US State Department waivers on suspended foreign assistance worldwide have not resulted in the resumption of many vital programs protecting and promoting human rights, Human Rights Watch said today. President Donald Trump's executive order on January 20, 2025, suspending $44 billion in funds administered by the US State Department, United States Agency for International Development (USAID), and the President's Emergency Plan for AIDS Relief (PEPFAR), are affecting thousands of programs around the globe and endangering the health, safety, and livelihoods of millions of people.
"President Trump's sudden suspension of US foreign aid has forced health programs all over the world to halt or curtail operations, including HIV prevention programs, and deny patients lifesaving medicines," said John Sifton, an advocacy director at Human Rights Watch. "Despite the State Department's claims about resuming some 'life-saving humanitarian assistance,' many programs remain paused due to massive staffing disruptions and inconsistent and unclear guidance."
Starting on January 24, State Department and USAID officials began sending stop-work orders to thousands of implementing partners, contractors, and grantees around the world. Besides assistance programs, stop-work orders were sent to numerous projects gathering vital information about infectious diseases, disinformation, and human rights abuses, and programs supporting at-risk pro-democracy activists, Human Rights Watch said. The State Department also issued limited waivers for "emergency food assistance" and "foreign military financing for Israel and Egypt" but without guidance on their interpretation.
Since the January 20 order, implementing partners and State Department and USAID officials in embassies, consulates, and missions worldwide have received conflicting and confusing information about how to interpret restrictions and what permissions were needed to restart vital programs. Officials and partners have struggled to obtain specific waivers for programs as enormous staffing upheavals occurred across the State Department and USAID after the administration dismissed, furloughed, or reassigned most employees and contractors involved in administering suspended projects.
PEPFAR programming includes work to prevent mother-to-child transmission of HIV ("vertical transmission") for approximately 750,000 pregnant and HIV positive people requiring specialized medicines during pregnancy, childbirth, and postpartum care. PEPFAR was expected to provide preventative care for approximately 850,000 newborns of pregnant and HIV-positive people. Without these treatments, pregnant people are at higher risk of severe health complications and the chances of transmitting HIV to newborns increase significantly.
On January 28, the State Department issued a waiver that appeared to allow the resumption of certain forms of "life-saving humanitarian assistance," including delivery of "core life-saving medicine, medical services, food, shelter, and subsistence assistance." And on February 6, more than two weeks after the January 28 memo, the State Department issued guidance clarifying that the waiver included HIV care and treatment services, prevention of mother-to-child transmission services, and associated administrative costs.
By then, however, with tens of thousands of relevant staff dismissed from work, few personnel were left to administer the programs' funding and necessary administrative activities, and on the same day, the Trump administration effectively closed USAID. On February 7, a federal court judge temporary halted orders putting several thousand agency staff members on leave, but it remains unclear whether they could return to work given the closure of USAID's headquarters and conflicting orders to place USAID staff under the State Department.
The suspensions have already begun affecting programming to prevent HIV, including pre-exposure prophylaxis (PrEP) for HIV and PEPFAR's delivery of essential medicines including antiretroviral treatments (ART) to over 20 million people with HIV, about two-thirds of those who are receiving HIV treatment globally. While some programing has resumed, it remains unclear how and when many other suspended activities will resume. PEPFAR also provides services or care to over 7 million children affected or orphaned by HIV.
The impact on PEPFAR programs could be devastating, Human Rights Watch said. It is unclear how many of the people receiving antiretroviral treatment medicines before the suspension have since been unable to access them. Every day that passes without access to these medicines further endangers the health of those needing the medicines and raises the risk of their viral loads increasing. If left untreated because of disruptions, many recipients of PEPFAR-funded medicines may soon develop life-threatening illnesses. Untreated recipients will also become more infectious, which will lead to higher rates of HIV infection worldwide.
According to the United Nations program on HIV and AIDS, UNAIDS, as of February 10, the suspension of preventative programing has resulted in over 2,800 additional HIV infections that would not have occurred if PEPFAR funding had not been suspended.
"Secretary of State Marco Rubio needs to take urgent action to ensure suspended services are restored as quickly as possible and adopt safer and more humane methods for reviewing current funding," Sifton said. "The State Department also needs to bring back thousands of federal employees and contractors who implemented and administered the funding of PEPFAR and other vital and lifesaving projects."
