As Congress reconvened on Tuesday, activists gathered near the White House to protest against cuts to global HIV funding, calling attention to funds they say are being withheld illegally by the Trump administration despite being appropriated by Congress.
The end of the fiscal year 2025 is 30 September, which means the majority of the withheld federal funds will disappear. The activists called for the release of the funding for programs such as Pepfar (the President’s Emergency Plan for Aids Relief), a program established in 2003 that has saved an estimated 26 million lives around the world and promised to help bring the HIV epidemic to an end.
An estimated 450,000 people have died because of the abrupt cuts to the United States Agency for International Development (USAID). Millions have paused or ended taking the medications that either keep them from getting HIV or keep the virus from progressing and becoming infectious again.
“The funding is there. The global health programs that have been shuttered, Congress has funded them … but OMB is not permitting it to be spent. They are impounding those funds,” said Atul Gawande, the former assistant administrator for global health at USAID, who spoke at the protest. “That is not legal.”
The activists marched to the office of the General Services Administration wearing masks and holding signs depicting the face of Russell Vought, the head of the office of management and budget (OMB).
They blocked traffic by sitting and lying in the intersection outside the building where Vought works. As horns honked, one man leapt from his car to confront a protester.
The protest came at a particularly fraught moment in Washington DC, which for several weeks has been occupied by local and out-of-state national guardsmen as well as federal agents.
“It’s been surreal seeing the national guard come through the neighborhoods,” said Gawande, who lives in DC. The risks of protest and civil disobedience are heightened because “anything could happen”.
But, he said, it was important to speak out about the illegal withholding of congressionally appropriated funds.
In the past, progress on HIV had moved forward because of actions like this, Gawande said. “And that’s where we are again.”
The OMB did not respond to the Guardian’s questions about how much funding for Pepfar remained and whether it is legal to impound funds in this way.
“The administration has not obligated (let alone disbursed) much of the funding that has been appropriated for Pepfar,” said Jen Kates, senior vice-president and director of the global health & HIV policy program at KFF, a non-partisan health organization.
There is a formal process for rescinding funds like this, “but OMB has not submitted such a request”, she said.
In July, Donald Trump submitted a request to rescind $9bn in funding that Congress had already set aside for foreign aid and broadcasting programs.
The request included a $400m cut to Pepfar – but while lawmakers agreed to other cuts, they protected Pepfar.
“Russ Vought is defying the will of Congress. He’s breaking the law,” said Asia Russell, executive director of Health Gap and one of the protest organizers, calling the impediments on funds “illegal and unprecedented”.
In places like Kenya, Uganda and South Africa, people working on Pepfar programs have been told to cut their budgets by half, she said.
“This was their strategy from the beginning: delay the release of funds until the clock of the fiscal year comes up. It’s a bomb,” Russell said. “It’s happening without any ability to track.”
Jerilyn Hoover, a nurse, worked on Pepfar for five years before she was terminated in sweeping staffing cuts earlier this year. At the protest, she pushed her sleeping daughter in a stroller.
The program she worked on supported more than 300,000 global health workers.
When many of them lost their jobs overnight, they couldn’t bear to think about seeing the members of the communities they had supported with HIV treatment for so long. They were “forced to watch those same people show up to clinics that were closed or go without their needed medications”, Hoover said.
“We got reports of health workers who committed suicide,” she said.
Rebecca Denison, who learned she was HIV-positive 42 years ago, attended the protest with her partner. Preventive measures like medications that lower the virus to undetectable levels have meant that her partner has stayed HIV-negative for four decades.
Though they had thought they might never have children, their twins were born healthy 29 years ago. The same preventive measures that kept her partner and children from contracting HIV have now been yanked away from other families, she said.
“I feel the responsibility to show up for everyone to have the opportunities we’ve had,” Denison said.
The Trump administration reportedly drafted plans to kill Pepfar entirely.
“I sincerely believe that they picked foreign aid on purpose as what they thought would be a soft target to try out shredding these norms,” Russell said. “Actually, foreign aid is a kitchen table issue. This is not a distraction. This is a real thing, causing real harm.”
Kates noted that “numerous studies have shown that Pepfar has saved millions of lives and is also associated with significant improvement in broader health and non-health outcomes.”
“Reducing funding in an abrupt way will affect the ability to end HIV and dampen success in other areas,” Kates added.
In Mozambique, there has been a decline in testing infants who were exposed to HIV through pregnancy, birth and breastfeeding. Infants with HIV who cannot get treatment have a 50% chance of dying before their second birthday.
In Zimbabwe, HIV mortality may soar. In South Africa, there are declines in diagnosis and new initiations of HIV treatment. In Nairobi, two patients died after their doctors were ordered to stop working during the USAID pause, Atul Gawande said on Tuesday. The patients had opportunistic infections because of HIV/Aids; when they could no longer receive antibiotics for the infections, they died.
“The administration continues to deny that dismantling assistance for health and public health systems costs lives,” Gawande said. “They believe these lives won’t matter to anybody.
“Tell me: will you bear witness?” he asked the crowd.
