to calling on the U.S. government to reverse the cuts, the brief calls on the Ugandan and Tanzanian governments to urgently develop a national transition plan and ensure high-quality health care services are available to all people. Other donors should also step in to help fill the gaps left by the abrupt United States withdrawal of global health aid.
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.