PEPFAR keeps millions of people with HIV alive and may be spared from Trump spending cuts
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Fears of an AIDS resurgence
Today, many babies are born infection-free to mothers with HIV — the U.S. State Department says PEPFAR has been responsible for 5.5 million such births — and most people around the world no longer see an infection as a death sentence.
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Governments in Africa and elsewhere had even begun to worry about complacency as people, especially youths, took the widespread availability of HIV drugs for granted. In another significant step forward, the U.S. Food and Drug Administration recently approved for use the world's only twice-a-year shot to prevent HIV.
But the abrupt U.S. aid cuts have health officials in developing countries warning of a return to the early days of the AIDS pandemic, when drugs were nonexistent or severely limited and clinics were filled with the dying. PEPFAR was launched in 2004 in response to those grim scenes.
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Also known as the U.S. President's Emergency Plan for AIDS Relief, the program has partnered with nonprofit groups to provide HIV medication — including the preventative PrEP — to millions around the world. It has strengthened national health care systems, cared for children orphaned by AIDS and provided job training for people at risk. It has played an important role in testing for and tracking HIV infections.
HIV/AIDS has no cure, and it has killed over 40 million people globally over the years. Now the U.N. agency on AIDS is warning that analysis suggests 4 million additional AIDS-related deaths between now and 2029, including 300,000 additional children's deaths, if programs permanently lose PEPFAR's support.
From widespread support to baseless claims
Since PEPFAR's creation by Congress and Republican President George W. Bush, the program has largely enjoyed support across the political spectrum — and gratitude from countries whose health systems have been poorly equipped to care for millions with HIV.
But misinformation has crept in. The Heritage Foundation, an influential conservative Washington think tank, accused the Biden administration of using PEPFAR 'to promote its domestic radical social agenda overseas.' Conservatives claimed there were efforts to integrate abortion with HIV/AIDS prevention, a claim the Biden administration denied. Similar claims linger under the Trump administration.
Trump and his officials also claim widespread waste and fraud as they seek to dismantle U.S. foreign aid. But PEPFAR has been repeatedly scrutinized. Last year, the government said the State Department's Office of Inspector General had conducted 80 audits, inspections, and special reviews that included oversight of PEPFAR programs, 'including 21 thematic reviews and audits specifically focused on PEPFAR.'
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Impossible to replace US funding
The $400 million proposed cut to PEPFAR still could be restored, in part or in full, as the bill on spending cuts faces a final vote in the Senate, a vote in the House of Representatives and Trump's signature before a Friday deadline.
'We must stay vigilant,' International AIDS Society President Beatriz Grinsztejn said in a statement Wednesday after PEPFAR appeared to be spared.
No matter what, countries and health experts say it will be impossible to fill the funding gap left by the overall U.S. withdrawal of billions of dollars in aid for the global HIV response, including via PEPFAR.
Last month, a UNAIDS report said the abrupt cuts have 'destabilized supply chains, led to the closure of health facilities, left thousands of health clinics without staff, set back prevention programs, disrupted HIV testing efforts and forced many community organizations to reduce or halt their HIV activities.'
South Africa, where more people live with HIV than anywhere else in the world, has said 12 specialized HIV clinics that were funded by the U.S. have had to close down and over 8,000 health workers in its national HIV program are out of work.
Now health workers there and elsewhere are trying to track down an unknown number of people who have lost access to HIV medication. The stakes are deadly. Stopping the drugs allows the virus to start multiplying again. HIV can rebound to detectable levels in people's blood in just a few weeks, putting sexual partners at risk. The virus could even become drug-resistant.
'It has really been hectic for us,' said Mbonisiwe Hlongwane, manager of the HIV program at the Bertha Gxowa public hospital in Germiston, east of Johannesburg. And the uncertainty only continues.
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Associated Press writer Mogomotsi Magome in Johannesburg contributed reporting.
