Editor's note: Since the publication of this story, credible reports from journalists and researchers indicated that the Trump administration continued to withhold lifesaving HIV medications and services despite the emergency humanitarian waiver reported on in this story.
On his first day in office in January 2025, President Trump signed an executive order putting a 90-day pause on funding virtually all foreign aid initiatives and programs pending a review for alignment with Trump's priorities.
That order read, in part, that:
It is the policy of United States that no further United States foreign assistance shall be disbursed in a manner that is not fully aligned with the foreign policy of the President of the United States. [...]
All department and agency heads with responsibility for United States foreign development assistance programs shall immediately pause new obligations and disbursements of development assistance funds to foreign countries and implementing non-governmental organizations, international organizations, and contractors pending reviews of such programs for programmatic efficiency and consistency with United States foreign policy, to be conducted within 90 days of this order.
On Jan. 24, the State Department issued a memo (which Trump later rescinded) putting Trump's executive order into effect. One program that was affected, at least initially, had been put in place by George W. Bush in 2003 — the President's Emergency Plan for AIDS Relief, or PEPFAR. The program distributes lifesaving HIV medication to patients in countries fighting the AIDS epidemic.
The news led to headlines about Trump's plans to deprive AIDS patients of life-saving treatments:
These claims were initially accurate. In a statement to NPR, Trump's State Department confirmed that PEPFAR was to halt their activities as part of the order:
The State Department confirmed the halt in an email to NPR. The United States "is no longer going to blindly dole out money with no return for the American people," State spokesperson Tammy Bruce said in a statement, calling the pause "a moral imperative."
According to a Jan. 22 report from The New York Times, the order had immediate consequences:
Appointments are being canceled, and patients are being turned away from clinics, according to people with knowledge of the situation who feared retribution if they spoke publicly. Many people with H.I.V. are facing abrupt interruptions to their treatment.
But most federal officials are also under strict orders not to communicate with external partners, leading to confusion and anxiety, according to several people with knowledge of the situation.
U.S. officials have also been told to stop providing technical assistance to national ministries of health.
PEPFAR's ability to operate during the 90-day pause was soon resurrected, however. Responding to controversy over the confusion and potential harm caused by the order, Secretary of State Marco Rubio issued an "emergency humanitarian waiver" on Jan. 29 — something the original executive order empowered him to do — for groups distributing life-saving supplies or services.
The waiver, which has also been criticized for its lack of clarity, allowed PEPFAR programs to continue operating in spite of any pause, at least according to the UNAIDS Foundation, a partner in the program:
The executive order announcing a "90-day pause in United States foreign development assistance for assessment of programmatic efficiencies and consistency with United States foreign policy" was one of the first major foreign policy decisions of the new administration. This waiver approves the continuation or resumption of "life-saving humanitarian assistance" which applies to core life-saving medicine and medical services, including HIV treatment, as well as to supplies necessary to deliver such assistance.
Issues related to Trump's executive order were, for the time being, further complicated by the fact that a judge halted, at least for a week, the portions of the order related to existing funds already allocated by Congress. That action took place on Jan. 28. A hearing on that matter was set for Feb. 3 and could potentially allow the order to move forward.
It is true, however, that Trump issued an executive order that initially included stopping the activities of a foreign aid program that delivered life-saving AIDS medications to individuals abroad. That is no longer the case because of Rubio's waiver and pending judicial challenges.