Federal budget office is withholding HIV funds that Congress appropriated

The Trump administration is ignoring a directive from Congress and refusing to fully fund a landmark HIV program that is widely credited with saving millions of lives over the past two decades.

The Office of Management and Budget, headed by Russell Vought, has apportioned only $2.9 billion of $6 billion appropriated by Congress for the President’s Emergency Plan for AIDS Relief in the 2025 fiscal year spending bill, according to budget documents and members of the program’s staff.

PEPFAR, as the program is known, was created in 2003, during the George W. Bush administration, to provide funding for HIV prevention and treatment to low-income countries. It has long enjoyed broad bipartisan support and is often cited as the most effective public health campaign ever, credited with saving an estimated 26 million lives.

In July, the Trump administration withdrew a proposed $400 million rescission from PEPFAR’s budget in the face of bipartisan Senate opposition. But that fight was a distraction, according to staff members who work on the program, because, they said, they have repeatedly been told by Vought’s budget office that the program would be receiving only about half of the $6 billion appropriated by Congress for the 2025 fiscal year, even with that $400 million restored.

That cut is visible in budget documents that appear on a federal website tracking the activity of the White House Office of Management and Budget. The Trump administration took that website offline in January, but it was restored late last week after a court order.

Whether the executive branch can withhold money appropriated by Congress has been a focus of a number of legal battles since the President Donald Trump took office vowing to slash government spending and terminate many foreign aid programs.

The decision not to release the PEPFAR funds is in keeping with Vought’s stated belief that the executive branch can use the budget office forcibly to shrink the size of government. He has faced limited resistance from Congress, although some members have accused him of impoundment.

The Impoundment Control Act restricts how a president can withhold funds appropriated by Congress. It was passed in 1974 to give Congress greater control over the budget in response to the impoundment practices of President Richard Nixon.

A spokesperson for Vought’s office said that further financial allocations were awaiting a planning document and that those funds could be disbursed through 2029.

PEPFAR funds are normally appropriated by Congress in five-year cycles but allocated to the program each year. At this point in previous years, PEPFAR’s funding had been allocated in full, according to veteran staff members at the program, to allow for planning for disbursement of those resources.

The amount the OMB has released for the 2025 fiscal year roughly aligns with the budget proposal the Trump administration sent to Congress in May for 2026 – $2.9 billion – offering a possible clue to Vought’s view on how much money the program should have.

William Hoagland, an expert on federal budgets with the Bipartisan Policy Center, a Washington think tank, said the failure to apportion the 2025 funds appeared to be a deliberate slow-walk. The effect was preventing PEPFAR from using the money and creating a justification for a much bigger rescission, said Hoagland, who was once a top aide to former Senate Majority Leader Bill Frist, R-Tenn.

A footnote on the OMB document outlines a multistep process in which the PEPFAR leadership would need to submit a spending plan for this fiscal year (of which less than six weeks remain), the OMB would revise that plan, and there would be further back-and-forth consultation. It requests that the submission include “a detailed description of how such spending plan aligns with Administration priorities.”

If Congress does not intervene, the funds will have been effectively cut, as the period for their use has passed, Hoagland said.

“Then Vought has achieved the goal that he wanted, which was to reduce funding for PEPFAR,” he said.

The withholding of PEPFAR funds is eroding HIV programs that have relied on the program’s support to operate. While many have had to close completely since the Trump administration began to curtail foreign aid with an Inauguration Day executive order, others were continuing to operate on a reduced budget.

Lifesaving HIV programs were covered by a waiver that allowed them to resume operations.

But now some are being told to pare back their budgets, on a scale that mirrors the amount of money being withheld.

Dr. Pasquine Ogunsanya, the director of a large HIV program in Uganda, said that this month her organization had received money only for salaries and limited administrative costs, and that there was no budget for services such as delivering medications to bedridden patients or admitting critically ill individuals to the clinic.

She said she had been told this week that her program’s budget would shrink by a further 40%. “I’m just thinking how can we do that, I’m having sleepless nights,” she said. “How can we have five people providing lifesaving HIV services to 10,000 clients?”

The administration has criticized global health programs as frequently bloated and wasteful, and argued that the countries that received the aid should do more to help their citizens. It has also urged other organizations and high-income countries to do more.

As part of the administration’s effort to end diversity, equity and inclusion programs, it has terminated HIV care for gay and transgender people. HIV prevention programs for high-risk groups – such as sex workers and injecting drug users – have been cut and only pregnant and breastfeeding women can now receive U.S.-funded prevention drugs or condoms.

“OMB is blocking funding for PEPFAR,” said Sen. Susan Collins, R-Maine, who chairs the Senate Appropriations Committee. “Congress rejected OMB’s proposed $400 million rescission in PEPFAR funding, yet none of these funds have been obligated to program. PEPFAR funds are simply not reaching those in need, as confirmed by those in the field.”

Sen. Patty Murray, D-Wash., vice chair of the Appropriations Committee, called the failure to appropriate the PEPFAR funds a de facto funding cut. “Even after promising Republican lawmakers that the program would be protected, Russ Vought has choked off a huge chunk of funding provided by Congress for PEPFAR,” she said. “And he’s managed to hide this cut from lawmakers and the public until now because he took down a key spending transparency website.”

Internal documents from the State Department show that the person approving these documents is Amarallyis Fox Kennedy, identified as the “Program Associate Director for Intelligence and International Affairs Programs.” Fox Kennedy is the daughter-in-law of Health Secretary Robert F. Kennedy Jr. and was reported to have helped broker his endorsement of Trump. She did not respond to requests for comment on her role in supervising the PEPFAR budget.

Staff members in the new Bureau of Global Health Security and Diplomacy at the State Department, which now oversees PEPFAR, described verbal directives from the OMB in which they were told that the maximum amount that they would be given would be $2.9 billion, and that they should make plans with implementing partners accordingly. They spoke on condition of anonymity for fear of reprisal.

Another footnote on the OMB document says that the funds apportioned are for PEPFAR but also “Global Health security, Tuberculosis, Malaria, and Polio eradication and prevention.”

PEPFAR funding appropriated from Congress is earmarked strictly for HIV programs; other global health activities have a separate funding stream.

The chokehold on funding comes at the same time that senior staff members are drafting a plan, at the direction of the State Department, to shut PEPFAR down, cutting some countries off in as little as two years and shuttering the whole program within eight.

This article originally appeared in The New York Times.