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San Francisco Chronicle
27 minutes ago
- San Francisco Chronicle
Dozens of kids and adults in Gaza have starved to death in July as hunger surges
DEIR AL-BALAH, Gaza Strip (AP) — Five starving children at a Gaza City hospital were wasting away, and nothing the doctors tried was working. The basic treatments for malnourishment that could save them had run out under Israel's blockade. The alternatives were ineffective. One after another, the babies and toddlers died over four days. In greater numbers than ever, children hollowed up by hunger are overwhelming the Patient's Friends Hospital, the main emergency center for malnourished kids in northern Gaza. The deaths last weekend also marked a change: the first seen by the center in children who had no preexisting conditions. Symptoms are getting worse, with children too weak to cry or move, said Dr. Rana Soboh, a nutritionist. In past months, most improved, despite supply shortages, but now patients stay longer and don't get better, she said. 'There are no words in the face of the disaster we are in. Kids are dying before the world ... There is no uglier and more horrible phase than this,' said Soboh, who works with the U.S.-based aid organization Medglobal, which supports the hospital. This month, the hunger that has been building among Gaza's more than 2 million Palestinians passed a tipping point into accelerating death, aid workers and health staff say. Not only children — usually the most vulnerable — are falling victim under Israel's blockade since March, but also adults. In the past three weeks, at least 48 people died of causes related to malnutrition, including 28 adults and 20 children, the Gaza Health Ministry said Thursday. That's up from 10 children who died in the five previous months of 2025, according to the ministry. The U.N reports similar numbers. The World Health Organization said Wednesday it has documented 21 children under 5 who died of causes related to malnutrition in 2025. The U.N. humanitarian office, OCHA, said Thursday at least 13 children's deaths were reported in July, with the number growing daily. 'Humans are well developed to live with caloric deficits, but only so far,' said Dr. John Kahler, Medglobal's co-founder and a pediatrician who volunteered twice in Gaza during the war. 'It appears that we have crossed the line where a segment of the population has reached their limits' 'This is the beginning of a population death spiral," he said. The U.N.'s World Food Program says nearly 100,000 women and children urgently need treatment for malnutrition. Medical workers say they have run out of many key treatments and medicines. Israel, which began letting in only a trickle of supplies the past two months, has blamed Hamas for disrupting food distribution. The U.N. counters that Israel, which has restricted aid since the war began, simply has to allow it to enter freely. Hundreds of malnourished kids brought daily The Patient's Friends Hospital overflows with parents bringing in scrawny children – 200 to 300 cases a day, said Soboh. On Wednesday, staff laid toddlers on a desk to measure the circumference of their upper arms — the quickest way to determine malnutrition. In the summer heat, mothers huddled around specialists, asking for supplements. Babies with emaciated limbs screamed in agony. Others lay totally silent. The worst cases are kept for up to two weeks at the center's 10-bed ward, which this month has had up to 19 children at a time. It usually treats only children under 5, but began taking some as old as 11 or 12 because of worsening starvation among older children. Hunger gnaws at staff as well. Soboh said two nurses put themselves on IV drips to keep themselves going. 'We are exhausted. We are dead in the shape of the living,' she said. The five children died in succession last Thursday, Saturday and Sunday. Four of them, aged 4 months to 2 years, had suffered gastric arrest: Their stomachs shut down. The hospital no longer had the right nutrition supplies for them. The fifth — 4 1/2-year-old Siwar — had alarmingly low potassium levels, a growing problem. She was so weak she could barely move her body. Medicine for potassium deficiency has largely run out across Gaza, Soboh said. The center had only a low-concentration potassium drip. The little girl didn't respond. After three days in the ICU, she died Saturday. 'If we don't have potassium (supplies), we will see more deaths,' she said. A 2-year-old is wasting away In the Shati Refugee Camp in Gaza city, 2-year-old Yazan Abu Ful's mother, Naima, pulled off his clothes to show his emaciated body. His vertebrae, ribs and shoulder-blades jutted out. His buttocks were shriveled. His face was expressionless. His father Mahmoud, who was also skinny, said they took him to the hospital several times. Doctors just say they should feed him. 