Health
Foreign Aid Freeze Leaves Millions Without H.I.V. Treatment
Two weeks into President Trump’s sweeping freeze on foreign aid, H.I.V. groups abroad have not received any funding, jeopardizing the health of more than 20 million people, including 500,000 children. Subsequent waivers from the State Department have clarified that the work can continue, but the funds and legal paperwork to do so are still missing.
With the near closure of the American aid agency known as U.S.A.I.D. and its recall of officers posted abroad, there is little hope that the situation will resolve quickly, experts warned.
H.I.V. treatment and services were funded through the President’s Emergency Plan for AIDS Relief, or PEPFAR, a $7.5 billion program that was frozen along with all foreign aid on Mr. Trump’s first day in office.
Since its start in 2003 during the George W. Bush administration, PEPFAR has delivered lifesaving treatment to as many as 25 million people in 54 countries and had enjoyed bipartisan support. The program was due for a five-year reauthorization in 2023; it survived an effort by some House Republicans to end it and was renewed for one year.
Without treatment, millions of people with H.I.V. would be at risk of severe illness and premature death. The loss of treatment also threatens to reverse the dramatic progress made against H.I.V. in recent years and could spur the emergence of drug-resistant strains of H.I.V.; both outcomes could have a global impact, including in the United States.
The pause on aid and the stripping down of U.S.A.I.D. have delivered a “system shock,” said Christine Stegling, a deputy executive director at UNAIDS, the United Nations’ H.I.V. division.
“Now you need to see how you can work with the system as it is, to make sure that what is theoretically possible will actually happen,” she said.
On Jan. 28, Secretary of State Marco Rubio issued a waiver for lifesaving medicines and medical services, ostensibly allowing for the distribution of H.I.V. medicines. But the waiver did not name PEPFAR, leaving recipient organizations awaiting clarity.
On Sunday, another State Department waiver said more explicitly that it would cover H.I.V. testing and treatment as well as prevention and treatment of opportunistic infections such as tuberculosis, according to a memo viewed by The New York Times. The memo did not include H.I.V. prevention — except for pregnant and breastfeeding women — or support for orphaned and vulnerable children.
Although PEPFAR is funded by the State Department, roughly two-thirds of its grants are implemented through U.S.A.I.D. and the Centers for Disease Control and Prevention. Neither organization has released funds to grantees since the freeze was initiated.
In an interview with The Washington Post, Mr. Rubio appeared to blame the recipient organizations for not acting on the waiver, saying he had “real questions about the competence” of the groups. “I wonder whether they’re deliberately sabotaging it for purposes of making a political point,” he said.
But experts familiar with PEPFAR’s requirements said his comments belied the complexity of its system of approvals.
“The messaging and guidance from the State Department expose an ignorance of how these programs function — and an alarming lack of compassion for the millions of lives at risk,” said Jirair Ratevosian, who served as chief of staff for PEPFAR in the Biden administration.
For instance, the stop-work orders compelled each program to cease immediately. The organizations are now legally required to wait for equally explicit instructions and cannot proceed on the basis of a general memo, according to a senior official at a large global health organization that receives PEPFAR funds.
“We have to wait till we get individual letters on each project that tell us not only we can start work, but tell us which work we can start up and with how much money,” the official said. The official asked not to be named for fear of retaliation; 90 percent of the organization’s money comes from PEPFAR.
The freeze is also disrupting the network of smaller organizations that deliver H.I.V. treatment and services in low-income nations.
In a survey of 275 organizations in 11 sub-Saharan countries conducted over the past week, all reported that their programs or services had shut down or were turning people away, said Dr. Stellah Bosire, executive director of the Africa Center for Health Systems and Gender Justice.
At least 70 organizations reported disruptions in H.I.V. prevention, testing and treatment services, and 41 said that some programs had closed. “Without immediate intervention, these funding suspensions could lead to devastating reversals in public health progress,” Dr. Bosire said in an email.
In Kenya, 40,000 doctors, nurses and other health workers have been affected by the freeze, according to Mackenzie Knowles-Coursin, who was deputy chief of communications at the American mission in Nairobi until Monday. In South Africa, the halt in funding will affect the salaries of more than 15,000 health workers and operations across the country, the nation’s health minister, Aaron Motsoaledi, said during a televised news conference last week.
Some organizations rely on a patchwork of grants, with a stream of funding from one donor applied to purchasing medications and another stream applied to paying staff. Interruption of even one source can hobble the clinics, leaving them without medications to dispense or workers to dispense them.
The Uganda Key Populations Consortium, an umbrella organization that provides H.I.V. treatment and other services, has lost 70 percent of its funding. It has shuttered 30 of the 54 drop-in centers around the country that dispense medications, and it terminated the contracts of 28 of its 35 staff members.
