The real-world and life-threatening consequences of President Donald Trump’s sweeping freeze of U.S. foreign aid are coming into focus as HIV/AIDS treatment programs around the globe are thrown into chaos and shutting down.

Last week, Trump began dismantling the semi-autonomous United States Agency for International Development (USAID), which is the primary source of funding for HIV/AIDS relief for over 25 million people in 54 countries.

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The aid is distributed annually through PEPFAR, the President’s Emergency Plan for AIDS Relief.

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While PEPFAR is funded by the State Department, about two-thirds of its grants are implemented through USAID and the Centers for Disease Control and Prevention. Neither organization has released funds to grantees since the freeze was initiated, putting the health of tens of millions of people, including 500,000 children, into jeopardy.

The sudden halt on funding is a “system shock,” Christine Stegling, a deputy executive director at UNAIDS, the United Nations’ HIV division, told The New York Times.

Last week, Secretary of State Marco Rubio issued a waiver for lifesaving medicines and medical services affected by the freeze, but the PEPFAR funds still await release as recipient organizations confront the chaos unleashed at USAID.

A large portion of the agency’s personnel have been furloughed or fired; PEPFAR recipients have been left without longtime contacts and guidance.

On Tuesday, the administration said it’s pulling almost all USAID workers off the job and out of the field worldwide. Rubio put the onus on recipient organizations to apply for waivers to restart the funding.

If an aid group is receiving funds from the United States and “does not know how to apply for a waiver, then I have real questions about the competence of that organization — or I wonder whether they’re deliberately sabotaging it for purposes of making a political point,” Rubio told reporters traveling with him in Costa Rica.

“The messaging and guidance from the State Department expose an ignorance of how these programs function — and an alarming lack of compassion for the millions of lives at risk,” Jirair Ratevosian, chief of staff for PEPFAR in the Biden administration, told the Times.

Recipient organizations can’t proceed on the basis of a general memo, according to a senior official at a large global health organization that receives PEPFAR funds.

“We have to wait till we get individual letters on each project that tell us not only we can start work, but tell us which work we can start up and with how much money,” the official said. 90 percent of the organization’s money comes from PEPFAR.

“Without immediate intervention, these funding suspensions could lead to devastating reversals in public health progress,” said Dr. Stellah Bosire, executive director of the Africa Center for Health Systems and Gender Justice. 

Her group surveyed 275 health organizations in 11 sub-Saharan countries last week. All reported their programs or services had shut down or were turning people away.

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