'I tell the doctors, 'You see for yourself, there is no food,'' he said, Naima, who is pregnant, prepared a meal: Two eggplants they bought for $9 cut up and boiled in water. They will stretch out the pot of eggplant-water – not even a real soup – to last them a few days, they said. Several of Yazan's four older siblings also looked thin and drained. Holding him in his lap, Mahmoud Abu Ful lifted Yazan's limp arms. The boy lies on the floor most of the day, too weak to play with his brothers. 'If we leave him, he might just slip away from between our fingers, and we can't do anything.' Adults, too, are dying Starvation takes the vulnerable first, experts say: children and adults with health conditions. On Thursday, the bodies of an adult man and woman with signs of starvation were brought to Gaza City's Shifa Hospital, hospital director Mohammed Abu Selmia said. One suffered from diabetes, the other from a heart condition, but they showed severe deficiencies of nutrients, gastric arrest and anemia from malnutrition. Many of the adults who have died had some sort of preexisting condition, like diabetes or heart or kidney trouble, worsened by malnutrition, Abu Selmia said. 'These diseases don't kill if they have food and medicine,' he said. Deaths come after months of Israeli siege Israel cut off entry of food, medicine, fuel and other supplies completely to Gaza for 2 ½ months starting in March, saying it aimed to pressure Hamas to release hostages. During that time, food largely ran out for aid groups and in marketplaces, and experts warned Gaza was headed for an outright famine. In late May, Israel slightly eased the blockade. Since then, it has allowed in around 4,500 trucks for the U.N. and other aid groups to distribute, including 2,500 tons of baby food and high-calorie special food for children, the Israeli Foreign Ministry said Wednesday. That is an average of 69 trucks a day, far below the 500-600 trucks a day the U.N. says are needed. The U.N. has been unable to distribute much of the aid because hungry crowds and gangs take most of it from its trucks. Separately, Israel has also backed the Gaza Humanitarian Foundation, which opened four centers distributing boxes of food supplies. Hundreds of Palestinians have been killed trying to reach the sites. On Tuesday, David Mencer, spokesman for the Israeli Prime Minister's office, denied there is a 'famine created by Israel' in Gaza and blamed Hamas for creating 'man-made shortages' by looting aid trucks. ___ El Deeb reported from Beirut, Keath from Cairo.
Washington Post
34 minutes ago
- Washington Post
Dozens of kids and adults in Gaza have starved to death in July as hunger surges
DEIR AL-BALAH, Gaza Strip — Five starving children at a Gaza City hospital were wasting away, and nothing the doctors tried was working. The basic treatments for malnourishment that could save them had run out under Israel's blockade. The alternatives were ineffective. One after another, the babies and toddlers died over four days. In greater numbers than ever, children hollowed up by hunger are overwhelming the Patient's Friends Hospital, the main emergency center for malnourished kids in northern Gaza. The deaths last weekend also marked a change: the first seen by the center in children who had no preexisting conditions. Symptoms are getting worse, with children too weak to cry or move, said Dr. Rana Soboh, a nutritionist. In past months, most improved, despite supply shortages, but now patients stay longer and don't get better, she said. 'There are no words in the face of the disaster we are in. Kids are dying before the world ... There is no uglier and more horrible phase than this,' said Soboh, who works with the U.S.-based aid organization Medglobal, which supports the hospital. This month, the hunger that has been building among Gaza's more than 2 million Palestinians passed a tipping point into accelerating death, aid workers and health staff say. Not only children — usually the most vulnerable — are falling victim under Israel's blockade since March, but also adults. In the past three weeks, at least 48 people died of causes related to malnutrition, including 28 adults and 20 children, the Gaza Health Ministry said Thursday. That's up from 10 children who died in the five previous months of 2025, according to the ministry. The U.N reports similar numbers. The World Health Organization said Wednesday it has documented 21 children under 5 who died of causes related to malnutrition in 2025. The U.N. humanitarian office, OCHA, said Thursday at least 13 children's deaths were reported in July, with the number growing daily. 'Humans are well developed to live with caloric deficits, but only so far,' said Dr. John Kahler, Medglobal's co-founder and a pediatrician who volunteered twice in Gaza during the war. 