The organization received about $200,000 per year from the C.D.C. via the Infectious Diseases Institute at Makerere University, as well as an $8 million grant over five years from U.S.A.I.D. The latter provided housing and employment assistance, including to gay and transgender people, and has been shut down to comply with Mr. Trump’s executive order on diversity, equity, inclusion and accessibility.
In 2023, Uganda enacted a sweeping law that criminalized consensual sex between same-sex adults and made same-sex relations while having H.I.V. punishable by death. It has caused scores of Ugandans to be evicted from homes and fired from jobs.
“Cases of human rights violations haven’t really slowed, and now it’s really concerning,” said Richard Lusimbo, director general of the Uganda Key Populations Consortium.
“We don’t even have the capacity or even the tools that we need to actually respond to some of these issues,” he said.
Some organizations dispense medicines to children, which requires more skill than treating adults. Children’s medications are tailored to their age, weight and prior exposure to antiretroviral drugs, and the children must be carefully monitored for drug resistance.
In children who acquired H.I.V. at birth, the infection can progress very quickly to illness, with death occurring as early as eight to 12 weeks after birth — shorter than the 90-day pause on foreign aid.
On Tuesday night, the Trump administration put nearly all of U.S.A.I.D.’s global work force on leave and recalled those posted abroad to return to the United States within 30 days.
“There’s a loss of institutional memory, which may be purposeful, but it’s also creating just a backlog of paperwork, and it’s paralyzing the whole system,” said Elisha Dunn-Georgiou, the president of Global Health Council, a membership organization of health groups.
“Who do you ask questions to?” she said. “How do you move to the next step?”
Without U.S.A.I.D. staff to process waiver applications, organizations fear they will not see funds anytime soon. Even large global health organizations are struggling to stay afloat; some have already cut programs and staff.
Even if the funds return quickly, it may not be easy to restart programs and return to something resembling normalcy, Ms. Dunn-Georgiou said.
“It costs a lot to restart something, so I don’t think we really know yet if that’s even possible,” she said.
Lynsey Chutel and Stephanie Nolen contributed reporting.
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Research continues to uncover new details on how fasting may help extend life.
A new study published in the journal Nature Communications investigated how intermittent fasting can boost longevity in small worms often used in aging research.
Researchers from the University of Texas Southwestern Medical Center in Dallas compared worms that were fed normally to those that underwent a 24-hour fast in early adulthood and were then fed again, according to a press release.
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The scientists measured a variety of factors, including stored fat, gene activity related to fat metabolism and lifespan.
The results showed that the life-boosting benefit did not depend on the fasting itself but on the body’s behavior after eating again.
Experts say sustainability is key when choosing a long-term weight-loss strategy. (iStock)
Study lead Peter Douglas, associate professor of molecular biology and a member of the Hamon Center for Regenerative Science and Medicine at UT Southwestern, suggested that these discoveries “shift the focus toward a neglected side of the metabolic coin – the re-feeding phase.”
“Our data suggest that the health-promoting effects of intermittent fasting are not merely a product of the fast itself, but are dependent on how the metabolic machinery recalibrates during the subsequent transition back to a fed state,” he said.
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“Our findings bridge a gap between lipid metabolism and aging research,” he added. “By targeting aging, the single greatest risk factor for human disease, we move beyond treating isolated conditions toward a preventive model of medicine that enhances quality of life for all individuals.”
Lauri Wright, director of nutrition programs at the University of South Florida’s College of Public Health, called this a “high-quality” study that adds an “important nuance to how we think about fasting and longevity.”
Intermittent fasting typically involves limiting meals to an eight-hour daily window or fasting every other day. (iStock)
The benefits of the refeeding phase after fasting were “especially interesting,” Wright, who was not involved in the study, told Fox News Digital.
“The researchers showed that longevity was linked to the body’s ability to turn off fat breakdown after fasting, allowing cells to restore energy balance,” she reiterated.
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“From a scientific standpoint, that’s a meaningful shift because it suggests fasting is not just about burning fat, but about metabolic flexibility.”
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Fasting may support longevity through triggering metabolic switching, enhancing cellular repair and stress resistance and improving markers like insulin sensitivity, research shows.
Limitations and cautions
Although this study provides “important insight” on the power of refeeding, Wright noted that the findings should be approached with caution, as the study was done on worms and cannot always be translated to humans.
“Additionally, it explains how a process might work in a controlled lab condition rather than real-world eating behaviors,” she added as a limitation. “Finally, the study is short-term and doesn’t give us the long-term translation on lifespan outcomes.”
The review found intermittent fasting was barely more effective than doing nothing, according to the study authors. (iStock)
Wright cautioned that fasting is “not a magic solution for longevity, and how you eat overall matters more than when you eat.”
“I advise, first and foremost, to focus on diet quality, including a variety of fruits and vegetables, healthy fats and minimally processed foods,” she said.
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For those who are considering fasting, it’s better to stick with a moderate plan — like a 12- to 14-hour overnight fast — rather than going to extremes, Wright said. After fasting, she recommends focusing on well-balanced meals.
