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Engage Men’s Health, a nonprofit organization in South Africa, offers testing and medications to prevent and manage HIV at three clinics throughout the country — all for free.

That is, they did until Monday. That’s when the clinic, which has been funded by the U.S. initiative PEPFAR, says it received orders from the U.S. government to stop all work immediately. It is now closed until further notice, according to notices on its website and social media.

This development is the consequence of the Trump administration action on Friday ordering a stop-work for all global health funding, including PEPFAR — the U.S. President’s Emergency Plan for AIDS Relief.

That action had an immediate impact.

Clinics have “stopped distributing medications and PEPFAR central information systems were shut down,” Atul Gawande, assistant administrator for global health at USAID under the Biden administration, told NPR in an email.

At least 220,000 patients around the world visit the network of PEPFAR-supported clinics daily, according to a fact sheet from amfAR, the Foundation for AIDS Research, a premiere advocacy organization for people with HIV and AIDS.

Some 20 million people around the world rely on these programs for medications.

Many patients take home a three- to six-month supply of medications. The meds keep the virus at bay for those who are HIV-positive and protect HIV-negative people from infection. Those who were able to receive medicine in early December will run out in early February, Deborah Birx, a senior fellow at the Bush Institute and former Global AIDS coordinator, told NPR.

“What I hope is true, and only the program can know that, [is that] the majority of patients would have medications through the end of February,” Birx said. “It’s really critical for us to be working together right now” to restore this access to medications, she said.

If a person who is HIV positive does not take these medications, the virus can multiply, leading to illness and the spread onward to other people through intimate contact. And these developments can also lead to mutations in the virus, potentially making it more transmissible or resistant to medications that were previously effective at keeping it in check.

One clinic serving the transgender community in Johannesburg, South Africa posted a message on X, notifying patients that it would be closed until further notice because of the stop-work order. (The organization running the clinic subsequently deleted all of their social media accounts and mentions of the clinic on its website.)

“Visit the clinic on 28 January before 4 PM to collect your medication,” the clinic wrote hours before closing its doors indefinitely.

That kind of shutdown is happening at PEPFAR-supported clinics all over sub-Saharan Africa, Asia Russell, executive director of the HIV access organization Health GAP, told NPR. She’s seen messages from staff to patients that say, “Our clinics are closing. You must come in today to get a supply of medicines.”

The clinics say in statements they had to close because of the stop-work order issued by the United States. All USAID partners in Tanzania, for example, were ordered to “to immediately stop, cease, and/or suspend any work being performed,” according to a memo from USAID obtained by NPR.

“They have to stop work, or they will be in defiance of the stop-work order and disciplinary action will be taken,” Russell said. “Everyone is devastated by this.”

Contractors at PEPFAR, both within the U.S. and abroad, were also laid off, which means some of the staff running the health-care centers funded by the initiative no longer have jobs. In addition, data systems for the program, which tracks everything from the work of local programs to country-level commitments to fight HIV, were dismantled on Monday.

An ‘unprecedented’ order

It’s not unusual for a new administration to order a review of existing programs or even to pause new spending, Matthew Kavanagh, director of Georgetown University’s Center for Global Health Policy & Politics, told NPR in an email. “But the stop-work order shutting down life-sustaining medical care is both unprecedented and reckless.”

“There is no good rationale for this,” he said. “This is a dangerous move.”

Senior PEPFAR officials have submitted a waiver to the State Department for medications to continue being disbursed, Russell said.

It’s not clear what the system is for processing these waivers and how long that takes — but it’s critical for this to happen as soon as possible, she told NPR.

“The waiver authority of Secretary Rubio needs to be applied immediately to the entirety of the PEPFAR program,” she said.

The State Department confirmed the halt on foreign assistance to NPR in an email on Sunday but has not responded to further inquiries.

Laying off contractors

The stop-work action is not the only shakeup affecting PEPFAR and health programs that address HIV. Senior staff at USAID were placed on administrative leave unexpectedly on Monday. And all contractors in the USAID global health bureau, who constitute half of the bureau’s workforce, were also told to stop working, said a source at USAID who requested anonymity because they were not authorized to speak to the press. These contractors work within the U.S. and internationally.

The contractors who work on PEPFAR were “fully laid off, not furloughed,” the source told NPR.

Family Health International (FHI 360), a key contractor that implements PEPFAR and supporting programs for the prevention and treatment of HIV/AIDS, received a letter from USAID via email ordering the organization to “cease implementation immediately” and not resume work until “this Stop Work Order has been canceled.” A USAID official shared a copy of this memo with NPR.

All of PEPFAR’s data systems were dismantled on Monday, Russell confirmed. Those systems track everything that happens across the massive $6.5 billion program, which is mainly overseen by USAID but also by the State Department and the U.S. Centers for Disease Control and Prevention.

Fatma Tanis of NPR contributed to this story.

Melody Schreiber is a journalist and editor of What We Didn’t Expect: Personal Stories About Premature Birth. Follow her on Bluesky @melodyschreiber.com.