'It appears that we have crossed the line where a segment of the population has reached their limits' 'This is the beginning of a population death spiral,' he said. The U.N.'s World Food Program says nearly 100,000 women and children urgently need treatment for malnutrition. Medical workers say they have run out of many key treatments and medicines. Israel, which began letting in only a trickle of supplies the past two months, has blamed Hamas for disrupting food distribution. The U.N. counters that Israel, which has restricted aid since the war began, simply has to allow it to enter freely. The Patient's Friends Hospital overflows with parents bringing in scrawny children – 200 to 300 cases a day, said Soboh. On Wednesday, staff laid toddlers on a desk to measure the circumference of their upper arms — the quickest way to determine malnutrition. In the summer heat, mothers huddled around specialists, asking for supplements. Babies with emaciated limbs screamed in agony. Others lay totally silent. The worst cases are kept for up to two weeks at the center's 10-bed ward, which this month has had up to 19 children at a time. It usually treats only children under 5, but began taking some as old as 11 or 12 because of worsening starvation among older children. Hunger gnaws at staff as well. Soboh said two nurses put themselves on IV drips to keep themselves going. 'We are exhausted. We are dead in the shape of the living,' she said. The five children died in succession last Thursday, Saturday and Sunday. Four of them, aged 4 months to 2 years, had suffered gastric arrest: Their stomachs shut down. The hospital no longer had the right nutrition supplies for them. The fifth — 4 1/2-year-old Siwar — had alarmingly low potassium levels, a growing problem. She was so weak she could barely move her body. Medicine for potassium deficiency has largely run out across Gaza, Soboh said. The center had only a low-concentration potassium drip. The little girl didn't respond. After three days in the ICU, she died Saturday. 'If we don't have potassium (supplies), we will see more deaths,' she said. In the Shati Refugee Camp in Gaza city, 2-year-old Yazan Abu Ful's mother, Naima, pulled off his clothes to show his emaciated body. His vertebrae, ribs and shoulder-blades jutted out. His buttocks were shriveled. His face was expressionless. His father Mahmoud, who was also skinny, said they took him to the hospital several times. Doctors just say they should feed him. 'I tell the doctors, 'You see for yourself, there is no food,'' he said, Naima, who is pregnant, prepared a meal: Two eggplants they bought for $9 cut up and boiled in water. They will stretch out the pot of eggplant-water – not even a real soup – to last them a few days, they said. Several of Yazan's four older siblings also looked thin and drained. Holding him in his lap, Mahmoud Abu Ful lifted Yazan's limp arms. The boy lies on the floor most of the day, too weak to play with his brothers. 'If we leave him, he might just slip away from between our fingers, and we can't do anything.' Starvation takes the vulnerable first, experts say: children and adults with health conditions. On Thursday, the bodies of an adult man and woman with signs of starvation were brought to Gaza City's Shifa Hospital, hospital director Mohammed Abu Selmia said. One suffered from diabetes, the other from a heart condition, but they showed severe deficiencies of nutrients, gastric arrest and anemia from malnutrition. Many of the adults who have died had some sort of preexisting condition, like diabetes or heart or kidney trouble, worsened by malnutrition, Abu Selmia said. 'These diseases don't kill if they have food and medicine,' he said. Israel cut off entry of food, medicine, fuel and other supplies completely to Gaza for 2 ½ months starting in March, saying it aimed to pressure Hamas to release hostages. During that time, food largely ran out for aid groups and in marketplaces, and experts warned Gaza was headed for an outright famine. In late May, Israel slightly eased the blockade. Since then, it has allowed in around 4,500 trucks for the U.N. and other aid groups to distribute, including 2,500 tons of baby food and high-calorie special food for children, the Israeli Foreign Ministry said Wednesday. That is an average of 69 trucks a day, far below the 500-600 trucks a day the U.N. says are needed. The U.N. has been unable to distribute much of the aid because hungry crowds and gangs take most of it from its trucks. Separately, Israel has also backed the Gaza Humanitarian Foundation, which opened four centers distributing boxes of food supplies. Hundreds of Palestinians have been killed trying to reach the sites . On Tuesday, David Mencer, spokesman for the Israeli Prime Minister's office, denied there is a 'famine created by Israel' in Gaza and blamed Hamas for creating 'man-made shortages' by looting aid trucks. The U.N. denies Hamas siphons off significant quantities of aid. Humanitarian workers say Israel just needs to allow aid to flow in freely, saying looting stops whenever aid enters in large quantities. ___ The headline of this story has been corrected to show that the dozens of deaths in Gaza from starvation in July include kids and adults. ___ El Deeb reported from Beirut, Keath from Cairo.
