Health and humanitarian groups around the world were still uncertain on Wednesday if and how they could resume work after the United States issued a waiver for "life-saving" assistance in President Donald Trump's freeze on US foreign aid.

Secretary of State Marco Rubio issued the waiver on Tuesday night after aid groups worldwide warned that the blanket ban on foreign aid funding and activity for 90 days had put millions of lives at risk. 

Trump imposed the freeze within hours of taking office on January 20, part of a larger-scale effort to align international aid with his "America First" agenda.

In his waiver, Rubio defined life-saving aid as core medicine and medical services, food, shelter and any associated costs to deliver such assistance. The waiver excluded services like abortion, gender, diversity, transgender and non-life saving work.  

UNAIDS, the United Nations agency leading the fight against HIV, said on Wednesday the waiver included HIV treatment, and that it would lobby for other HIV services to be included too, including prevention. 

However, officials from the US Agency for International Development (USAID), aid groups, and health workers in Africa, Asia, Europe and the United States told Reuters they were unclear what the waiver meant for their work or if it was in effect a full reversal of previous orders telling them to stop work immediately.

Most of those who spoke requested anonymity in order to speak freely.

Three aid sources said they were hoping for more information about the waiver later on Wednesday.  

One group funded by USAID that was providing emergency food aid in an African country, work that was theoretically already exempt from the funding freeze before Rubio's latest waiver, said on Wednesday they were still unclear if they could resume operations. 

“There’s a lot of shock and confusion, because there’s these big announcements, but then the implementation of that is complex,” said one senior global health official.

There are cases where USAID may fund one part of an assistance programme while other groups, including domestic governments, provide other elements, the official said, adding that halting one element risked overloading or paralysing the others.

HIV, TRANSGENDER CLINICS IN JOHANNESBURG

In Johannesburg, a clinic treating HIV patients and several health centres for transgender people were shuttered on Tuesday and remained closed on Wednesday while organisations sought more guidance. 

Those clinics are run by South Africa's Wits Reproductive Health and HIV Institute, which is part of the Wits Health Consortium, a research organization leading several USAID-funded programmes.

"There hasn't been any communication that you can reinitiate a, b and c components of your programme but you can't do d and e,” said Shabir Madhi, chair of the Wits Health Consortium.

"As things stand, those stop work orders haven't been reversed, which means that we still need to comply," he said.

As of Wednesday afternoon, employees of the United States President's Emergency Fund for AIDS Relief (PEPFAR) in at least one African country had not received information from Washington on how Rubio's waiver impacted the programme and specifically which parts of their work would be allowed to continue, a source familiar with the matter told Reuters.

Another source close to a project supplying key medicines globally said the project was still working this out, when asked if their work could resume.

Yirga Gebregziabher, a manager at the Organization for Social Service, Health and Development in the Ethiopian region of Tigray, said:

"We were told to stop, even ongoing activities. It is not clear."

His group uses USAID funding to provide food aid, HIV medicines and children's education, in total for more than 30 000 people. He also said it was unclear if they could pay staff salaries for February.

The United States is the largest single donor of aid globally. In fiscal year 2023, it disbursed $72-billion in assistance.