$17.5 Million for Circumcision and Condom Programs Overseas

The Science Is Unambiguous. The Politics Are Messy. DOGE Flagged It Anyway.

USAID, operating under the President’s Emergency Plan for AIDS Relief (PEPFAR), funded $17.5 million in Voluntary Medical Male Circumcision (VMMC) and condom programming in sub-Saharan Africa and Southeast Asia. VMMC and condom distribution are the two best-evidenced biomedical HIV prevention interventions available outside of antiretroviral treatment. Three randomized controlled trials — the gold standard of medical evidence — demonstrated that VMMC reduces heterosexual HIV acquisition in men by approximately 60%. WHO and UNAIDS have recommended VMMC as a core HIV prevention intervention since 2007.

DOGE flagged these programs — along with dozens of other PEPFAR and global health items — during the January 2025 USAID review. All were suspended under Executive Order 14169. The programs are among the most cost-effective in the entire USAID portfolio: the cost per HIV infection averted through VMMC has been estimated at $150–$900 depending on setting, compared to lifetime HIV treatment costs of $400,000+ per patient in the United States.

Three Randomized Controlled Trials. WHO Recommendation. Flagged Anyway.

The randomized controlled trials supporting VMMC were conducted in Uganda, Kenya, and South Africa between 2005 and 2007, and were stopped early — a standard research ethics decision — because the evidence of benefit was so strong it was considered unethical to continue withholding the intervention from the control group. The WHO and UNAIDS endorsed VMMC as a core HIV prevention strategy in 2007, and have maintained that recommendation through every subsequent evidence review.

The CDC’s Compendium of Evidence-Based Interventions classifies VMMC as a “best evidence” intervention. The Lancet has published multiple systematic reviews confirming the original trial findings. This is not contested science. The DOGE review did not make a scientific argument against the programs; the programs were flagged because they appeared under a budget category that matched the keyword sweep.

“Voluntary medical male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Three randomized controlled trials, halted early because of overwhelming evidence of benefit, support this recommendation.”

WHO/UNAIDS — Voluntary Medical Male Circumcision for HIV Prevention: Joint Statement (2007, reaffirmed 2020)

The Legitimate Debate: Whether Americans Should Pay for Health Programs in Other Countries.

The genuine policy argument for terminating these programs is not that VMMC doesn’t work — it does. It’s that American taxpayers should not be responsible for funding public health infrastructure in sub-Saharan African countries indefinitely, and that the goal of PEPFAR, since its inception under President George W. Bush in 2003, has always been to build host-country capacity to sustain these programs independently. DOGE’s position, articulated by the administration, is that PEPFAR has become a permanent subsidy rather than a time-limited transition program, and that host-country governments should bear these costs.

The counterargument: the countries where VMMC programs are most needed — Uganda, Zambia, Mozambique, Tanzania — have GDP per capita under $1,200. Building and sustaining surgical capacity for an ongoing VMMC program requires health system infrastructure those countries do not currently have. Pulling PEPFAR support before that infrastructure exists doesn’t transfer responsibility to host-country governments; it simply ends the programs and allows the HIV epidemic to rebound.