The new ‘America First Global Health Strategy’ could erode years of progress under PEPFAR
The President’s Emergency Plan for AIDS Relief (PEPFAR) was initiated in 2003 under President George W.
总统艾滋病紧急救援计划 (PEPFAR) 于 2003 年在乔治·W·布什总统的领导下启动。
Bush.
布什。
As of end-2024 , the program had saved over 25 million lives, supported treatment for 21 million people, prevented 7.8 million babies from contracting HIV/AIDS, supported 6.6 million AIDS orphans and their caregivers, and strengthened pandemic preparedness in recipient countries , all at a cost of less than 0.08% of total U.S. FY 2024 government spending .
截至 2024 年底，该计划已挽救了超过 2500 万人的生命，支持了 2100 万人的治疗，防止 780 万婴儿感染艾滋病毒/艾滋病，支持了 660 万艾滋病孤儿及其照顾者，并加强了受援国的流行病防备，所有这些费用不到美国 2024 财年政府支出总额的 0.08%。
PEPFAR is widely regarded as one of the world’s most successful, high-impact, and relatively low-cost health interventions and has long enjoyed strong bipartisan support .
PEPFAR 被广泛认为是世界上最成功、影响最大且成本相对较低的卫生干预措施之一，长期以来一直得到两党的大力支持。
The program has also been an important source of U.S. soft power , building grassroots good will and long-term alliances around global health issues.
该计划也是美国软实力的重要来源，围绕全球健康问题建立草根善意和长期联盟。
This progress is now threatened.
这一进展现在受到了威胁。
On July 1, 2025, the U.S. Agency for International Development (USAID) was formally dissolved , with its remaining functions absorbed into the State Department, ending more than 60 years of U.S. global health assistance (including PEPFAR) delivered through a dedicated development agency.
2025 年 7 月 1 日，美国国际开发署 (USAID) 正式解散，其剩余职能并入国务院，结束了 60 多年来美国通过专门的发展机构提供的全球卫生援助（包括总统防治艾滋病紧急救援计划）。
Funding that was previously appropriated to USAID for health programming was transferred to the State Department—but without the large, professional, field-based U.S. government (USG) workforce which supported tactical decisions and implementation, PEPFAR was jeopardized .
之前拨给美国国际开发署用于卫生规划的资金被转移到国务院，但如果没有大量、专业、实地的美国政府 (USG) 劳动力来支持战术决策和实施，总统防治艾滋病紧急救援计划就会受到威胁。
While appropriations from Congress for global HIV/AIDS programs have only fallen by about 4% (nominal) since FY 2024, appropriated funds have not been flowing to activities on the ground.
尽管自 2024 财年以来，国会对全球艾滋病毒/艾滋病项目的拨款仅下降了约 4%（名义），但拨款并没有流向实地活动。
In FY25, there was a 34% decline in spending on HIV-related activities owing to various funding disruptions (including the dissolution of USAID).
25 财年，由于各种资金中断（包括美国国际开发署的解散），艾滋病毒相关活动的支出下降了 34%。
Funding disbursement bottlenecks continue in FY26, including a failure to release funds to the CDC for the country-level assistance activities that they normally conduct using PEPFAR funds.
26 财年资金支付瓶颈依然存在，包括未能向 CDC 发放资金用于通常使用总统防治艾滋病紧急救援计划 (PEPFAR) 资金开展的国家级援助活动。
The human consequences are already becoming visible.
人类的后果已经变得显而易见。
Funding disruptions in 2025 were associated with a 22% decline in the number of people tested for HIV globally and a rise in new infections detected.
2025 年的资金中断与全球艾滋病毒检测人数下降 22% 以及检测到的新感染人数增加有关。
In Zambia , where USAID was the primary PEPFAR implementer, health officials report rising HIV infection rates and a growing emergency that they associate with cuts to testing and prevention programs.
在赞比亚，美国国际开发署是总统防治艾滋病紧急救援计划的主要实施者，卫生官员报告说，艾滋病毒感染率不断上升，紧急情况日益严重，他们将这与检测和预防计划的削减联系在一起。
In Rakai, Uganda, where researchers have monitored HIV trends for more than two decades, PEPFAR-funded antiretroviral therapy (ART) was associated with a decline in orphanhood prevalence from 21.5% in 2003-2004 to 6.3% by 2020-2022.
