Goats and soda: NPR

When Kenneth Ngure thinks of the global effort to control HIV / AIDS, he says, he feels like flying.

“It is like an airplane that moves to the cruise altitude, looking for its destination,” said Ngure, elected president of the International AIDS Society and Associate Professor of World Health at Jomo Kenyatta University in Kenya.

This destination, he says, is a world in which HIV / AIDS is no longer a threat. Even if there are even more than half a million deaths related to AIDS each year, he used to feel as if this goal was in view of his flight card. He says that a large part of the credit goes to the huge American investment in the fight against the virus.

“”[Lawmakers in the U.S.] are the pilots. These are the engines, “explains Ngure.” They have put enough resources. “”

Then came an unexpected plot of severe turbulence.

The day of the inauguration, President Donald Trump announcement that he stopped the vast majority of foreign aid. It was a shock.

“You hit the turbulence and you start to lose altitude. And you don’t know if we’re going to get to your destination,” said Ngure. “Everyone was in a panic. Is it the end?”

But last week, he said, came the equivalent of a reassuring message from the pilot.

The American effort to tackle HIV / AIDS had been part of the Trump administration effort to recover billions of dollars Previously allocated by Congress to public media and foreign aid. The total promised to pepfar,, or the president‘s Emergency plan for the relief of AIDS,, This had to be reduced: $ 400 million. But the word came on July 15 That the Senate tears the pepfar from the cancellation list and rejected these cuts. The program has long had bipartite support and the leaders wanted to avoid a revolt inspired by the Pepfar in the package. The rest of the cancellation package adopted both the room and the Senate, taking up $ 9 billion. But Pepfar escaped unscathed.

When Ngure heard that Pepfar had survived the cuts of cuts, he said, he said to himself: “There is hope, but still maintain your safety belts.”

But it was only a small positive note in an increasingly bumpy flight. This bipartite effort to help Pepfar enough to stabilize the plane and make sure it reaches its destination? Rumors abound. Some say that Pepfar is condemned. Others hope for its bipartite history. What does the future contain?

The story of Pepfar

President George W. Bush created the Pepfar in 2003 – an era when HIV / AIDS was devastating communities in Africa and other parts of the world, killing About 3 million people per year.

“I saw very, very dark days – the daily hospitals showed up, honestly, the excruciating death of young people at the end of adolescence and the twenties,” said Dr Charles HolmesWho worked in Malawi as a student in medicine in 1999, then again in 2002 before the birth of Pepfar. He was then the head doctor of the program during the Obama administration.

Holmes returned to Malawi in February and found himself “to recall how far we came”. Since its foundation, Pepfar has put more than $ 120 billion in the fight against the virus in more than 50 countries. The result of all this money and these efforts, he saysis clear, citing achievements that are widely accepted: 26 million lives saved, a fall in HIV infection rates and a rebound in life expectancy, especially in Africa.

However, that was not enough to protect Pepfar from the reshuffle of foreign aid. When Trump started reducing international aid programs, many clinics and Pepfar services stopped overnight As the workpayers have been extinguished.

This HIV / AIDS clinic funded by PEPFAR, nestled on a market in Lusaka, Zambia, initially closed due to disturbances of American foreign aid. He has since reopened, but with fewer services. Clinical prevention work is now only limited to pregnant women.

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“Customers come to the clinic and, in some cases, have found that the doors are literally locked and that their trusted clinicians are not there to see them, and their drugs they had planned to receive are not there,” said Holmes, who now directs the Center for Innovation and Global Health at Georgetown University.

All the disturbances of the last seven months have had a real and serious impact, explains Ngure. He underlines a new study carried out by researchers from the National Institute of Health and the Ministry of Health of Mozambique who found that, among the children who are on the treatment of HIV, the percentage which successfully kept the remote virus dropped from 43% from February 2024 to 2025. The researchers – who presented their results during the meeting of the International AIDS Society and Drop-to pepfar.

