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Impact of PEPFAR Stop Work Orders on PrEP

Impact of the Stop-Work Order on PrEP

The impact of PEPFAR stop-work orders on HIV prevention outcomes is expected to be severe. This section of PrEPWatch (with downloadable slides) shares the impact of these orders, including widespread disruptions across the HIV prevention continuum—including halted PrEP services, stalled product introductions (with PEPFAR’s CAB rollout paused), terminated research studies, and significant reductions in healthcare workforce.

Programmatic Supply of Injectable PrEP

As of March 2025

botswana

Botswana

Partial disruption

Eswatini

Eswatini

Partial disruption

Malawi

Malawi

Partial disruption

mozambique

Mozambique

Good service

namibia

Namibia

Suspended

botswana

South Africa

Partial disruption

Ukraine

Ukraine

Partial disruption

zambia

Zambia

Good service

Zimbabwe

Zimbabwe

Partial disruption

→ Click here for full details on the impact to CAB rollout

What Just Happened?

  • January 20: US President issued an executive order calling for a 90-day freeze on foreign aid
  • January 27: Stop work orders issued on all USAID-funded grants, halting significant proportion of HIV prevention research and delivery across the world
  • February 1: Limited waiver announced for PEPFAR activities, though it does not cover any HIV prevention activities outside of vertical transmission
  • February 26-28: Despite waiver and a judicial temporary restraining order against the freeze, the vast majority of USAID-funded programs received terminations; confusion remains

Impact to date has already been significant, as quantified in the PEPFAR Impact Tracker and documented by PEPFAR Watch, amfAR and the HIV Modelling Consortium.

PEPFAR Stop-Work Orders and HIV Prevention

The impact of PEPFAR stop-work orders on HIV prevention outcomes is expected to be severe.

  • If PEPFAR is not re-authorized and no other resources fill the gap, “there would be a 400% increase in AIDS deaths, amounting to 6.3 million deaths” – UNAIDS
  • Without funding for prevention programmes in Africa, over the next ten years, incidence rates amongst adults could triple and vertical transmission is likely to double – HIV Modelling Consortium
  • “Organizations that deliver HIV services not covered by the [PEPFAR] waiver, such as those primarily implementing prevention services…, are especially unlikely to survive the 90-day freeze… The national and global HIV response will fall back from these hard-fought gains and create the environment for HIV to re-surge.” – amfAR
  • 84% of 65 implementing partners reported disruption to PrEP service delivery following the stop work order – PEPFAR Watch

Learn More

This is the result of analysis drawing on key informant interviews with representatives of Ministries of Health and PrEP implementers conducted between 27 January 2025, when stop-work orders were issued by the US government, and the end of February 2025, when the vast majority of USAID-funded projects received official termination notices.

AVAC will continue to assess the situation as it develops and update this document as more information becomes available. If you have any additional information or insights to share, please contact [email protected].