在乌干达拉凯，研究人员二十多年来一直在监测艾滋病毒趋势，PEPFAR 资助的抗逆转录病毒治疗 (ART) 与孤儿感染率从 2003-2004 年的 21.5% 下降到 2020-2022 年的 6.3% 相关。
Researchers there warn that funding cuts will reverse those hard-won gains, particularly for children and young women.
那里的研究人员警告说，资金削减将扭转这些来之不易的成果，特别是对于儿童和年轻女性而言。
1 A PBS report highlighted how lack of treatment drugs in Uganda has been associated with rising HIV/AIDS-related mortality rates.
1 美国公共广播公司 (PBS) 的一份报告强调了乌干达缺乏治疗药物与艾滋病毒/艾滋病相关死亡率上升的关系。
In South Africa, cuts have extended beyond HIV testing and community programming to primary preventive care , including blood pressure monitoring and tuberculosis immunization.
在南非，削减开支已从艾滋病毒检测和社区规划扩展到初级预防保健，包括血压监测和结核病免疫。
The cuts have also disrupted key public health data collection systems, making it harder to track new HIV diagnoses and treatment coverage in real time.
削减还扰乱了关键的公共卫生数据收集系统，使得实时跟踪新的艾滋病毒诊断和治疗覆盖率变得更加困难。
Under the longstanding PEPFAR model , Congress appropriates funding annually, with the State Department’s Bureau for Global Health Security and Diplomacy coordinating U.S. HIV programs worldwide.
根据长期的总统紧急救援计划（PEPFAR）模式，国会每年拨款，国务院全球卫生安全和外交局负责协调美国在全球的艾滋病毒项目。
USAID was one of the key implementing agencies, alongside the Centers for Disease Control and Prevention and the Department of Defense.
美国国际开发署是主要执行机构之一，其他机构还有疾病控制与预防中心和国防部。
Funding was also provided to multilateral agencies involved in HIV/AIDS treatment and prevention, including the Global Fund to Fight AIDS, Tuberculosis and Malaria.
还向参与艾滋病毒/艾滋病治疗和预防的多边机构提供了资金，包括全球抗击艾滋病、结核病和疟疾基金。
PEPFAR implementation historically relied heavily on international and local NGOs and U.S. consulting firms under contract to the USG.
PEPFAR 的实施历来严重依赖于与美国政府签订合同的国际和当地非政府组织以及美国咨询公司。
This feature allowed PEPFAR to quickly scale up in the 2000s, when national health systems were underdeveloped, and to reach many vulnerable groups—including LGBTQ+ populations—who may not have trusted their own government’s public health system.
这一特点使得总统紧急救援计划在 2000 年代（当时国家卫生系统还不发达）迅速扩大规模，并覆盖到许多弱势群体——包括 LGBTQ+ 人群——他们可能不信任自己政府的公共卫生系统。
This model was justifiably criticized for failing to gradually shift resources into country national health systems.
这种模式因未能逐步将资源转移到国家卫生系统而受到批评。
Vertical programs such the original PEPFAR model result in wasted expenditures and a lack of sustainability.
诸如最初的总统紧急救援计划（PEPFAR）模式之类的纵向计划会导致支出浪费和缺乏可持续性。
In response, PEPFAR programming has been shifting towards a country health systems model.
作为回应，PEPFAR 规划已转向国家卫生系统模式。
U.S. funding has helped strengthen national health information systems, expand the national health workforce through paid community health workers, and (together with the Global Fund) strengthen supply chains to support the delivery of HIV treatment and prevention products.
美国的资金帮助加强了国家卫生信息系统，通过付费社区卫生工作者扩大了国家卫生人力，并（与全球基金一起）加强了供应链以支持艾滋病毒治疗和预防产品的提供。
PEPFAR’s 2022 comprehensive strategy , prepared by President Joe Biden’s administration, targeted “ending HIV/AIDS as a public health threat by 2030” by continuing PEPFAR programs while empowering recipient country health systems to take greater ownership of the HIV/AIDS problem by assuming responsibility for key program elements.
PEPFAR 的 2022 年综合战略由乔·拜登总统政府制定，目标是通过继续 PEPFAR 项目“到 2030 年结束艾滋病毒/艾滋病这一公共卫生威胁”，同时授权受援国卫生系统通过承担关键项目要素的责任，更好地掌控艾滋病毒/艾滋病问题。
Under this strategy, PEPFAR also continued to fund local NGOs implementing PEPFAR testing and treatment programs to ensure that all vulnerable groups could be reached.
