Trump and Musk Are Strangling the Government
HIV prevention is hampered. The social safety net is falling apart. Federal employees fear for their safety. And it’s only week three.
ON SATURDAY, THE STATE DEPARTMENT issued a memo clarifying that PEPFAR, the world’s most successful initiative to combat HIV and AIDS, was exempt from President Donald Trump’s pause on foreign aid.
The announcement was a relief to the global health community, which had been uncertain if prior waivers for life-saving medical services had put PEPFAR in the clear. But in the days since, officials on the front line of the fight against HIV in Africa say operations remain hampered, resource-strained, and stuck in limbo.
On Wednesday, the New York Times reported on a survey that had found that 275 organizations in eleven sub-Saharan countries reported that their programs or services delivering HIV treatment had shut down or were turning people away. One Trump administration official told The Bulwark that the situation was most particularly problematic in South Africa, where PEPFAR has the biggest footprint, both because of Trump’s vow to cut off aid to the country and the administration’s hampering of USAID, which administers a lot of PEPFAR’s services.
“This attack on USAID had made it nearly impossible to implement at least half of the [PEPFAR] programming that is covered under the already limited waiver in the countries,” the official told The Bulwark.
The State Department did not return a request for comment.
Advocates are hoping that Secretary of State Marco Rubio, who now also claims jurisdiction over USAID, will ultimately take a more expansive view of what constitutes “mission-critical functions” and keep PEPFAR-supporting functions in place. And there are some faint signals that he has.
One pediatrician who works on AIDS prevention in an East African country told The Bulwark on Wednesday that the situation at his clinic was so dire that they had sent five of their nine people home and made plans to conserve resources by not HIV testing infants less than a year old. By Thursday, the funding resumed—albeit with a significant caveat.
The approval was for a one-month budget with instructions to submit monthly budgets for the next three months.
The uncertainty around PEPFAR, which had a $6.5 billion budget in 2024 and has saved an estimated 26 million lives since inception, may have striking consequences. But it’s just a piece of the larger disorder and confusion that has defined the first few weeks of the second Trump administration. Though Trump officials insist that their early efforts to rein in government spending have been clarified or rescinded, groups that carry out critical social services both abroad and at home say the government, plainly, isn’t working.
Politico reported that the “administration is still freezing many climate and infrastructure grants despite two federal court orders barring it from doing so.” In Virginia, local news reported that community health centers were closed because of a lack of federal grant access. Tommy Sheridan, the deputy director of the National Head Start Association, told The Bulwark that as of Wednesday evening, his group was “aware of about 63 Grant Recipients in 25 states plus DC and Puerto Rico who are having issues accessing grant funding.”
A Trump White House official insisted that, outside of the early executive orders the president issued curtailing the promotion of DEI and trans rights, the administration was not restricting funds. The official suggested that the issue had to do with individual organizations failing to file their paperwork properly.
But elsewhere, organizations that rely on government funding complained of similar problems. Dr. Hosai Todd Hesham, who volunteers at Afghan Medical Professionals Association of America (AMPAA), a non-profit that provides mental health services to refugee populations in the United States, said her group was still looking for guidance from its funding entity, the U.S. Committee for Refugees and Immigrants. She said that within a month, the AMPAA would be unable to issue all its paychecks and that the refugees she works with wouldn’t get the services they need.
“The only thing I can think of is they are sitting down and going through their projects and are deciding what to cut and keep,” said Todd Hesham. “I feel defeated. I don’t know if anyone in the current administration will listen or even care to listen.”
In the biomedical and scientific research community, posters on an NIH-dedicated Reddit page described how their grant applications were now in doubt. On Thursday, the National Advisory General Medical Sciences Council announced that it would be postponing its winter meeting—at which it had expected to award grants.
“Some entities cannot access funds that have already been obligated,” said one scientific research advocate. “Some entities are not receiving the [Notice of Award] they need to begin their work, and some entities can’t get an extension to finish their work that costs the taxpayer nothing.”
As was the case with PEPFAR, there have been some signs that the government was loosening its restrictions on funding and communication. Also on Thursday, the Centers for Disease Control and Prevention released its first weekly epidemiological digest, the Morbidity and Mortality Weekly Report, since mid January. And some other NIH study sections, which review grant applications, were beginning to start up again.
But even as the functions of government began churning once more, the damage inflicted by the past two weeks was evident. In conversations, federal workers said they believed that Trump and Musk were trying deliberately not just to sever foreign aid and parts of the domestic social safety net, but also to create a climate in which the government itself fell apart.
In interviews, workers described losing access to their personnel records. Many are communicating on encrypted channels for fear that they were being digitally monitored. One employee at the CDC said that a network maintenance being planned for Thursday was sparking dark humor about staffers suddenly discovering their job had been erased, since it coincided with the deadline for employees to accept Musk’s paid leave offer. Others noted that the demands that they return to work in the office were guaranteed to fail.
“There are far more staff than assigned work spaces,” said one worker at a federal agency outside of D.C. “The feds got rid of expensive leased property during the pandemic and as people moved to heavy telework.”
These civil servants also relayed their fear about how the administration has operated. More than four federal employees independently sent along a list that had been published by American Accountability Foundation, a Trump-supporting outside group, listing what it described as DEI hires in the administration alongside their headshots and job titles. The Bulwark is not linking to this page due to concerns that those listed could be physically targeted. One person said his friend, who was on the list, had contacted law enforcement about it. The American Accountability Foundation did not return a request for comment. But among the workforce, the group’s actions had produced a chilling effect. Perhaps that was the point.
One employee who flagged the DEI watch list reported, “Everyone is on edge and morale is nonexistent.”