500,000 Children at Risk: PEPFAR Funding Crisis

Editor's Note: This article originally published April 08, 2025, on our sister site advocate.com.

A new expert policy analysis published Tuesday in The Lancet projects that nearly 500,000 children in sub-Saharan Africa could die of AIDS-related causes by 2030 if the United States does not restore consistent, long-term funding to the President’s Emergency Plan for AIDS Relief program. The same analysis estimates that 1 million children could become newly infected with HIV, and as many as 2.8 million more could be orphaned in the next five years unless PEPFAR is fully restored.

The dire forecast comes as the Trump administration’s January executive order pausing all foreign aid continues reverberating. Although PEPFAR received a limited waiver to continue some services, the Lancet study states that “many of PEPFAR’s services have been disrupted or suspended since 20 January 2025.”

While the limited waiver allowed some PEPFAR services to resume, many programs remain suspended—and a separate policy change has triggered a global backlash by restricting access to HIV prevention for LGBTQ+ people.

According to a February State Department memo, PEPFAR-funded clinics can now offer pre-exposure prophylaxis only to “pregnant and breastfeeding women.” People previously eligible for PrEP—including gay and bisexual men, transgender individuals, and sex workers—have been excluded from the lifesaving medication. UNAIDS warned in March that thousands of new HIV infections have already occurred as a result.

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“The future of PEPFAR programmes hang in the balance,” co-lead author Lucie Cluver, a professor at the University of Oxford, said in a press release. “A sudden withdrawal of PEPFAR programmes, especially in the absence of a long-term strategy to replace them, could lead to a resurgence of HIV infections and preventable deaths, and a dramatic rise in the number of children orphaned by AIDS in the coming years — a setback that could erode two decades of progress.”

Launched in 2003, PEPFAR has long been viewed as a bipartisan success, credited with saving over 26 million lives and ensuring 7.8 million babies were born HIV-free. But as the Trump administration, with support from Elon Musk’s Department of Government Efficiency, moves to gut foreign aid programs, global health leaders warn that lives are already being lost.

Related: Marco Rubio exempts PEPFAR's HIV relief from international aid freeze

PEPFAR-funded programs support more than just HIV treatment, including child health initiatives, efforts to prevent sexual violence, and broader health care infrastructure. “Many of the children and adolescents who currently benefit from PEPFAR programmes will slip through the cracks,” co-author Susan Hillis of Imperial College London, noted.