根据这一战略，PEPFAR 还继续资助当地非政府组织实施 PEPFAR 检测和治疗计划，以确保所有弱势群体都能受益。
In place of that model, the second Donald Trump administration has introduced the “ America First Global Health Strategy ” (AFGHS), rolled out by the State Department on September 18, 2025.
唐纳德·特朗普第二届政府推出了美国国务院于 2025 年 9 月 18 日推出的“美国第一全球健康战略”(AFGHS)，以取代这一模式。
Rather than relying on multiple implementing agencies and partners to coordinate and deliver USG-funded health sector foreign assistance, the strategy envisions bilateral five-year memoranda of understanding (MOUs) negotiated individually with PEPFAR-recipient countries.
该战略不是依靠多个执行机构和合作伙伴来协调和提供美国政府资助的卫生部门对外援助，而是设想与总统防治艾滋病紧急救援计划受援国单独谈判达成双边五年谅解备忘录（MOU）。
The stated goals are to advance “public health goals” and accelerate “country self-reliance,” with most of the 71 PEPFAR-supported countries expected to transition to full self-reliance (i.e. no more USG funding) by the end of the agreement period.
既定目标是推进“公共卫生目标”并加速“国家自力更生”，71 个总统紧急救援计划支持的国家中的大多数预计将在协议期结束时过渡到完全自力更生（即不再有美国政府资助）。
Under this new strategy, recipient country MOUs specify the amounts, type, and purpose of the foreign assistance (in USD, by input type) that the USG will offer in the health sector.
根据这一新战略，受援国谅解备忘录规定了美国政府将在卫生部门提供的外国援助的金额、类型和目的（按投入类型以美元计）。
These compacts cover assistance under PEPFAR, as well as in a few other select areas: malaria, tuberculosis, polio, and measles prevention and treatment; limited support for reducing maternal and neonatal mortality; and support for the public system of disease surveillance and outbreak response as part of an explicit goal of containing emerging disease threats before they reach U.S. borders.
这些契约涵盖了总统防治艾滋病紧急救援计划下的援助以及其他一些选定领域的援助：疟疾、结核病、脊髓灰质炎和麻疹的预防和治疗；对降低孕产妇和新生儿死亡率的支持有限；支持公共疾病监测和疫情应对系统，作为在新出现的疾病威胁到达美国边境之前遏制其这一明确目标的一部分。
Compacts contain yearly outcome targets (e.g., percent of people who know their HIV status on treatment), and yearly targets for recipient country expenditures on inputs for HIV programs.
契约包含年度成果目标（例如，了解自己艾滋病毒治疗状况的人的百分比）以及受援国艾滋病毒项目投入支出的年度目标。
AFGHS MOUs support a rapid and complete transition to national health systems in recipient countries.
AFGHS 谅解备忘录支持受援国快速、完整地向国家卫生系统过渡。
Instead of funding contractors, USG support will be provided through government-to-government budget transfers or direct provision of supplies (vaccines, test kits, drugs and commodities) to government systems (such as national warehouses).
美国政府将通过政府间预算转移或直接向政府系统（例如国家仓库）提供物资（疫苗、检测试剂盒、药品和商品）来提供支持，而不是资助承包商。
Technical assistance will be provided by U.S.-funded contractors to systems if needed (for example, to improve country-run supply warehouse management and control).
如果需要，美国资助的承包商将向系统提供技术援助（例如，改善国家运营的供应仓库管理和控制）。
The MOUs also include conditionality provisions allowing the U.S. to withhold funding if recipient countries fail to meet specified financial or programmatic benchmarks or abide by other terms of the MOUs, including supporting U.S. business interests in the recipient country.
谅解备忘录还包括条件性条款，允许美国在受援国未能达到指定的财务或计划基准或遵守谅解备忘录的其他条款（包括支持美国在受援国的商业利益）的情况下扣留资金。
As of April 2026, multiple MOUs had been signed under this framework, including 24 with African countries.
截至 2026 年 4 月，已在此框架下签署了多项谅解备忘录，其中与非洲国家签署了 24 份谅解备忘录。
USG contracts with previous implementing partners have largely been terminated .
