Two weeks into President Donald Trump’s sweeping freeze on foreign aid, HIV groups abroad have not received any funding, jeopardizing the health of more than 20 million people, including 500,000 children. Subsequent waivers from the State Department have clarified that the work can continue, but the funds and legal paperwork to do so are still missing.

With the near closure of the American aid agency known as the U.S. Agency for International Development, or USAID, and its recall of officers posted abroad, there is little hope that the situation will resolve quickly, experts warned.

HIV treatment and services were funded through the President’s Emergency Plan for AIDS Relief, or PEPFAR, a $7.5 billion program that was frozen along with all foreign aid on Trump’s first day in office.

Since its start in 2003 during the George W. Bush administration, PEPFAR has delivered lifesaving treatment to as many as 25 million people in 54 countries and had enjoyed bipartisan support. The program was due for a five-year reauthorization in 2023; it survived an effort by some House Republicans to end it and was renewed for one year.

Without treatment, millions of people with HIV would be at risk of severe illness and premature death. The loss of treatment also threatens to reverse the dramatic progress made against HIV in recent years and could spur the emergence of drug-resistant strains of HIV; both outcomes could have a global impact, including in the United States.

The pause on aid and the stripping down of USAID have delivered a “system shock,” said Christine Stegling, a deputy executive director at UNAIDS, the United Nations’ HIV division.

“Now you need to see how you can work with the system as it is, to make sure that what is theoretically possible will actually happen,” she said.

On Jan. 28, Secretary of State Marco Rubio issued a waiver for lifesaving medicines and medical services, ostensibly allowing for the distribution of HIV medicines. But the waiver did not name PEPFAR, leaving recipient organizations awaiting clarity.

On Sunday, another State Department waiver said more explicitly that it would cover HIV testing and treatment as well as prevention and treatment of opportunistic infections such as tuberculosis, according to a memo viewed by The New York Times. The memo did not include HIV prevention — except for pregnant and breastfeeding women — or support for orphaned and vulnerable children.

Although PEPFAR is funded by the State Department, roughly 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.

In an interview with The Washington Post, Rubio appeared to blame the recipient organizations for not acting on the waiver, saying he had “real questions about the competence” of the groups. “I wonder whether they’re deliberately sabotaging it for purposes of making a political point,” he said.