Trump announces new funding restrictions, limiting PrEP access for LGBTQ+ and high-risk groups

The U.S.A. State Department has released a memo indicating that the President’s Emergency Plan for AIDS Relief (PEPFAR), a program designed to prevent HIV in low- and middle-income countries abroad, is now restricted to providing HIV-preventing pre-exposure prophylaxis (PrEP) medications solely to pregnant and breastfeeding women (PBFW), and not to LGBTQ+ individuals, sex workers, or other high-risk groups, according to ‘LGBTQ Nation’.

This memo, distributed by the State Department’s Global Health Security and Diplomacy program, specifies, “People outside of PBFW, who may be at high risk of HIV infection or who were previously started on PrEP, cannot receive PrEP funded by PEPFAR during this pause in U.S. Foreign Assistance or until further notice.” The “pause” mentioned refers to a 90-day suspension of all foreign aid, following President Donald Trump’s executive order aiming to “reevaluate and realign” U.S.A. foreign assistance. The State Department explained that Trump’s order targets “waste reduction” and “blocking woke programs” to ensure funds support initiatives “fully in line” with Trump’s foreign policy.

Wayne Besen, executive director of the LGBTQ+ advocacy group Truth Wins Out, stated, “We are outraged by the Trump Administration’s narrow allocation of life-saving medication, which blatantly discriminates against those not engaging in sex solely for procreation. This... could lead to the infection and potential death of hundreds of thousands globally.” Besen further remarked, “There is no other explanation for these guidelines other than malicious and spiteful intent to harm vulnerable communities not favored by President Trump’s right-wing supporters,” and questioned, “Aren’t conservatives supposed to be pro-life, or are they only concerned with ‘life’ that mirrors their own values?”

Secretary of State Marco Rubio has issued a waiver for lifesaving drugs and medical services impacted by the pause, yet his memo clarified that PEPFAR funding would still face restrictions. Aside from limiting PrEP distribution to PBFW, Rubio’s restrictions also bar surveys and systems that track HIV spread and child abuse in regional populations, as well as any projects planned beyond December 31 of this year.

As a consequence, the HIV-prevention medications appear to be ineffectively reaching those in need, many clinics have stopped offering services, and healthcare workers remain unpaid, as reported by the Kaiser Family Foundation (KFF). This raises the potential for increased HIV rates, outbreaks, and associated deaths abroad, according to KFF and Besen.

These funding pauses and limitations on PEPFAR have occurred alongside the dismantling of USAID – the independent U.S. international development agency responsible for most U.S.A. global health programs – by Trump’s unofficial Department of Government Efficiency (DOGE). DOGE, not officially established through the necessary congressional approval, is headed by Elon Musk, the world’s richest man.

Musk has prioritised the termination of the agency, claiming, “USAID is a criminal organization. Time for it to die,” without providing evidence. Despite being the principal funding source for HIV/AIDS relief to over 25 million individuals across 54 countries, the USAID website has since been deactivated.

A significant portion of USAID staff has been laid off or dismissed; PEPFAR recipients are now unable to contact longstanding partners or obtain guidance. The Trump administration declared its intention to remove nearly all USAID personnel from their roles and out of international locations. Rubio noted that organisations receiving aid would need to apply for waivers to resume funding.

Critics have labeled Trump and Musk’s actions against PEPFAR and USAID as illegal and unconstitutional. Lawsuits contesting the dismantling of USAID have been filed by USAID contractors, claiming the Trump administration owes them millions in unpaid obligations included in the most recent congressional budget, and by nonprofit organisations, such as the AIDS Vaccine Advocacy Coalition (AVAC), advocating for HIV prevention.