USG 与先前执行伙伴的合同已基本终止。
Programs run by local NGOs—supporting AIDS orphans and their caregivers, community-based testing and treatment for people living far from public health clinics, and targeted services for high-risk adolescent girls—will not be continued under the new approach unless the countries themselves decide to organize and fund them.
当地非政府组织开展的项目——支持艾滋病孤儿及其照顾者、为远离公共卫生诊所的人们提供基于社区的检测和治疗，以及为高危少女提供有针对性的服务——将不会在新方法下继续下去，除非各国自己决定组织和资助这些项目。
In Uganda, PBS documented how the funding cuts to local NGOs implementing PEPFAR programs in rural areas have left infected people without access to life-saving antiretrovirals and halted the detection of new infections among high-risk groups such as sex workers.
在乌干达，美国公共广播公司 (PBS) 记录了在农村地区实施总统防治艾滋病紧急救援计划 (PEPFAR) 的当地非政府组织的资金削减如何导致感染者无法获得挽救生命的抗逆转录病毒药物，并导致性工作者等高危群体中新感染的检测停止。
While the State Department presents the AFGHS as a rapid solution to aid dependency and the problems of vertical programs, it represents a fundamental shift in the logic of global health policy: rather than prioritizing collective health security, pandemic risk reduction, and humanitarian needs, health funding becomes subject to geopolitical calculation and terminable whenever programs are deemed misaligned with U.S. national interests.
尽管美国国务院将 AFGHS 视为解决援助依赖和垂直项目问题的快速解决方案，但它代表了全球卫生政策逻辑的根本转变：卫生资金不再优先考虑集体卫生安全、减少流行病风险和人道主义需求，而是受到地缘政治计算的影响，只要项目被认为与美国国家利益不一致，就可以终止。
The suspension of HIV funding to South Africa is an early illustration of this shift.
暂停向南非提供艾滋病毒资助是这一转变的早期例证。
While the new approach contains some welcome elements, including the transition to country ownership of the HIV/AIDS problem and the build-up of country systems to implement HIV/AIDS prevention and treatment programs, several aspects of the new approach pose serious risks to the achievements of PEPFAR to date and continued progress in the future.
虽然新办法包含一些受欢迎的内容，包括将艾滋病毒/艾滋病问题交给国家自主权以及建立国家系统来实施艾滋病毒/艾滋病预防和治疗方案，但新办法的几个方面对总统防治艾滋病紧急救援计划迄今为止所取得的成就和未来的持续进展构成了严重风险。
Our review of the publicly available country compacts revealed that these compacts specify year-by-year reductions in U.S. assistance alongside binding commitments for recipient government health spending—with no credit given for grants or concessional loans from other donors.
我们对公开的国家契约的审查显示，这些契约规定了美国援助的逐年减少，同时对受援国政府卫生支出做出了具有约束力的承诺，但没有对其他捐助者的赠款或优惠贷款给予信贷。
Often the co-financing levels are specified in USD, not local currency, which means dollar-denominated co-financing requirements can become more burdensome when recipient currencies depreciate or when countries experience external shocks such as commodity price spikes or trade disruptions.
联合融资水平通常以美元而非当地货币指定，这意味着当受援国货币贬值或当国家经历大宗商品价格飙升或贸易中断等外部冲击时，以美元计价的联合融资要求可能会变得更加繁重。
Macroeconomic conditions in several MOU signatories have already deteriorated from their positions at the time of MOU negotiations .
与谅解备忘录谈判时相比，几个谅解备忘录签署国的宏观经济状况已经恶化。
While country cofinancing of HIV/AIDS programs is a necessary element of country ownership, it is not clear that the country funding commitments embedded in the compacts were informed by standardized guidelines on country need for funding (the humanitarian basis) or fiscal analysis of country co-payment capacity given overall health expenditures, competing demands on health systems, or macroeconomic position.
虽然国家对艾滋病毒/艾滋病方案的联合供资是国家自主权的必要组成部分，但尚不清楚契约中包含的国家供资承诺是否是根据国家供资需求的标准化准则（人道主义基础）或考虑到总体卫生支出、对卫生系统的竞争性需求或宏观经济状况对国家共同支付能力进行的财政分析来确定的。
A few examples of this misalignment in country MOU requirements are as follows.
国家谅解备忘录要求不一致的一些例子如下。
In Kenya, the compact requires public health spending to reach 50 billion Kenyan shillings ($387 million) by 2030, representing a 36% increase over five years—a significant demand for a country the World Bank has flagged as already at high risk of debt distress.