Hamilton Spectator
44 minutes ago
- Hamilton Spectator
Dozens of kids and adults in Gaza have starved to death in July as hunger surges
DEIR AL-BALAH, Gaza Strip (AP) — Five starving children at a Gaza City hospital were wasting away, and nothing the doctors tried was working. The basic treatments for malnourishment that could save them had run out under Israel's blockade. The alternatives were ineffective. One after another, the babies and toddlers died over four days. In greater numbers than ever, children hollowed up by hunger are overwhelming the Patient's Friends Hospital, the main emergency center for malnourished kids in northern Gaza. The deaths last weekend also marked a change: the first seen by the center in children who had no preexisting conditions. Symptoms are getting worse, with children too weak to cry or move, said Dr. Rana Soboh, a nutritionist. In past months, most improved, despite supply shortages, but now patients stay longer and don't get better, she said. 'There are no words in the face of the disaster we are in. Kids are dying before the world ... There is no uglier and more horrible phase than this,' said Soboh, who works with the U.S.-based aid organization Medglobal, which supports the hospital. This month, the hunger that has been building among Gaza's more than 2 million Palestinians passed a tipping point into accelerating death, aid workers and health staff say. Not only children — usually the most vulnerable — are falling victim under Israel's blockade since March, but also adults. In the past three weeks, at least 48 people died of causes related to malnutrition, including 28 adults and 20 children, the Gaza Health Ministry said Thursday. That's up from 10 children who died in the five previous months of 2025, according to the ministry. The U.N reports similar numbers. The World Health Organization said Wednesday it has documented 21 children under 5 who died of causes related to malnutrition in 2025. The U.N. humanitarian office, OCHA, said Thursday at least 13 children's deaths were reported in July, with the number growing daily. 'Humans are well developed to live with caloric deficits, but only so far,' said Dr. John Kahler, Medglobal's co-founder and a pediatrician who volunteered twice in Gaza during the war. 'It appears that we have crossed the line where a segment of the population has reached their limits' 'This is the beginning of a population death spiral,' he said. The U.N.'s World Food Program says nearly 100,000 women and children urgently need treatment for malnutrition. Medical workers say they have run out of many key treatments and medicines. Israel, which began letting in only a trickle of supplies the past two months, has blamed Hamas for disrupting food distribution. The U.N. counters that Israel, which has restricted aid since the war began, simply has to allow it to enter freely. Hundreds of malnourished kids brought daily The Patient's Friends Hospital overflows with parents bringing in scrawny children – 200 to 300 cases a day, said Soboh. On Wednesday, staff laid toddlers on a desk to measure the circumference of their upper arms — the quickest way to determine malnutrition. In the summer heat, mothers huddled around specialists, asking for supplements. Babies with emaciated limbs screamed in agony. Others lay totally silent. The worst cases are kept for up to two weeks at the center's 10-bed ward, which this month has had up to 19 children at a time. It usually treats only children under 5, but began taking some as old as 11 or 12 because of worsening starvation among older children. Hunger gnaws at staff as well. Soboh said two nurses put themselves on IV drips to keep themselves going. 