Will the Pepfar change?

Holmes is not exactly optimistic. Even if the congress has retained the funding of $ 400 million for the PEPFAR during the current financial year, it says that the future of the organization is far from sure.

“The president has proposed major financing discounts for next year,” he said. “I don’t think the program is still out of the woods.”

Others echo this uncertainty. Yap Boum II, from Africa Centers for Disease Control and Prevention, says it is “premature for us to really know how [PEPFAR] will change. “”

Even if funding has continued as in recent years, says Holmes, a key question is what this funding is going on. Until now, under Trump, the vast majority of HIV prevention work have ceased – with the limited exception to prevent the transmission of mother to child – just like a large part of the support that the United States has used to provide millions of AIDS orphaned. For example, Pepfar has paid for purchases and the distribution of Preparation, A drug that prevents HIV infections in high -risk individuals such as couples where you are HIV positive and one is seronegative. Trump administration quickly moved After taking up his duties to limit this medication to pregnant and breastfeeding women – and did not allow him to be provided to others.

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“Without prevention and care for orphans and vulnerable children, Pepfar will be much, a lot,” said Holmes.

A spokesperson for the State Department did not answer specific questions on the resumption of complete efforts of Pepfar prevention efforts as well as his care for AIDS orphans and vulnerable children. However, the State Department Congress budget justification For the next exercise, underlines the importance of “deploying targeted campaigns to reduce new HIV infections” and simple HIV prevention plans.

An uncertain future

Experts say that there are several reasons why it is difficult to predict what the PEPFAR will look like in the future.

To begin with, the pepfar authorization of the Congress expired in March and has not yet been renewed. This does not mean the end of PEPFAR operations – Congress can always provide funding even without authorization – but there are risks.

“Without authorization, this can lead to special interests to try to insert things in the financing of invoices that dilute the program,” explains Holmes.

Another challenge is that the PEPFAR generally extinguishes the country and the region operations plans To describe the program strategies and clarify the activities it will support in different parts of the world. This information has not yet been published for 2026. The spokesperson for the State Department has not answered questions about the moment when these plans are published.

However, a statement sent by e-mail to NPR said: “Secretary Rubio said PEPFAR is an important and vital program that will continue. He also said PEPFAR, like all assistance programs, should be reduced over time because it would carry out its mission.”

And there is another concern about how PEPFAR can work in this very modified world of foreign aid: the interaction of HIV and other diseases.

“The biggest killer of people living with HIV is actually tuberculosis,” said Holmes. And the United States tuberculosis program has been considerably cut, “he said.

Not knowing what the rest of the world health landscape will look like, it is difficult to know what the situation of HIV / AIDS will be. “It is a period of such great uncertainty,” he said.

“We start to see a glow”

However, some HIV / AIDS specialists are more and more confident about the future of PEPFAR – even if they predict that the United States will probably make the reins to other countries.

“I have the impression that we see the resurgence of a strong bipartite commitment,” explains Susan Hillis, who spent seven years in Pepfar. During Trump’s first term, she was selected to lead a $ 100 million initiative to use denominational groups to advance HIV / AIDS work. “We are starting to see a glow of: Yes, it is possible to advance in the same direction together.”

Hillis met the legislators and, she says, people are starting to agree on certain things, in particular by working with countries to weaned them with pepfar money – gradually.

In the State Department Congress budget justificationThe administration underlined the American plan to “accelerate the transition from HIV control programs to beneficiary countries and increase international property of efforts to combat HIV / AIDS”, including a “ramp out of responsible ramp”.

Hillis admits that no one knows exactly what the Pepfar of the future will look like – and how long it will be as an independent program.

However, despite a turbulent year so far, Ngure is not ready to parachute. He says that in recent months, other countries are trying to make sure that the plane reaches its destination, even by bringing additional pilots. He says that the HIV / AIDS plane “cannot go back”.