在肯尼亚，该契约要求到 2030 年公共卫生支出达到 500 亿肯尼亚先令（3.87 亿美元），五年内增长 36%——对于一个被世界银行标记为已经处于债务困境高风险的国家来说，这是一个巨大的需求。
In Nigeria, which has the third-highest number of people living with HIV in Africa , the government must contribute nearly $3 billion in new public funds over 2026-2030 to receive $2 billion from the U.S., meaning Nigeria is effectively co-financing nearly 60% of the agreed program.
尼日利亚是非洲艾滋病毒感染者人数第三多的国家，政府必须在 2026 年至 2030 年期间贡献近 30 亿美元的新公共资金，才能从美国获得 20 亿美元，这意味着尼日利亚实际上正在共同资助商定项目的近 60%。
Meanwhile, El Salvador, with nearly four times Nigeria’s per capita income and one-third of its HIV prevalence, is only required to contribute 38% of compact costs .
与此同时，萨尔瓦多的人均收入是尼日利亚的近四倍，艾滋病毒感染率是尼日利亚的三分之一，只需缴纳契约费用的38%。
Rather than the previous humanitarian objective of “ending HIV/AIDS as a public health threat by 2030,” AFGHS seems to seek to end U.S. overseas funding for HIV/AIDS mitigation by 2030.
AFGHS 似乎寻求到 2030 年停止美国为缓解艾滋病毒/艾滋病问题提供的海外资助，而不是之前“到 2030 年消除艾滋病毒/艾滋病这一公共卫生威胁”的人道主义目标。
Although the strategy envisages some post-2030 funding for the poorest and most vulnerable countries, the level of copayments required in some countries and the disparities among them suggest the AFGHS expenditure framework was not designed with humanitarian need, equity across countries, or fiscal capacity as primary organizing principles.
尽管该战略设想为最贫穷和最脆弱的国家提供一些2030年后的资金，但一些国家所需的共同付款水平及其之间的差异表明，AFGHS支出框架的设计并未将人道主义需求、各国公平或财政能力作为主要组织原则。
The reasons for the discrepancies across countries have not been explained, and the criteria used to determine country obligations have not been made transparent.
各国之间存在差异的原因尚未得到解释，用于确定国家义务的标准也尚未变得透明。
The design of the MOUs also contains limitations on how the broader goal of transitioning to national responsibility for financing and implementing HIV/AIDS programs is to be achieved.
谅解备忘录的设计还对如何实现将资助和实施艾滋病毒/艾滋病项目的责任转为国家责任这一更广泛的目标进行了限制。
The input-based, rigid, year-by-year and subcategory spending commitments in the MOUs leave little room for the local innovation that drives efficiency gains.
谅解备忘录中基于投入的、僵化的、逐年和子类别的支出承诺，为推动效率提升的本地创新留下了很少的空间。
2 Output-based financing, where outputs are promised but inputs are left to the country to design and procure, would be a better approach.
2 基于产出的融资（承诺产出但投入由国家设计和采购）将是更好的方法。
In addition, by setting global health spending targets and refusing to recognize the contribution of other sources of funding (such as multilateral agency loans or grants) to this target, MOUs penalize country initiatives with other heath funding actors who are a normal part of national health system development in less developed countries.
此外，通过设定全球卫生支出目标并拒绝承认其他资金来源（例如多边机构贷款或赠款）对该目标的贡献，谅解备忘录对与其他卫生资助参与者的国家举措进行了惩罚，而这些参与者是欠发达国家国家卫生系统发展的正常组成部分。
Under the AFGHS template, African governments are being asked to grant the U.S. access to national health information systems , electronic medical records, and genomic and pathogen data in exchange for continued health assistance.
根据 AFGHS 模板，非洲各国政府被要求允许美国访问国家卫生信息系统、电子病历以及基因组和病原体数据，以换取持续的卫生援助。
This poses structural, legal, and ethical issues related to a transactions-based approach to the provision of health sector foreign assistance.
这带来了与基于交易的方式提供卫生部门对外援助相关的结构、法律和道德问题。
MOUs and associated data sharing agreements contain no binding restrictions on how U.S. agencies may reuse African health data, no provisions for benefit-sharing, and no enforceable safeguards against sharing data with third parties.