'We are exhausted. We are dead in the shape of the living,' she said. The five children died in succession last Thursday, Saturday and Sunday. Four of them, aged 4 months to 2 years, had suffered gastric arrest: Their stomachs shut down. The hospital no longer had the right nutrition supplies for them. The fifth — 4 1/2-year-old Siwar — had alarmingly low potassium levels, a growing problem. She was so weak she could barely move her body. Medicine for potassium deficiency has largely run out across Gaza, Soboh said. The center had only a low-concentration potassium drip. The little girl didn't respond. After three days in the ICU, she died Saturday. 'If we don't have potassium (supplies), we will see more deaths,' she said. A 2-year-old is wasting away In the Shati Refugee Camp in Gaza city, 2-year-old Yazan Abu Ful's mother, Naima, pulled off his clothes to show his emaciated body. His vertebrae, ribs and shoulder-blades jutted out. His buttocks were shriveled. His face was expressionless. His father Mahmoud, who was also skinny, said they took him to the hospital several times. Doctors just say they should feed him. 'I tell the doctors, 'You see for yourself, there is no food,'' he said, Naima, who is pregnant, prepared a meal: Two eggplants they bought for $9 cut up and boiled in water. They will stretch out the pot of eggplant-water – not even a real soup – to last them a few days, they said. Several of Yazan's four older siblings also looked thin and drained. Holding him in his lap, Mahmoud Abu Ful lifted Yazan's limp arms. The boy lies on the floor most of the day, too weak to play with his brothers. 'If we leave him, he might just slip away from between our fingers, and we can't do anything.' Adults, too, are dying Starvation takes the vulnerable first, experts say: children and adults with health conditions. On Thursday, the bodies of an adult man and woman with signs of starvation were brought to Gaza City's Shifa Hospital, hospital director Mohammed Abu Selmia said. One suffered from diabetes, the other from a heart condition, but they showed severe deficiencies of nutrients, gastric arrest and anemia from malnutrition. Many of the adults who have died had some sort of preexisting condition, like diabetes or heart or kidney trouble, worsened by malnutrition, Abu Selmia said. 'These diseases don't kill if they have food and medicine,' he said. Deaths come after months of Israeli siege Israel cut off entry of food, medicine, fuel and other supplies completely to Gaza for 2 1/2 months starting in March, saying it aimed to pressure Hamas to release hostages. During that time, food largely ran out for aid groups and in marketplaces, and experts warned Gaza was headed for an outright famine. In late May, Israel slightly eased the blockade. Since then, it has allowed in around 4,500 trucks for the U.N. and other aid groups to distribute, including 2,500 tons of baby food and high-calorie special food for children, the Israeli Foreign Ministry said Wednesday. That is an average of 69 trucks a day, far below the 500-600 trucks a day the U.N. says are needed. The U.N. has been unable to distribute much of the aid because hungry crowds and gangs take most of it from its trucks. Separately, Israel has also backed the Gaza Humanitarian Foundation, which opened four centers distributing boxes of food supplies. Hundreds of Palestinians have been killed trying to reach the sites . On Tuesday, David Mencer, spokesman for the Israeli Prime Minister's office, denied there is a 'famine created by Israel' in Gaza and blamed Hamas for creating 'man-made shortages' by looting aid trucks. The U.N. denies Hamas siphons off significant quantities of aid. Humanitarian workers say Israel just needs to allow aid to flow in freely, saying looting stops whenever aid enters in large quantities. ___ The headline of this story has been corrected to show that the dozens of deaths in Gaza from starvation in July include kids and adults. ___ El Deeb reported from Beirut, Keath from Cairo.
