How Our Work is Impacted by Recent Executive Orders (March 2025)
* This post continues to be updated as the landscape changes. The below information is up to date as of March 27, 2025. *
At Untold, we believe in a world where no story is cut short or silenced by AIDS. Our vision is audacious, and we have always known we cannot achieve it alone.
Our work relies on strong local ecosystems, including clinics, pharmacies, and hospitals. In East and Southern Africa, the clinics and dispensaries that provide our clients with medication are primarily funded through PEPFAR and USAID.
In January 2025, the Trump administration issued a stop-work order affecting the United States Agency for International Development (USAID) and its funded programs, including the President's Emergency Plan for AIDS Relief (PEPFAR). This directive led to the suspension of numerous foreign aid initiatives, notably impacting the distribution of antiretroviral (ARV) medications in sub-Saharan Africa.
Timeline of events:
On January 20th, President Trump issued a series of executive orders, including one focused on reevaluating and realigning United States foreign aid. The order called for a 90-day pause on U.S. foreign development assistance and a review of all foreign assistance programs with the caveat that the Secretary of State has the power to waive the pause for specific, ongoing obligations.
On January 24th, a stop work order was sent to USAID employees worldwide, including those implementing PEPFAR programs. This was unexpected, as the executive order targeted new programs, but the stop-work order impacted all programs, including ongoing commitments and reimbursements for programs that have already been implemented. The stop-work order also immediately impacted PEPFAR-funded ARV distribution in Sub-Saharan Africa.
On January 29th, Secretary of State Marco Rubio issued an Emergency Humanitarian Waiver, which paused the stop work order for ongoing program implementers. This waiver was designed to exempt life-saving humanitarian assistance from the broader foreign aid freeze implemented by the Trump administration. The assistance covered under this waiver includes essential services such as core life-saving medicine (including ARVs), medical services, food, shelter, and subsistence assistance. Despite the waiver's intent to allow critical aid to continue, many organizations have reported ongoing financial and logistical obstacles, leading to disruptions in essential services.
As of today, there are consistent reports of ARV distribution disruptions despite the Emergency Humanitarian Waiver, primarily due to a lack of staff at clinics and hospitals. Communities where we work in Kenya, Tanzania, and Uganda are experiencing these disruptions, and several clinics and hospitals are closed or understaffed. Our teams in East Africa are navigating drug shortages, specifically 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). We are currently purchasing these medications on behalf of our clients who need them and will continue to do so as needed.
Our work to equip men and women to live a life beyond AIDS is more critical than ever. We are, as always, wholeheartedly committed to the flourishing of our clients. We will do everything in our power to ensure consistent access to medication and clinical support even as the global landscape changes. We are so grateful to our community of dedicated partners for their continued support. Please know that your partnership equips us to provide lifesaving care in times of uncertainty.
FAQs:
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If ARV distribution continues to be disrupted, our clients will not have access to the medication they need to maintain viral suppression and stay physically healthy. Without medication, it only takes a few weeks for the HIV in their bodies to mutate and for them to be highly likely to transmit HIV to babies and sexual partners. Over extended time without ARVs, viral load increases, immune cell counts decrease, and clients are vulnerable to opportunistic infection and death.
We are working with our Procurement Officer in Nairobi to explore wholesale ARV purchasing opportunities through existing pharmacy partners so that we can fill the gap in case of a continued PEPFAR disruption. If we do need to fill a gap and purchase ARVs, it would be disruptive to our typical work and require a reallocation of funds to keep our clients on their treatment regimens. It’s hard to imagine long-term that other global players would not fill the ARV access gap if the US does not continue funding PEPFAR.
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USAID was created by President Kennedy in 1961 through an executive order as an agency of the State Department. USAID runs programs focused on global health, humanitarian assistance, economic growth, education, agriculture, etc. worldwide. Kennedy created USAID as
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PEPFAR is the President’s Emergency Plan for AIDS Relief, established by President George W. Bush in 2003 to address the AIDS epidemic. PEPFAR funds HIV prevention, testing, and treatment– most pertinent to our work, PEPFAR provides access to and funding for ARV medication for people living in Sub-Saharan Africa. In large part, USAID implements PEPFAR initiatives, which is why the funding freeze strongly impacts ARV access.
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Service Disruptions: The halt in USAID funding forced many HIV clinics across sub-Saharan Africa to cease operations. Staff were sent home, and the distribution of ARVs purchased with U.S. funds was suspended, cutting off treatment for millions.
Health Risks: Interruptions in ARV treatment can lead to severe health consequences, including increased illness, death, and higher transmission rates of HIV. The degree of harm depends on factors such as the patient's health status, duration of treatment, and length of the interruption.
Programmatic Challenges: The suspension affected not only treatment but also prevention efforts, such as the distribution of pre-exposure prophylaxis (PrEP) and HIV testing services. This comprehensive halt jeopardizes the progress made over decades in combating the HIV epidemic in the region.
As a proud member of the Accord Network, a collective of 150 Christ-centered relief and development organizations, we echo the network’s statement in support of reform and realignment of U.S. foreign aid while holding equal the necessity to ensure that U.S. policy and foreign assistance affirm and support the God-given dignity of all people, especially the most vulnerable.
Your partnership is what enables us to support our clients’ flourishing. In times of uncertainty, this is how we’re able to meet their needs - whatever those may be.
In this continuously changing landscape, your gift could make more of a difference than ever before.