The Biden administration has announced significant budget cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR), a program that has saved millions of lives over its 21-year history. The cuts, amounting to over 6 percent for fiscal year 2025, have sparked concern among AIDS relief activists and PEPFAR grantees who argue that essential programs for the most at-risk populations will be disproportionately affected.
The Biden administration is set to reduce funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) by more than 6 percent in the fiscal year 2025. This program, established 21 years ago, is credited with saving 25 million lives, primarily in Africa. However, the State Department, which oversees PEPFAR, has confirmed these cuts, citing the depletion of surplus funds from previous years when Congressional appropriations exceeded spending capabilities.
A senior PEPFAR official, speaking anonymously, confirmed the impending budget cuts to POLITICO, indicating that the program’s $4.4 billion budget will remain flat despite rising needs. This decision has drawn criticism from AIDS relief activists and grantees who believe the State Department has not done enough to protect crucial initiatives, particularly those targeting populations most vulnerable to HIV/AIDS.
Programs aimed at key populations—men who have sex with men, people who inject drugs, prison inmates, sex workers, and transgender individuals—will see reductions ranging from 3 percent in the Democratic Republic of the Congo to as much as 29 percent in Burundi. On average, these targeted programs will experience a 3.4 percent cut compared to the broader program’s 6.2 percent decrease.
Asia Russell, executive director of Health GAP, an international advocacy organization for HIV treatment access, criticized the reductions. She highlighted the severe risks faced by at-risk groups in countries where they often face legal and social persecution. “People are getting attacked, arrested, brutally assaulted, and it’s legitimate to ask what is PEPFAR’s strategy around communities, and how is it possible to implement a robust strategy when the math is going in the opposite direction,” Russell stated.
The discriminatory environments in many African countries exacerbate the situation. For example, in Burundi, where same-sex relationships can result in up to two years in jail, President Évariste Ndayishimiye has publicly stated that gay people should be stoned. Kenya has also seen PEPFAR-funded clinics close due to violence and threats, with a parliament member proposing a bill to punish gay sex with prison or even death, similar to Uganda’s legislation.
Despite these challenges, PEPFAR will increase funding by 4 percent for key populations in Uganda next year. Advocates argue that this demonstrates the State Department’s ability to do more to protect these vulnerable groups across all affected countries.
John Nkengasong, U.S. Global AIDS Coordinator who leads PEPFAR, emphasized in a Senate Foreign Relations Committee meeting in May that the program is committed to reducing HIV rates among adolescent girls, young women, children, and key populations. However, the State Department has not made Nkengasong available for interviews to provide further clarity on the program’s strategy.
Brian Honermann, deputy director for public policy at amFAR, the Foundation for AIDS Research, called for a detailed plan to address the treatment gaps among at-risk groups. “You have to come up with a programmatic understanding of how these differences matter and how we’re gonna programmatically respond,” he said.
Advocates and PEPFAR grantees are still hopeful that the State Department will reconsider the cuts before finalizing the budget. The department plans to make the country-specific budgets public towards the end of summer, leaving some time for potential adjustments.
The impact of these budget cuts could be profound, particularly for the most vulnerable populations who already face significant barriers to accessing HIV prevention and treatment services. As the global community strives to meet the United Nations’ 2030 target of ending HIV as a public health concern, the allocation of resources to the most affected and at-risk groups remains a critical issue.
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