Defying Trump: Some Pepfar projects can now restart in full — without a waiver

The original grants of Pepfar-funded organisations that get funds through the Centers for Disease Control & Prevention (CDC) have been reinstated after a federal judge enforced a temporary restraining order blocking US President Donald Trump’s administration from freezing federal grants. 

As a result, they’re restarting their original projects, and have permission to reinstate thousands of workers who had to be laid off, reopen clinics that had to close down and restart work — such as the handing out of HIV preventive medication, voluntary medical male circumcision and projects for injecting drug users that provide clean needles and methadone — that were not allowed under waivers they had to apply for this week. 

The temporary restraining order was originally issued on January 31, but Trump ignored it. On February 10, however, the district court of Rhode Island enforced the order. As a result, at 3am on Wednesday, such organisations received a notice on a portal of GrantSolutions, a grants management service which handles CDC grants on behalf of the agency. 

“In compliance with the temporary restraining order issued on January 31 2025, in the US district court of Rhode Island, notices of award issued between January 24 and February 11 2025, that instructed termination, ceasing, suspending, or limiting of activities under this award consistent with administration executive orders are officially rescinded,” the notice said. “Activities under this award are no longer terminated, ceased or suspended. All other existing terms and conditions are still in effect.”

Health department spokesperson Foster Mohale says the department, which receives Pepfar funding through the CDC, didn’t receive a notice. 

On Wednesday afternoon, Bhekisisa sent the US embassy & consulates questions, including what will happen to projects receiving their funds through the US Agency for International Development (USAID), but they had not responded by the time of publication.

What has happened so far

Pepfar, the US President’s Emergency Plan for Aids Relief, was launched in 2003 to help fight Aids in countries with high HIV infection rates such as South Africa. The country has since received around $8bn, of which $439.537,828 was for the current US financial year, which stretches from October 1 2024 to September 30 2025. 

Pepfar funds are sent to organisations via federal agencies, mostly the CDC and USAID. The CDC is situated within the department of health & human services. Roughly half of Pepfar funds in South Africa are distributed through the CDC to about 20 organisations. These include the Wits Reproductive Health Institute, Shout it Now, TB HIV Care, Right to Care, the Aurum Institute, the Human Sciences Research Council, the BroadReach Corp, the South African National Aids Council, the South African Medical Research Council, the Foundation for Professional Development and the national health department.

The Trump administration froze funding globally for all US-funded aid projects on January 24. It then announced a limited waiver for some projects on February 1. On February 7, however, Trump signed an executive order that cancelled all funding from his government for South Africa for what he labels as “unjust and immoral practices” of South Africa that “harm our nation [the US]”. 

But on Monday the US embassy & consulates in South Africa announced that Pepfar-funded projects could still apply for waivers with rules that allowed only activities that were directly related to “lifesaving treatment”. 

Gone are the waiver rules — but for how long? 

Now those waivers no longer apply to organisations receiving their funds via the CDC and they can continue with the original grants — but for how long is uncertain. At the same time, this does not appear to be the case for Pepfar projects funded through USAID, as this funding comes through the US state department and remains on an overall pause, with only some limited waivers. 

Trump appealed the ruling on February 11 — and asked that the issue be resolved by February 14. 

Nonetheless, Bhekisisa has spoken to six Pepfar-funded organisations whose funds get to them through the CDC, and they’re all adamant that they will restart their work now. One organisation, which has had to lay off 1,500 workers, is meeting with them to tell them they’ve been reinstated. “We’re restarting services,” the organisation’s director, who doesn’t want to be named, says. “Of course we’re scared that the US government will once again not stick to what it said it would, but we’re also thinking about the impact the closing down of our clinics and programmes have had on our clients and we therefore think it’s important to restart it.”

A project director who works in the field of mental health, and whose project didn’t qualify for a waiver, and as such was stopped with 430 staff members, mostly health workers, being laid off, says: “We’re anxious, because we don’t know for how long this will carry on, but at least it gives us a while to plan for proper transition, as opposed to the abrupt shutting down of projects which is so disruptive — and cruel. 

“It’s a wake-up call for everyone involved.”

What happens to Pepfar after this year? 

Last year warning signs emerged when the US Congress authorised only one year of Pepfar funding as opposed to the normal five years. That meant projects could only be funded — and could only plan — for a year at a time. 

Most projects therefore have year-long budgets that end on September 30 2025 (the end of the US financial year). Even in the case of multiyear grants, Pepfar grants currently have to be reconfirmed by the end of September.

The reauthorisation of Pepfar is needed by the end of March. The big question is: what happens after that? 

The Trump administration has said it’s re-evaluating projects to see if they’re worth funding at all. But the US president doesn’t have the power to end Pepfar — that authority lies with members of Congress. 

On Monday, though, secretary of state Marco Rubio said in an interview with African Media Hub, a US government media service, that while he thinks Pepfar should be phased out eventually, he supports it. 

“I’m a supporter of Pepfar. I have been in Congress … It’s a programme we want to continue. Obviously, we’re going to have questions about it … It’s a programme that should be getting smaller over time, not bigger, right? Because you’re preventing HIV, you’re preventing the spread of HIV, and so people aren’t testing positive because their viral load gets down, they’re not passing it on to their children. So ideally, it’s a programme that over time shrinks, not expands, because less and less people are getting HIV or are transmitting it to their children.”

Talks about phasing Pepfar out and getting local governments to take over the financial support have been happening for a few years, but such plans were based on a gradual transition to make sure projects were sustainable. 

“Pepfar has been a hugely successful long-term investment, but it was never meant to be a forever investment,” says Mitchell Warren, the executive director of the New York-based HIV advocacy organisation Avac. 

“The conversations among all partners over the past few years have been on designing strategic transitions. Now, even with the temporary return of CDC projects, we are all still dealing with chaos. We should be moving from an emergency response (in the original name) to a sustainable response. 

“Tragically, we are dealing with a crisis response.” 

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.