谅解备忘录和相关数据共享协议对美国机构如何重复使用非洲健康数据没有任何约束性限制，没有利益共享条款，也没有针对与第三方共享数据的可执行保障措施。
As a result, health and pathogen data could be used to train AI models or support pharmaceutical research with no guaranteed return to the contributing countries in the form of products, intellectual property, or economic benefit.
因此，健康和病原体数据可用于训练人工智能模型或支持药物研究，但不能保证以产品、知识产权或经济利益的形式回报贡献国。
More importantly, private medical data could end up being publicly shared because of inadequate research protocols of end-users.
更重要的是，由于最终用户的研究协议不充分，私人医疗数据最终可能会被公开共享。
The AFGHS data-sharing framework embedded in the MOUs bypasses the World Health Organization’s Pathogen Access and Benefit Sharing framework (which the U.S. rejected prior to withdrawing from the WHO).
谅解备忘录中嵌入的 AFGHS 数据共享框架绕过了世界卫生组织的病原体获取和利益共享框架（美国在退出世界卫生组织之前拒绝了该框架）。
PEPFAR was implemented, monitored, and evaluated efficiently and effectively for more than 20 years without these data sharing requirements.
20 多年来，PEPFAR 一直在没有这些数据共享要求的情况下高效实施、监测和评估。
Most African countries already regularly provide data to the WHO and other multilateral agencies under internationally accepted data sharing protocols; presumably there would be less resistance to supplying these data directly to the USG as long as the same protocols were followed.
大多数非洲国家已经根据国际公认的数据共享协议定期向世界卫生组织和其他多边机构提供数据；据推测，只要遵循相同的协议，直接向美国政府提供这些数据的阻力就会较小。
In some cases, separate agreements have explicitly linked health assistance to access to mineral assets.
在某些情况下，单独的协议明确将卫生援助与获取矿产资产联系起来。
The Democratic Republic of the Congo signed a strategic mineral partnership agreement alongside its AFGHS compact, with the two reportedly linked .
刚果民主共和国在签署 AFGHS 契约的同时还签署了一项战略矿产合作伙伴协议，据报道两者存在关联。
The agreement’s stated aim is that “mineral resources are managed responsibly for the long-term benefit of the Congolese people as well as the people of the United States of America.” The agreement contains no provisions to protect worker health and safety, respect the rights of mining communities and support their development, or prevent environmental harm.
该协议的既定目标是“为了刚果人民以及美利坚合众国人民的长期利益，负责任地管理矿产资源。”该协议不包含保护工人健康和安全、尊重采矿社区权利并支持其发展或防止环境危害的条款。
The USG is demanding a similar agreement with Zambia , which is holding up compact signing.
美国政府要求与赞比亚达成类似的协议，但该协议的签署却被搁置。
The State Department has refused to share signed compacts despite Freedom of Information Act (FOIA) requests, and suits have now been filed.
尽管《信息自由法》(FOIA) 提出要求，但国务院仍拒绝分享已签署的协议，目前已提起诉讼。
The signed Nigeria compact is marked “NOT FOR PUBLIC RELEASE”—an apparent violation of U.S. transparency laws , and an echo of the opaque loan agreements imposed on developing countries by actors such as China , whom the U.S. has historically criticized.
签署的尼日利亚协议被标记为“不得公开发布”——这明显违反了美国的透明度法，也是对中国等行为体向发展中国家强加的不透明贷款协议的呼应，美国历来批评中国。
In the United States, withholding lifesaving medical care to coerce behavior is considered unethical and, in most circumstances, illegal .
在美国，通过拒绝提供救生医疗服务来胁迫行为被认为是不道德的，而且在大多数情况下是非法的。
The same principle should apply with equal force to U.S. dealings with developing countries.
同样的原则也同样适用于美国与发展中国家的交往。
Zambia had brought 95% of diagnosed HIV cases under treatment by 2024; that progress is now in jeopardy after Secretary of State Marco Rubio signaled an intent to make an example of Zambia by withholding all foreign assistance , including programs financed by PEPFAR, unless USG demands are met.
到 2024 年，赞比亚已使 95% 的艾滋病毒确诊病例得到治疗；在国务卿马可·鲁比奥表示打算以赞比亚为榜样，除非美国政府的要求得到满足，否则将停止所有外国援助，包括总统防治艾滋病紧急救援计划资助的项目，这一进展现在面临危险。
PEPFAR funding saved lives at scale and at low cost, albeit with a model that was slow to adapt to the efficiency and sustainability issues that characterize vertical programs.
