Senate blocks $400M cut to PEPFAR, but it's a shell of its former self

The U.S. Senate removed a proposed $400 million funding cut to the country’s flagship HIV/AIDS program, PEPFAR, from President Donald Trump’s multibillion-dollar rescissions package. The rescission package aims to claw back funds previously approved by Congress. Sparing this funding is a move that’s being celebrated by the global health community — but it comes in the wake of the Trump administration’s broader battering of HIV programming in the past six months due to a barrage of steps taken to dismantle America’s foreign aid apparatus. As a result, the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR, is in a weakened state. It’s been subject to project terminations and is still operating under a waiver that significantly severs prevention programming. It's also operating under a State Department with a greater workload yet diminished staffing. “It's a small win, and in the current environment, and over the last six months, we do have to take the small victories when we can,” Mitchell Warren, the executive director of the AIDS Vaccine Advocacy Coalition, or AVAC, told Devex. His organization has been involved in a lawsuit against the Trump administration’s dismantling of the U.S. Agency for International Development. “Yes, PEPFAR lives to see another day, but it's doing it with at least one — if not a couple — of hands tied behind its back,” he added. The larger rescission package remains with an additional $500 million in other global health funding cuts. The ongoing battle PEPFAR was launched by Republican President George W. Bush and has enjoyed over two decades of bipartisan congressional support. While the Trump administration can propose PEPFAR cuts — ultimately Congress must appropriate funds. A number of members of Congress — including Republicans — pushed back on the $400 million PEPFAR cuts. The administration’s recession package now stands at $9 billion — without the PEPFAR cuts. “The Senate will vote on it in the next day or two. It's possible that there could be new amendments added to this bill,” said Jirair Ratevosian, senior global health security and development expert at Duke Global Health Institute, during a press conference on Wednesday in Kigali during the International Aids Society conference. “PEPFAR is the most important and consequential contribution to public health — certainly in my lifetime and probably ever.” --— Dr. Linda-Gail Bekker, director, Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town Congress has until Friday to act on Trump’s rescission package. The Senate vote on Tuesday cleared procedural obstacles to moving the bill forward. But changes need approval by the House of Representatives before it can be forwarded for Trump’s signature. If lawmakers miss that deadline, the rescissions request expires, and the money must be spent as originally intended. In June, White House budget chief Russell Vought told a Senate committee that PEPFAR spent $9.3 million “to advise Russian doctors on how to perform abortions and gender analysis.” “A big reason why we have a victory on the $400 million for PEPFAR is because the administration lied about where that money was going,” Ratevosian said. “They said the spending was going towards Russia, but we were able to prove that there's been no spending in Russia, and PEPFAR has not been in Russia since 2012.” And while this particular tranche of PEPFAR funding could be spared, maintaining funding will be an ongoing battle. “The administration can slow down spending. They can send another rescission package next year,” Ratevosian said. “We have to be ready to fight.” The administration’s FY 2026 budget request includes $2.9 billion for PEPFAR activities, which is a decrease of $1.9 billion — but this also will ultimately be determined by Congress. Ratevosian added that there are other signs that Congress is pushing back against the Trump administration’s proposed cuts. This week, the House of Representatives started the fiscal year 2026 process with the subcommittee on foreign operations and released a draft budget that rejected the administration’s global health cuts. But in this week’s rescission package, beyond PEPFAR, there are still $500 million in cuts to other global health programs, such as efforts to fight malaria, tuberculosis, polio, and other infectious diseases. Experts told Devex that there are also expected to be funding cuts within that tranche that impact HIV programming. “It's a cruel and truly despicable package of cuts,” said Asia Russell, executive director of Health GAP. “The entire package should be voted down.” The rescission package also doesn’t include granular detail around cuts, leaving members of Congress to vote on them without line items around their impact, experts said. A weakened PEPFAR Despite the current victory — PEPFAR has been significantly weakened and its focus narrowed under the Trump administration. It’s still operating under a waiver issued in February, which prevents certain programs. For example, pre-exposure prophylaxis, or PrEP, can only be offered to pregnant and breastfeeding women. That excludes prevention efforts for high-risk groups dependent on it — such as men who have sex with men, drug users, and sex workers. Trump also signed an executive order eliminating any elements of diversity, equity, and inclusion across federal programming — which wipes out programming targeting LGBTQ+ communities and women, which have been pivotal in reducing infections. “PEPFAR is not going away, but it's clear that it is being changed dramatically,” Warren said. “If you can't do prevention, if you can't focus on the most marginalized populations, you can't actually have a robust evidence-based AIDS response.” USAID was also a key implementor of PEPFAR — but it’s now dismantled. The majority of its programs were slashed and its employees fired. The U.S. State Department is taking on the remaining programs. But there are concerns that it doesn’t have the expertise to do so. It is losing nearly 3,000 members of its workforce. The USAID awards that remain — along with the new ones — need technical staff to run them. But the State Department is now down to a “skeleton crew, without the expertise crucial to ensuring impact, accountability, and that every investment focuses on what communities actually need,” Health Gap’s Russell said. Russell added that there has also been “massive underspending” by the Trump administration as a result of “illegal impoundment of already appropriated funds” — hindering PEPFAR’s prevention and treatment goals. The road ahead is long in rebuilding the HIV programming destroyed this year, but for the moment, there’s a sigh of relief among many over the removal of the $400 million in PEPFAR cuts. “It was going to leave a huge gap,” said Dr. Linda-Gail Bekker, director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town. “The fact that the gap isn't as big is terrific.” “PEPFAR is the most important and consequential contribution to public health — certainly in my lifetime and probably ever. And that it is, in fact, not going away in its entirety, is just the best news ever,” Bekker added. Editor’s note: The International Aids Society supported Devex’s attendance at its conference through a media scholarship. Devex retains editorial independence.