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AVAC Advocates' Network Logo April 25, 2025
Global Health Watch is a weekly newsletter breaking down critical developments in US policies and their impact on global health. Tailored for our partners in the US and around the world, this resource offers a concise analysis of the week’s events, supporting advocates to respond to threats, challenges and opportunities in this critical period of change in global health. 

This week saw a significant reorganization of the State Department and a delay in the foreign assistance “review process”. There were also new threats to PrEP programs, critical HIV services and health systems, and research in South Africa. Read on for key developments, implications, and resources for action.


** Department of State Overhauled
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The US administration initiated a significant reorganization of the US State Department ([link removed]) , aiming to consolidate its 28 divisions into 15. This restructuring is part of a broader effort to streamline operations and reduce redundancy within the department. The plan situates the Bureau of Global Health Security and Diplomacy Office, which includes PEPFAR, under the undersecretary of State for economic growth and environment. This goes against the 2003 law that created PEPFAR, which placed PEPFAR and its Ambassador reporting directly to the Secretary of State.
​At the same time, the new Department of Government Efficiency (DOGE) implemented a "Defend the Spend" initiative, which imposes stringent new protocols on disbursing federal healthcare grants. The policy requires detailed justifications for each payment, effectively delaying or halting funding for programs such as salaries for healthcare workers at federal health centers. ​

IMPLICATIONS: The reorganization and funding constraints could affect the delivery of essential services, including those related to HIV prevention and treatment, both domestically and internationally and continue to raise concerns about potential disruptions to critical health services and the overall impact on public health infrastructure. And removing PEPFAR from the direct line to the Secretary of State potentially diminishes the program’s authority and visibility.

READ:
* Rubio unveils sweeping reorganization of State Department ([link removed]) —Washington Post
* How does butchering the State Department ‘make America great’? ([link removed]) —The Hill
* DOGE begins to freeze health-care payments for extra review ([link removed]) —Washington Post
* Rubio Downgrades PEPFAR in Proposed State Department Reorganization ([link removed]∏=alert&prodname=alertmail&linktype=headline&source=email) —Politico Pro


** Foreign Aid Review Extended
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The administration extended its supposed “foreign aid review” by an additional 30 days, pushing the conclusion to May 20. This follows the initial 90-day pause initiated by executive orders said to be assessing the alignment of US foreign assistance with the administration's "America First" policy. An internal State Department email from Jeremy Lewin, the newly appointed Director of Foreign Assistance, indicated that the additional time would be used for further bureau feedback and to align recommendations with the upcoming budget proposal.​

IMPLICATIONS: This extension continues amid continued uncertainty around HIV and global health programs. Organizations reliant on this funding remain in limbo, hindering their ability to plan and deliver essential programs and services. The extension also raises concerns about the potential for further cuts or restructuring of foreign assistance.

READ:
* Trump administration extends foreign aid review for another 30 days ([link removed]) —Devex


** Federal Workers to be Reclassified (“Schedule F”) to Remove Their Protections
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Approximately 50,000 federal employees will be reclassified under "Schedule F," a designation that would strip them of longstanding civil service protections and render them "at-will" employees. These actions target career staff in policy-influencing roles across agencies like the Department of Health and Human Services (HHS), aligning with the administration's broader agenda to reshape the federal workforce and consolidate executive control.

IMPLICATIONS: This reclassification could undermine the nonpartisan expertise essential for effective governance, particularly in areas like health research and service delivery. The potential impact on global health initiatives is significant, as the loss of experienced personnel could disrupt programs critical to HIV prevention and pandemic preparedness.

READ:
* Thousands of federal workers would be easier to fire under Trump rule change ([link removed]) —NPR
* Trump imposes Schedule F to more easily remove federal workers ([link removed]) —Fierce Healthcare


** South Africa HIV Gains at Risk
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Many news outlets and advocates this week are calling attention to South Africa’s HIV response, which is in crisis as the US funding freeze takes effect. Francois Venter argues in an opinion piece ([link removed]) that key HIV services are collapsing, including community outreach, PrEP access, and clinic operations, leaving thousands without care. A pre-print journal article, The cost of the plunge ([link removed]) , estimates that the termination of PEPFAR-supported services could result in over 13,000 additional deaths and more than 25,000 new infections each year in South Africa. The South African government's response has been criticized for its lack of coordination and contingency planning, with civil society advocates calling for urgent action, increased transparency, and new domestic investments to prevent the collapse of two decades of progress against
HIV.

