EXCLUSIVE: The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) received a devastating blow when USAID abruptly terminated a number of its contracts, cutting off funding that supported HIV treatment for 350,000 people in Africa. The cuts have led to medicine shortages, unpaid healthcare workers, and a crumbling medical infrastructure. The decision, potentially influenced by Elon Musk's confusion over a misreported funding allocation, has left EGPAF scrambling. "Large numbers of people are going to die" if the funding is not restored, a foundation exec told Fortune. Back in late January, when Elon Musk used X to falsely accuse USAID of sending $50 million of condoms to Gaza, the staff at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) did not realize he may have been referring to their work. "My guess is that a lot of that money ended up in the pockets Hamas, not actually condoms," Musk told his 220 million followers, offering no evidence for his assertion. Musk—and the White House, which first made the claim—turned out to be wrong. There were no condoms being sent to the war-torn territory controlled by terrorists. EGPAF was unaware of its potential involvement in the confusion: It wasn't doing work anywhere near the conflict. Its work was in Gaza, a territory of Mozambique, not the Middle East. This is what really happened, according to correspondence and charitable funding records seen by Fortune, and interviews with the staff responsible for administering the program. Countdown starts When headlines about the chaos inside USAID began pouring out of Washington D.C., staff at (EGPAF) were fearful but hoped the life-saving nature of their work would spare them. But at the end of February, the organization received the emails it had been dreading. Its three projects across Lesotho (the nation President Trump recently said "nobody has ever heard of"), Eswatini, and Tanzania had been terminated. Instantly, treatment for 350,000 HIV patients—including 10,000 children and 10,000 pregnant women—was thrown into disarray. "Large numbers of people are going to die" if the funding is not restored, according to Trish Karlin, executive vice president for business development and external affairs at EGPAF. The termination notice, seen by Fortune, offered no review process prior to the decision. It told the charity and its partners to cease activities immediately. The shortfall in funds, approximately $32.7m, had been earmarked for spending on a range of services which had been developed with White House support over the past two decades. As soon as the foundation received the emails from USAID, the countdown was on. HIV has a well-known 90-day window: During this time without treatment, HIV can become more easily transmitted. The virus can also rapidly mutate during a break in care, becoming resistant to the medicine which once kept its symptoms at bay. Hoarding medicine Karlin said the healthcare infrastructure her team had worked on for decades began disintegrating overnight. Patients began hoarding medicine and pharmacies ran out of stock. Staff running testing facilities started working for free, as did counsellors who help patients with the psychological aspect of their diagnosis. "The funds covered a range of things. Healthcare services are more than just a bottle of pills that show up in a country, it's also the infrastructure that delivers those services to the people that need them," Karlin explained to Fortune in an exclusive interview. This includes "the healthcare workforce, support for counseling, testing, blood samples to see how people are progressing in their disease, what other opportunistic infections they may have, psychosocial support training. In some cases logistics. We've seen stories of drugs are arriving in country but [there's no] system to then get those medications to the pharmacy. It's a complex service." On top of that the funds also supported quantification, ordering, and redistribution services of stock at treatment and testing sites, as well as specialised services in antenatal clinics and on maternity wards. The money also pays for specialist doctors, nurses, clinicians, lab teams and peer educators. "We didn't show up and build these programs overnight. Unfortunately some of them can be eroded very, very quickly, but we are ready to step back into action where we are needed and wanted to do so," Karlin said. USAID did not respond to Fortune's request for comment. Why fund it? The funds from Washington—be it through USAID, the Centers for Disease Control, or the Department of Defense—provides the vast bulk of funding to EGPAF, which is supplemented by grants from the likes of the Gates Foundation. Some of the funds came via PEPFAR (the President’s Emergency Plan for AIDS Relief) established by President George W. Bush, which has saved more than 26 million lives across 50 countries since its inception. Given the link to PEPFAR, a long-justified spend, EGPAF had hoped its support would be continued. The reasoning now to prevent the spread of HIV is the same as it was in 2003 when PEPFAR was created: Aside from mere humanitarian goodwill (a point recently made by Gates himself), it protects American lives. "Our world is so interconnected ... I thought that would be an outcome of COVID: That people would appreciate that more," Karlin explained. "[HIV] infections have come down in the United States, treatments have improved. We now have prevention technology that allows you to take two injections per year with 100% prevention from infection." "And a lot of that work, those clinical trials, were done in other other parts of the world. It's helping to discover new technology that's going to help all of us in the long run." She added: "It's hard for people to understand things that happen in places they've never been or with communities they don't meet, but then there are things that are unifying all of us. If you're a parent with a sick child, I don't care what country you live in, you want that child to be healthy." "If a pregnant woman is at risk of transmitting something to her baby, every mother can understand how horrible that is." The wrong Gaza When Department of Government Efficiency (DOGE) boss Elon Musk first claimed he had uncovered a $50 million payment for condoms bound for Gaza, Karlin didn't think her team would be dragged into the melee. EGPAF does buy contraceptive treatments, but it has never purchased the billion condoms a $50 million payment would supply. Nor does it work in the conflict-ridden territory of Gaza in the Middle East, but in the Gaza province of Mozambique. When it was put to Musk that this was an error he admitted, without specifics, that he could have made a mistake. Karlin does not know whether EGPAF's contracts were canceled because of this confusion. "I can say definitively that we were not purchasing condoms for Gaza in our program in Mozambique," she said. Fortune's multiple requests for comment from the White House, the Department of State and DOGE did not receive a response. The confusion over these tens of millions of dollars is indicative of the wider chaos being reported out of federal government at present: For example a DOGE employee was accidentally given permission to edit sensitive Treasury data, USAID staff were reportedly locked out of their Washington offices, and the policy about whether it is Musk or the cabinet responsible for axing headcount has needed to be clarified. Donors like the Gates Foundation have already contacted EGPAF to find out whether they can help fill the 90% funding hole the U.S. government has created. But Karlin said: "When a gap this big is left behind, there's just no way to jump in and immediately fill it. And it's the rapid nature of it ... without a real transition strategy of 'OK [the government] want to get out of this work, we need a responsible handover plan.'" In time, Karlin hopes the work of EGPAF will be recognized and funding reinstated—she points to Musk admitting Ebola prevention measures were "briefly" canceled, for example. "I am an optimistic person, but it's harder and harder these days to stay that way," Karlin said. "When there is a greater understanding of the things that have been terminated, I'm hopeful that there will be some kind of reconciliation that some of these things need to continue because if they don't large numbers of people are going to die." Have you or your organisation been impacted by cuts to federal aid spending? Contact eleanor.pringle@fortune.com. This story was originally featured on Fortune.com ...read more read less