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Several groups of people should be cautioned against fasting, according to Wright, including those with diabetes who are on insulin or hypoglycemic medications, those who are pregnant or breastfeeding, anyone with a history of eating disorders and older adults at risk of malnutrition.
Anyone considering intermittent fasting should consult with a doctor before starting.
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More than three million people travel to undergo cosmetic surgery each year, statistics show — but the potential savings come at a cost.
Most people opting to pursue this so-called “medical tourism” are chasing budget-friendly price tags.
International surgeries, such as hair transplants in Turkey, can cost as little as $4,000 to $5,000 compared to $20,000 to $30,000 in the U.S., but often come with extreme risks, according to board-certified plastic surgeon Dr. Sheila Nazarian of California.
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The doctor recently joined Lisa Brady on the “The FOX News Rundown” podcast to discuss the rising trend of medical tourism. One of the biggest risks, she said, is the lack of safety regulations in popular destinations like Mexico and Turkey.
As demand spikes in these medical tourism “mills,” there have been reports of non-medically trained staff performing procedures like hair transplants.
Most people opting to pursue “medical tourism” are chasing budget-friendly price tags. (iStock)
“I’ve heard that they [international clinics] are even recruiting people who maybe were taxi drivers and then putting them through their own training program … to become hair transplant technicians,” Nazarian said. “That’s how high the demand has become.”
In the U.S., medical school graduates are granted a “physician and surgeon” license, which means doctors — including pediatricians or OB-GYNs — can legally perform cosmetic surgeries, even if they didn’t receive specialized training for those procedures during residency, Nazarian noted.
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Instead of pinching pennies, the doctor recommended paying whatever amount is necessary to ensure quality treatment.
“People think of it as, you know, going to the mall. … It’s surgery, and surgery has risks,” she said. “You need to be with someone who not only can perform a beautiful surgery, but who can handle possible complications well.”
“You need to ask them: ‘What was your residency training in? And if you wanted to, would you be allowed to do this procedure in a hospital?’”
Aftercare is another critical factor in the success and safety of a cosmetic procedure, as the doctor emphasized that 20% of a surgical result depends on post-operative care.
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This can be difficult or even impossible to manage when a doctor is in a different time zone, she cautioned, or if the clinic disappears shortly after the procedure.
Nazarian also noted the importance of addressing the psychological component of plastic surgery, noting that no procedure will fix underlying unhappiness. The doctor said she uses screening questionnaires to ensure that patients are truly seeking self-improvement rather than a “cure” for deeper issues.
International surgeries, such as hair transplants in Turkey, can cost as little as $4,000 to $5,000 compared to $20,000 to $30,000 in the U.S., but often come with extreme risks. (iStock)
“If you’re not already generally very content with your life, a knife in my hand is not going to bring you there,” Nazarian said.
“The analogy I always give is you don’t want a paisley couch — you want a neutral couch and you can put paisley pillows on it,” she said, noting that a procedure should “make you look normal, God-given, athletic. And then you can change your clothes when the trends come and go.”
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Samuel Golpanian, M.D., a double board-certified plastic surgeon in Beverly Hills, said he has also seen an increasing number of patients undergoing cosmetic procedures abroad, sometimes with “devastating consequences.”
“The key is being extremely careful before embarking on this journey.”
“I’ve seen a wide range of complications, including infections, poor wound healing, significant scarring and tissue necrosis (skin death),” he told Fox News Digital. “These complications often lead to prolonged pain, ongoing medical problems, and significant additional costs to repair the damage.”
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Golpanian said he’s treated patients who received unsafe or non-medical-grade injectable materials, which can lead to serious long-term health issues.
One surgeon said he’s treated patients who received unsafe or non-medical-grade injectable materials, which can lead to serious long-term health issues. (iStock)
“I’ve also seen damage to underlying structures, asymmetry and results that are extremely difficult — sometimes impossible — to correct.”
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“That said, I’ve also seen some good outcomes, so it’s not all bad,” he noted. “The key is being extremely careful before embarking on this journey.”
Quick tips for safe ‘medical tourism’
Fully vet the surgeon. “Most surgeons will provide information about their education and training, but it’s important not to accept these claims at face value,” Golpanian said. “Verify them directly by contacting the institutions where they trained.”
Ask for references from prior patients. Ideally, it’s best to get references from U.S.-based patients who can speak candidly about both their experience and their results, the surgeonsaid.
Think beyond the cost. Golpanian emphasized the adage “you get what you pay for.” “Cost should take a back seat to experience, training, judgment and proven results,” he advised.
Be cautious about relying on before-and-after photos. These can be selective or even enhanced, Golpanian warned.
Keep aftercare in focus. “Make sure the practice emphasizes comprehensive follow-up care and has a clear, realistic post-operative plan in place.”
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