How Our Work is Impacted by Changes in Federal Funding (August 2025)

Written By Untold

At Untold, our work relies on strong local partnerships with clinics, pharmacies, and hospitals, which enable our clients to receive daily care. Across Eastern and Southern Africa, many of these facilities are sustained by international funding, primarily through USAID and PEPFAR. Earlier this year, sweeping executive actions in the U.S. threatened to unravel that safety net, jeopardizing access to life-saving antiretroviral treatment for millions.

As a result of advocacy from faith-based and global health communities, those restrictions were recently reversed. We remain committed to safeguarding progress when it comes to global health equity, and invite you to stay up to date on how these changes impact our work.

What is PEPFAR? 

The President's Emergency Plan for AIDS Relief (PEPFAR), launched in 2003 by George W. Bush, is the largest commitment by any nation to fight a single disease. The program provides bilateral funding for HIV treatment and care, as well as multilateral funding to organizations such as the Global Fund. 

To date, PEPFAR has:

  • Saved over 26 million lives

  • Provided treatment to 20.6 million people, including 566,000 children

  • Enabled 7.8 million babies to be born HIV-free (Source: HIV.gov)

PEPFAR is a cornerstone of the global HIV/AIDS response, particularly as it relates to the provision of quality ARVs.

PEPFAR & USAID

PEPFAR is led by the U.S. State Department's Office of the Global AIDS Coordinator (OGAC) but is implemented through multiple U.S. agencies, notably:

  • USAID (U.S. Agency for International Development)

  • CDC (Centers for Disease Control and Prevention)

  • Department of Defense

  • Peace Corps

USAID is the key operational partner of PEPFAR, responsible for:

  • Community-level prevention and education

  • HIV testing and treatment delivery

  • Prevention of mother-to-child transmission

  • Health systems strengthening and supply chain logistics

USAID's field presence and partnerships with NGOs, local governments, and community-based organizations make it the operational backbone of PEPFAR's impact.

2025 Disruptions 

In January 2025, the White House issued a 90-day freeze on foreign aid, halting most new aid flows, including PEPFAR funding through USAID. A limited State Department waiver allowed some essential services to continue, but:

Projected Human Cost: 

Modeling by Oxford University and UNAIDS warned that disruptions could result in:

July 2025 Congressional Reversal

In July 2025, U.S. lawmakers reversed a proposed $400 million cut to PEPFAR, preserving full funding for the program this fiscal year. The reversal was part of a broader $9 billion rescission package, but it excluded PEPFAR from reductions following bipartisan advocacy. 

While funding has been maintained, many programs—especially those in prevention—remain disrupted, and the long-term impacts are still unfolding.

Historically, PEPFAR reauthorization has occurred in 5-year cycles, with the program being reauthorized four times since its creation in 2003. The first three reauthorizations were all for five-year periods. However, the most recent reauthorization was a short-term, one-year extension due to partisan debates, primarily concerning abortion-related provisions. 

Impacts on Untold 

Untold will not be impacted by the PEPFAR budget in 2025 based on the information we have today. 

Our regional Health Project Officers have been monitoring trends in ARV access across all communities where we work (reports linked here for reference). In Q1 and Q2 of 2025, the field team reported shortages of Septrin (used to treat and prevent HIV-related infections and malaria) and Nevirapine (used in our context to prevent babies from contracting HIV from their mothers). 

Supply chain disruptions have largely been resolved, and currently, all Untold clients in East Africa are connected to the medication they require. 

As we have stated in the past, the Untold program is designed with the assumption that ARV and complementary medications are available to clients at no cost. As PEPFAR and its implementing partners undergo changes, we will continue to monitor the landscape and adapt as needed to ensure continuity in client care. 

  • For the first time since 2003, PEPFAR is not reauthorized on a bipartisan basis due to concerns about alleged links to abortion-related services.

  • Without reauthorization, PEPFAR funding is maintained through annual appropriations, but long-term planning and commitments with partner countries are constrained.

  • Donald Trump is re-elected on a platform that includes skepticism of foreign aid. 

  • A broad freeze on all new foreign aid grants, including PEPFAR funding via USAID. Existing treatment services are at risk; new programs are halted globally. 

  • Allows essential HIV treatment services (e.g., ART, PMTCT) to continue under PEPFAR, but community prevention, PrEP, and testing programs remain frozen.

  • USAID terminates nearly 90% of its grants globally. In South Africa, over 8,000 health sector jobs were lost, and testing and outreach stalls.

  • Modeling shows the freeze could lead to 1 million new child infections, 500,000 child deaths, and 2.8 million orphans by 2030 if disruptions persist.

  • Global health advocates, bipartisan lawmakers, and former Presidents Bush and Obama publicly urge the restoration of PEPFAR funding.

  • As part of a larger $9B spending rescission bill, lawmakers reverse cuts to PEPFAR, fully restoring funding for 2025.

  • Although core treatment services have resumed, many prevention and community programs remain suspended. Long-term stability remains tied to future political decisions on reauthorization and foreign aid strategy.

Untold http://untold.org
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2025 Mid-Year Report