The Trump Administration’s Foreign Aid Review: Status of U.S. Support for the Global Fund to Fight AIDS, Tuberculosis and Malaria

Background on the U.S. and the Global Fund

• The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is an independent public-private, multilateral financing entity created in 2002. It raises and pools resources from multiple donors to address HIV, TB, and malaria and in turn, invests up to $5 billion per year in more than 100 low- and middle-income countries.
• The Global Fund reports that it has helped to save 70 million lives and reduce the combined death rate of its three focus diseases by 63% since 2002. With its support, in 2024, 25.6 million people were on antiretroviral therapy, 7.4 million were treated for TB, and 162 million mosquito nets were distributed.
• The U.S. government was instrumental in the creation of the Global Fund and is its largest donor, accounting for 33% of its funding. It also plays a significant role in governance and oversight of the Global Fund, holding one of twenty Board seats and currently sitting on two Board committees.
• Only LMICs whose most recent Gross National Income (GNI) per capita is below a certain threshold and meet disease burden criteria are eligible for Global Fund assistance. Countries are required to co-finance by investing in health systems and HIV, TB, and malaria national responses. To date, 11 countries have graduated from Global Fund support.

• The Global Fund has been considered the “multilateral component” of PEPFAR, as well as U.S. bilateral efforts focused on malaria and TB, complementing and extending the reach of U.S. programs to many more countries. It also works differently than U.S. bilateral health programs; unlike the U.S., it has no in-country presence and does not implement programs, instead providing financial assistance based on technical evaluations of country-led proposals. It also plays an important market shaping role through pooled procurement, driving down prices of health products, accelerating innovation and adoption of new products, and promoting quality standards, among other strategies.
• U.S. participation in the Global Fund is authorized in the legislation that created PEPFAR, as a permanent part of U.S. law. Other parts of the authorization are time-bound, including several related to the Global Fund such as a requirement that U.S. contributions to the Global Fund cannot exceed 33% of all contributions, used to limit U.S. funding and leverage support from other donors. Because PEPFAR’s current authorization expired on March 25, 2025, this requirement is not in place unless Congress includes it in appropriations or other legislative language.
• The Global Fund replenishes funding every three years, with periodic “pledging conferences” (the latest was held in November 2025). Its current replenishment (its eighth) generated $12.68 billion in pledges for the 2026-2028 period, including a pledge of $4.6 billion from the U.S.

• Prior to the start of the Trump administration, U.S. funding for the Global Fund in FY 2024 was $1.65 billion.

Current Status of U.S. Support for the Global Fund

• Stop-work order: The foreign aid review’s stop-work order initially froze all U.S. bilateral programming but was not applied to the Global Fund or other multilateral institutions. The administration subsequently announced that it canceled 86% of all USAID awards. Since the Global Fund relies on PEPFAR and other U.S. implementers, as well as U.S. government staff and expertise, to assist countries in delivering services, the disruption of that work affected some Global Fund efforts as well.
• International organizations review: A second executive order, calling for a 180-day review of U.S. participation in all international intergovernmental organizations, was initiated. Per the order, the purpose of the review was to determine which are “contrary to the interests of the United States and whether such organizations, conventions, or treaties can be reformed”. The Global Fund was not on the list of 66 international organizations from which the U.S. withdrew, per a January 7, 2026, presidential memorandum.
• America First Global Health Strategy: In September 2025, the administration released the America First Global Health Strategy, its roadmap for future U.S. government global health engagement. Per the strategy, the U.S. is negotiating bilateral, multi-year agreements with countries receiving U.S. global health assistance with an aim to transition the majority of countries to full self-reliance by the end of the agreement period. The U.S. government reports that it is coordinating with the Global Fund as it develops these agreements.
• Long-acting injectable PrEP: On September 4, 2025, the administration announced that PEPFAR would partner with the Global Fund to support provision of long-acting injectable pre-exposure prophylaxis (PrEP) to up to 2 million people in high-burden countries by 2028.
• Policy restrictions: In January 2025, the Trump administration reinstated the expanded Mexico City Policy from Trump’s first term and further expanded it in January 2026 to apply to almost all non-military foreign assistance, many more entities including multilateral organizations, and additional areas of restrictions including activities related to diversity, equity and inclusion and “gender ideology” under a broader umbrella known as the “Promoting Human Flourishing in Foreign Assistance” (PHFFA) Policy.
• Funding: The Trump administration has requested significantly less funding for the Global Fund in its budget requests, and has not provided to the Global Fund all of the funding pledged by the U.S. to, and appropriated for, the seventh replenishment period (which included 2025). Despite this, Congress has continued to appropriate funding in support of U.S. pledges, including $1.25 billion in FY 2026. In addition, Congress included language in the FY 2026 spending bill stating that there remained “sufficient unobligated balances” from prior acts “to fulfill the United States pledge for the seventh replenishment.”

What to Watch

• Implementation of the America First Global Health Strategy multi-year agreements with countries
• Status of U.S. funding appropriated by Congress for the Global Fund
• Impact of the PHFFA Policy on U.S. funding and programs, including support for multilateral organizations
• Impact of U.S. changes to global health programs on health outcomes