On 17 September 2025, over 360 health advocates, community leaders, and representatives from civil society worldwide participated in a virtual meeting to talk about the future of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The meeting was initiated by disclosed U.S. government papers detailing significant alterations to the program. The documents detail a “Bridge Planning” procedure for PEPFAR activities from October 2025 to March 2026. Though aimed to be a short-term solution, activists worry it could threaten PEPFAR's previous successes, reduce transparency, and alienate the program from the communities it supports, possibly jeopardizing the progress made in the battle against HIV over the past two decades.

The Bridge Plan: A shift in direction

The three-page document called the "FY 2026 PEPFAR Bridge Plan" has caused a lot of worry. Main highlights include:

• Decreased funding for programs. Materials shown during the meeting reveal that funding for specific countries has been significantly decreased in relation to previous years. In Zambia, the budget for six months totals $117 million. Representatives from civil society stated that this accounts for about 50% of past yearly funding totals, sparking worries about potential service interruptions
• Reduced range of services. The Bridge Plan highlights the importance of prioritizing "life-saving" services. This means prioritizing antiretroviral therapy, HIV testing, preventing mother-to-child transmission, and providing pre-exposure prophylaxis (PrEP) for women who are pregnant or breastfeeding. Broader prevention programs for adolescent girls, young women, and specialized services for key populations like sex workers and transgender individuals are excluded.
• Reduced engagement from the community. A significant change from past protocols is the recommendation that planning will primarily take place as an internal activity within the U.S. government. Future consultations exist, but direct engagement with host governments and civil society is notably limited in contrast.

Country reports: A lack of consultation

The meeting offered a chance for attendees from multiple countries to exchange their experiences. A recurring theme appeared: communities and civil society groups have not been sufficiently engaged in the planning process.

• Tanzania: Francis Luwole said local community groups haven’t been involved. “So far, CSOs and communities haven’t taken part in the planning,” he explained, adding that many didn’t even know it was happening.
• Malawi: Thandie Msukuma shared that civil society groups she contacted also hadn’t heard anything from PEPFAR offices.
• Zimbabwe: Munya Chimwara pointed out even bigger problems. The country office has no coordinator, making it very hard to engage. He said efforts to get updates from the Ministry of Health also failed, leaving people “in the dark.”
• Nigeria: Communication was limited, but details remained vague. Onyema George Ndukwe, representing key population communities, mentioned that he had communicated with the acting coordinator of PEPFAR Nigeria, who guaranteed him updates. Nevertheless, during the meeting, specific information had not been disclosed.

Reports highlight a gap between decisions made in Washington and the actual experiences of local organizations under PEPFAR.

The effect on key populations

A major problem is the absence of specialized programs for key populations. These groups - frequently marginalized or criminalized - have been central to PEPFAR’s prevention initiatives. Many worry that without focused initiatives, significant progress could be undone.

A delegate from the Key Population Consortium in Kenya stated that the waiver regulating the Bridge Plan guarantees ongoing treatment but overlooks prevention efforts. “Our initiatives are primarily centered on prevention,” he stated. “Most of our work cannot proceed without these services.” At-risk services include peer educator networks, drop-in centers, and community delivery models, offering medical care and safe spaces that reduce stigma and discrimination.

Maureen Milanga, the Director of Policy and Advocacy at Black Gay Men Connect (GBGMC), said that in many countries, community groups had already created detailed plans to provide full services for key populations. “Currently, those plans cannot be put into action,” she stated, “due to the lack of infrastructure and funding for essential population programs.”

Advocates warned that deficiencies in prevention will lead to new infections in the most at-risk populations, threatening years of advancements made.

A political dimension

Aside from the technical details, the Bridge Plan showcases more profound political discussions concerning the future of U.S. leadership in global health.

The document links budget allocations to the President's FY 2026 budget proposal, which intended to reduce PEPFAR funding to $2.9 billion - a 40 percent drop from the $4.85 billion provided by Congress in the previous year.

Advocates assert that this creates tension between the executive branch and Congress. Asia Russell, the Executive Director of Health GAP, pointed out that it is Congress, and not the president, that possesses the authority to decide on funding levels. She argued that by synchronizing the plan with the administration's budget proposal, the procedure jeopardizes congressional oversight

This political context has increased uncertainty. Media coverage highlights instances where the administration delayed or withheld Congress-approved funds, leading critics to argue these actions undermine stability and erode public trust.

Civil Society strategies

Regardless of the worries, the meeting attendees concentrated on positive approaches to safeguard vital services and uphold PEPFAR’s fundamental principles.

• Getting information. Many people called for quick action to confirm country budgets and make clear plans so that civil society can understand what’s going on.
• Bringing community goals together. Participants agreed that civil society should quickly collect and present particular priorities for incorporation into the plans. Many countries currently have "core care packages" that specify critical, life-saving services developed in reaction to previous funding challenges
• Involving national administrations. Some recommended circumventing PEPFAR offices if needed and collaborating directly with health ministries or national AIDS councils. As these institutions are engaged in discussions with PEPFAR, advocates claimed they might act as a link for community issues.
• Using policy: In Kenya, advocates said PEPFAR could fund long-acting PrEP for key populations if the national HIV policies clearly include them. This shows why national policies need to match the real needs of communities.

Preserving PEPFAR’s legacy

The meeting ended with a strong sense of urgency and unity. Almost 400 people stayed for the full 90 minutes, showing just how worried they are. Moderators called it a “family conversation,” highlighting the shared commitment to protect the progress PEPFAR has made.

For many, the impact goes beyond this planning stage. PEPFAR is regarded as a U.S. leadership model through strong partnerships and data use, but concerns arise that the new Bridge Plan compromises inclusivity and community involvement.

Looking ahead

With the September 24 deadline to submit national plans coming up, advocates promised to keep pushing. They want the process to stay open, encourage real discussion, and protect services for the most vulnerable.

The debate over PEPFAR’s future also shows the bigger challenges in global health today: politics, funding, and protecting programs for those most in need.

The determination of whether the Bridge Plan is merely a temporary solution or the beginning of lasting change will occur shortly. For those who have or are at risk of HIV, this is not just a policy issue - it directly affects their health and general well-being.