US-funded health programs worldwide—including critical HIV, malaria, and maternal health initiatives—received termination notices on Thursday as President Donald Trump’s administration moves to align foreign aid with its “America First” policy.

In January, Trump ordered a 90-day freeze on all foreign aid to assess whether projects aligned with his administration’s priorities. Despite earlier assurances from US Secretary of State Marco Rubio that life-saving aid would be protected, a court document dated February 25 revealed that over 90% of programs globally were ultimately terminated, even those initially granted exemptions.

The cuts have already impacted major health initiatives. In South Africa, several of the country’s largest US-funded HIV/AIDS programs were notified that their funding would not resume, according to three senior health organization leaders. A leading global nonprofit focused on malaria and maternal health also had most of its contracts canceled.

Documents reviewed by Reuters confirm that the United Nations’ UNAIDS agency had its contract with the United States Agency for International Development (USAID) canceled. Similarly, Khana, a Cambodian organization specializing in HIV and tuberculosis, also received a termination notice, a source familiar with its work said.

The US State Department has not responded to requests for comment, and it remains unclear how many organizations worldwide were affected or what criteria were used for the terminations.

A termination notice sent to affected groups, seen by Reuters, stated: “Secretary Rubio and (USAID) Deputy Administrator (Peter) Marocco have determined your award is not aligned with Agency priorities and made a determination that continuing this program is not in the national interest.”

International AIDS Society President Beatriz Grinsztejn warned that the widespread funding cuts were causing healthcare systems to collapse. “The US funding cuts are dismantling the system. HIV treatment is crumbling. TB services are collapsing… Lives are on the line,” she said. While her organization is not directly affected, she cautioned that millions of vulnerable patients worldwide will feel the impact.