New Trump administration rules on foreign assistance are prohibiting U.S.-backed programs from delivering HIV prevention drugs to large swaths of the at-risk population abroad, according to what appears to be new State Department guidance that HuffPost obtained and that a United Nations-affiliated program has now posted online.
State Department officials have not responded to HuffPost inquiries about the authenticity of the guidance or the motives behind it.
American foreign assistance has come nearly to a halt in the past two weeks. That’s the result of two separate but related actions: a blanket order from President Donald Trump’s administration freezing foreign aid, as well as an ongoing effort to dismantle the U.S. Agency for International Development, which oversees much of that assistance.
But the Trump administration has issued additional guidance exempting some ongoing food and health initiatives. That includes specific allowances for anti-HIV efforts through the President’s Emergency Program for AIDS Response, a George W. Bush-era initiative widely credited with saving more than 25 million lives.
Despite the exemption, many PEPFAR-affiliated programs have paused, scaled back or stopped operations anyway, as HuffPost and multiplemediaoutletshavebeenreporting. Frequently that’s because their leaders don’t know how to interpret the multiple overlapping orders ― and because the Trump administration has put most of the USAID staff on administrative leave, making it difficult to get official clarification.
On Thursday, according to the apparent directive that HuffPost obtained, the State Department attempted to address those ambiguities with a lengthy breakdown of what activities are and aren’t permissible. One section covers the provision of pre-exposure prophylaxis, known as PrEP, which when taken regularly is 99% effective at stopping transmission of HIV.
The guidance states that PEPFAR programs can continue providing PrEP “only to pregnant and breastfeeding women.” It goes on to say that other people “who may be at high risk of HIV infection or were previously initiated on a PrEP option can not be offered” the medication as long as the pause is in place.
“This really is talking about the population that is most in need of PrEP, especially those who are already on it, having to stop taking a medication that could virtually prevent most HIV infection,” Jennifer Kates, senior vice president and director of the Global Health & HIV Policy Program at the nonpartisan research organization KFF, told HuffPost after seeing the memo.
“The fact we have all these people with a disease that is highly transmissible and cannot be cured, that we can actually prevent all that transmission by successful treatment, is such a testimony to the success of these programs,” Judd Walson, an infectious disease physician who is chairman of the global health department at Johns Hopkins University, told HuffPost. “The thought that we would now withdraw access to this treatment so abruptly, without any planning for an alternative scenario, is so concerning.”
Mitchell Warren, executive director of the HIV advocacy and outreach group called AVAC, said one particular concern is that stopping long-term PrEP for people who were already receiving it could put them at risk for developing drug-resistant HIV strands in the future.
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“This decision is not just potentially missing the chance to prevent infections of people coming into PrEP programs,” Warren told HuffPost, “but now you’re actually causing harm by telling people you’re not allowed to get it.”
Bush, a conservative Republican, championed PEPFAR as both a president and former president; Christian activists and other faith-based organizations have long been among its most enthusiastic supporters But in recent years, some conservatives have been calling to scale back the program ― in part because, they say, the organizations implementing it are promoting a “woke,” left-wing agenda on issues such as abortion and sexuality.
And because HIV is so frequently transmitted through sexual contact or intravenous drug use, the distribution of PrEP in particular has long raised objections among some conservatives who believe it encourages sexual activity and drug use ― or because they believe the drug will “encourage and facilitate homosexual behavior,” as one conservative lawyer put it during 2022 court arguments in the U.S. over a domestic program.