PEPFAR 资金以低成本大规模挽救了生命，尽管其模式很难适应纵向计划所特有的效率和可持续性问题。
The Trump administration seeks to address these issues head on, but with an approach that appears rushed, more attuned to geopolitical needs than country humanitarian needs, raises ethical considerations, and as a result, risks undermining progress to date and the international goal of ending HIV/AIDS as a public health risk by 2030.
特朗普政府寻求正面解决这些问题，但其做法显得仓促，更适应地缘政治需求而不是国家人道主义需求，引发了道德考量，因此有可能破坏迄今为止取得的进展以及到 2030 年消除艾滋病毒/艾滋病这一公共卫生风险的国际目标。
Congress and the administration need to reform AFGHS implementation to ensure timely disbursement of already-appropriated PEPFAR funds, preserve effective local delivery channels for hard-to-reach groups, and add safeguards limiting fiscal demands, data-sharing requirements, and unrelated geopolitical conditions.
国会和政府需要改革 AFGHS 的实施，以确保及时支付已拨付的 PEPFAR 资金，为难以接触到的群体保留有效的当地交付渠道，并增加限制财政需求、数据共享要求和不相关的地缘政治条件的保障措施。
The administration has not indicated a willingness to change course or modify implementation in the face of domestic and international criticism.
面对国内和国际批评，政府并未表示愿意改变方针或修改实施措施。
The design and implementation of AFGHS is centralized in Washington because of the demise of USAID and its thousands of field-based staff.
由于美国国际开发署及其数千名现场工作人员的解散，AFGHS 的设计和实施集中在华盛顿。
Additionally, the Department is now moving forward with a plan to defund the CDC field-based staff that have been supporting PEFAR implementation, further increasing centralization to the State Department.
此外，国务院目前正在推进一项计划，取消对一直支持 PEFAR 实施的 CDC 实地工作人员的资助，进一步加强对国务院的集中管理。
Substantial pushback from Congress, in the form of hearings and authorization legislation, could lead to improvements in the strategy and its implementation.
国会以听证会和授权立法的形式提出的实质性阻力可能会导致该战略及其实施的改进。
Given the bipartisan support that PEPFAR enjoys, Congressional hearings on the AFGHS and PEPFAR implementation, and subsequent incorporation of reform directions and proposals in legislation, could play an important role in placing some guardrails around the strategy and implementation, fostering a bipartisan solution to the issues identified above.
鉴于 PEPFAR 得到了两党的支持，关于 AFGHS 和 PEPFAR 实施的国会听证会，以及随后将改革方向和提案纳入立法，可以在围绕战略和实施设置一些护栏方面发挥重要作用，促进两党解决上述问题。
In particular, some questions that remain unexplored include:
特别是，一些尚未探讨的问题包括：
Possible avenues for improving the State Department’s implementation of the AFGHS could include:
改进国务院实施 AFGHS 的可能途径包括：
Meanwhile, the State Department should consider retaining some contracts with local NGOs who have been responsible for implementing PEPFAR programs targeted at high-risk but often excluded groups.
与此同时，国务院应考虑保留与当地非政府组织的一些合同，这些非政府组织负责实施针对高风险但往往被排除在外的群体的总统防治艾滋病紧急救援计划。
This includes programs that reach people in rural areas and towns too far from public facilities to be served effectively and groups that are less likely to use public facilities for testing and treatment such as teenage girls, sex workers, and LGBTQ+ people.
这包括覆盖农村地区和城镇、距离公共设施太远而无法有效服务的人群的项目，以及不太可能使用公共设施进行检测和治疗的群体，如少女、性工作者和 LGBTQ+ 人群。
These contracts could be phased out as recipient countries make satisfactory progress toward reaching these groups within the official health system.
随着受援国在接触官方卫生系统内的这些群体方面取得令人满意的进展，这些合同可能会逐步取消。
The United States has built a foundation of global health leadership and public goodwill over decades.
几十年来，美国已经建立了全球卫生领导力和公众善意的基础。
Decisions made around the AFGHS have already eroded this progress precipitously.
围绕 AFGHS 做出的决定已经急剧削弱了这一进展。
The process of rebuilding may take quite a while, but making some needed changes in the AFGHS program could help.
重建过程可能需要相当长的时间，但对 AFGHS 计划进行一些必要的改变可能会有所帮助。