READ:
* Our HIV programme is collapsing — and our government is nowhere to be seen ([link removed]) —GroundUp
* The cost of the plunge: The impact and cost of a cessation of PEPFAR-supported services in South Africa ([link removed]) —medRxiv
* Inside government’s confused response to the US funding crisis ([link removed]) —Spotlight


** NIH Pauses HIV Research in South Africa
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The US National Institutes of Health (NIH) has restricted research programs in South Africa from enrolling new participants in its major HIV clinical trial networks. South Africa is a leader in trial participation and lab analysis, has been a critical partner in advancing HIV prevention and treatment strategies and has one of the world’s largest HIV epidemics. Experts, including Glenda Gray of the South African Medical Research Council, warn that this action is “petty and punitive,” especially given South Africa’s longstanding contributions to US and global HIV guidance.

IMPLICATIONS: This NIH decision, coupled with foreign aid cuts and the dismantling of USAID, risks sidelining one of the most capable research partners in the HIV field. It could slow progress in biomedical innovation, disrupt current trial pipelines, and further erode trust in US global health partnerships—at a moment when scientific collaboration and inclusive research are more critical than ever.

READ:
* NIH halts more collaborations with South Africa on HIV/AIDS trials ([link removed]) —Science
* We do the sums: The NIH funds $350-million (R6.65-billion) of research in SA ([link removed]) —Bhekisisa


** PrEP and Prevention at Risk in the US
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In the US, arguments just began in the Supreme Court on the Kennedy v. Braidwood Management case, which is challenging the Affordable Care Act’s (ACA) mandate that requires insurers to cover certain preventive services, including PrEP, at no cost. The case is brought by fundamentalist Christian business owners who oppose no-cost PrEP on religious grounds.

IMPLICATIONS: If the Court strikes down the mandate, insurers may no longer be required to fully cover services recommended since 2010, including new long-acting PrEP options. This could severely limit access, raise out-of-pocket costs, and threaten hard-won public health gains in HIV prevention and beyond.

READ:
* What to know about the Supreme Court case that could take away your access to PrEP and other care ([link removed]) —The Advocate
* Use of No-Cost Preventive Services Jeopardized by Kennedy v Braidwood ([link removed]) —JAMA

What We're Reading

• After U.S. decimates PEPFAR and USAID, the struggle to save HIV services at one nonprofit in southeastern Africa ([link removed]) —Positively Aware
• Researcher of 1918 flu virus takes over NIAID ([link removed]) —Science
• New NIH director defends grant cuts as part of shift to support MAHA vision ([link removed]) —Science
• Trump-Allied Prosecutor Sends Letters to Medical Journals Alleging Bias ([link removed]) —The New York Times
• The U.S. needs an alternative organization to protect vaccine guidance from political interference ([link removed]) —STAT
• Experts Say Abrupt and “Staggering” CDC Cuts Will Cost Lives ([link removed]) —JAMA
• African leaders are rising to challenge of aid cuts, but debt holds them back ([link removed]) —LinkedIn
• Fighting for funds: A new era of HIV activism ([link removed]) —Bhekisisa
• More Than 220 Academic Leaders Condemn Trump ‘Overreach’ ([link removed]) —The New York Times
• NEJM Perspective: An HIV Vaccine in the Era of Twice-Yearly Lenacapavir for PrEP — Essential or Irrelevant ([link removed]) ?—NEJM
• Former Trump official warns president he’s at risk of ruining his legacy on ending HIV ([link removed]) – STAT
• In a reversal, the Trump administration restores funding for women's health study ([link removed]) – NPR

RESOURCES
• The Trump Administration’s Foreign Aid Review: Status of PEPFAR ([link removed]) —KFF
• Analysis of USAID’s Active and Terminated Awards List: How Many Are Global Health? ([link removed]) —KFF
• Scaling Back the Nation’s HIV Response? What the Trump Administration’s HHS Budget May Do ([link removed]) —KFF
• Our Health ROI—[link removed]
• Tracking the Freeze: Real-Time Impact on Key Populations ([link removed]) —GBGMC
• The Best Investment You Didn’t Know You Made: How NIH Funding Fuels Innovation and Economic Growth ([link removed]) — amfAR

In solidarity,

AVAC
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AVAC Global Advocacy for HIV Prevention
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