On January 28, 2025, leaders of Mujer-LGBT Organization, based in Zamboanga City, Philippines, shared a screenshot of an official U.S. State Department memo entitled “Notice of Suspension.” The Notice informs Mujer that their award award is immediately suspended effective January 24, 2025, directing them to “stop all work on the program”, avoid incurring new costs, and “cancel as many outstanding obligations as possible.”
It’s finally here. The day that HIV advocates have long dreaded has come. As early as November 2024, as soon as it became evident that Trump will win a second term, HIV advocates in the Philippines have been worrying about the implications of a second Trump presidency on the Philippine HIV response.
On January 24, the Trump administration suspended all new funding for foreign assistance programs. In a memo, newly confirmed U.S. Secretary of State Marco Rubio directed senior U.S. State Department officials to “ensure that, to the maximum extent permitted by law, no new obligations shall be made for foreign assistance”. This temporary freeze is set to last for at least three months. In the first 85 days, Rubio is expected to make “decisions whether to continue, modify, or terminate programs.”
The inauguration of Donald Trump for a second term in January 2025 has introduced significant shifts in U.S. global health policies, notably impacting international organizations such as the World Health Organization (WHO), UNAIDS, The Global Fund, and as well as the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). These changes have already made an impact on the global HIV response, with particular ramifications for low- and middle-income countries like the Philippines, which are dependent on U.S. foreign aid when it comes to funding their national HIV responses.
Global observers have called the freeze order “simply evil” and “murder, pure and simple”. The Red Whistle joins HIV activists all over the world in condemning this murderous suspension order, which was done without regard for the lives of millions of people living with HIV who are dependent on humanitarian aid for their treatment.
U.S. global health policy shifts under Trump
One of President Trump's initial actions was to sign an executive order withdrawing the United States from the WHO, citing dissatisfaction with the organization's handling of the COVID-19 pandemic and concerns over political influences. This decision entails halting U.S. funding, which previously constituted about 18% of the WHO's budget, significantly supporting global programs for epidemics like HIV.
The U.S. exit from the WHO has prompted global health funds, such as The Global Fund to Fight AIDS, Tuberculosis and Malaria, to seek increased contributions from the private sector. The Global Fund plans to request nearly 50% more funding from private entities, an amount equivalent to USD 2 billion, due to concerns over a potential decline in government contributions. Historically, the U.S. has been a major donor, pledging USD 6 billion in the last funding round. The freezing of international aid under President Trump creates uncertainty for the continuity of these essential health programs.
Aligned with the principles outlined in Project 2025, there is an anticipated reinstatement of the Mexico City Policy, commonly known as the global gag rule. This policy prohibits international organizations that perform or promote abortion services from receiving U.S. funding. Its reinstatement is expected to adversely affect sexual health and reproductive health outcomes and services, indirectly disrupting essential HIV services, which are mostly delivered by intermational organizations involved in reproductive health services, and particularly impacting marginalized populations, including young people, males having sex with males, and trans persons.
Trump administration and global trans health
The Trump administration’s policy shifts significantly impact USAID's transgender health programs. These policy shifts align with the broader objectives outlined in Project 2025, a conservative blueprint aiming to reshape federal agencies and policies, and have significant implications for programs supporting marginalized communities, including transgender persons.
The reinstatement of the Mexico City Policy, or the "global gag rule," for example, has the broader implication of reduced funding for comprehensive reproductive health services, including those essential to transgender individuals.
The Trump administration’s review of foreign aid programs resulted in the temporary suspension of many USAID activities, which will affect various health initiatives, including those supporting transgender health, creating uncertainty regarding the future of these programs. It is expected that there will be a contraction of support for transgender health programs within USAID, potentially limiting access to essential health services for transgender individuals globally.
U.S. Contribution to Philippine HIV Response
The Philippines is currently facing a significant HIV epidemic. As of September 2024, the Department of Health (DOH) reported 131,335 diagnosed cases, with projections estimating that the number of people living with HIV (PLHIV) at 215,400 at the end of 2024 and could reach approximately 448,000 by 2030 if prevention and interventions are not scaled up.
The U.S. has been a significant contributor to the Philippines' national HIV response through various initiatives, primarily under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).
Between 2018 and 2023, the U.S. Agency for International Development (USAID) invested over PHP 14.6 billion (around USD 260 million) in comprehensive health programs within the Philippines, addressing various health challenges and encompassing a broad range of health initiatives. A portion of this overall funding was directed specifically toward HIV prevention and treatment programs.
The USAID, through PEPFAR, has provided more than PHP 2 billion (approximately USD 34.7 million) to support the Philippines' efforts in combating HIV since 2020. In June 2024, PEPFAR donated 20,000 bottles of pre-exposure prophylaxis (PrEP) to the Philippine Department of Health (DOH). This donation was part of a larger commitment exceeding PHP 875 million (USD 18.2 million) over two years to bolster bilateral HIV prevention and control efforts.
These contributions underscore the important partnership between the United States and the Philippines in addressing the HIV epidemic. The cumulative financial support has been instrumental in enhancing HIV prevention, testing, and treatment services across the country.
The potential reduction in U.S. funding and support for global health initiatives poses challenges for the Philippine HIV response. Programs supported by PEPFAR and The Global Fund, which have been instrumental in providing antiretroviral therapy (ART) and preventive services such as provision of PrEP, condoms, and lubricants, may face funding constraints. This could hinder efforts to manage and curb the rising number of HIV cases in the country, the fastest growing HIV epidemic in the Asia-Pacific region.
The policy shifts under Trump's second administration could impede progress in HIV prevention and treatment efforts. It underscores the need for the government and civil society to explore alternative funding sources and strengthen domestic health financing to halt and reverse its growing HIV epidemic.
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