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Many Africans had known that Trump’s “America First� outlook meant their continent among his priorities. But they hadn't expected the abrupt halt to foreign aid from the world's largest donor that stops money flowing for wide-ranging projects like disease response, girls' education and free school lunches.

Even after global outrage prompted some exemptions to Trump's order, sub-Saharan Africa could suffer more than any other region as most global aid pauses 90 days for a spending review. The U.S. gave the region more than $6.5 billion in humanitarian assistance last year.

For Madhuku and countless others, the damage has been done. His Platform For Youth and Community Development is one of hundreds of small non-governmental organizations in Africa that receive assistance from the U.S. government — and ultimately from the American people — to do good work.

Without U.S. aid, Madhuku's group can't give around 100 volunteers allowances for food and public transport as they do outreach seeking to keep girls in school and out of early marriages.

“We had to stop everything, no warning, no time to adjust," Madhuku said. “I appreciate that Trump might have some justification in trying to account for American taxpayers’ money ... but it has caused disaster here.�

The world's most successful foreign aid program

For many in Africa, thoughts immediately turned to arguably the world's most successful foreign aid program, the , or PEPFAR.

Over two decades, the program with bipartisan support has been credited with saving more than 25 million lives, the vast majority in Africa, the continent it was designed to help most.

“The world is baffled,� the health minister of South Africa, the country with the most people , said after the U.S. freeze on aid.

The minister, Aaron Motsoaledi, said the U.S. funds nearly 20% of South Africa’s $2.3 billion annual HIV/AIDS program through PEPFAR, and now the biggest response to a single disease in history is under threat.

More than 8 million in South Africa live with HIV, and authorities say PEPFAR helps provide life-saving antiretroviral treatment to 5.5 million people every day.

HIV patients are turned away

has announced that programs offering “life-saving� assistance including medicine, medical services, food and shelter would be exempted from the aid freeze, though what qualifies is not immediately clear.

The United Nations AIDS program said many organizations receiving PEPFAR funding had closed due to the aid pause and there was "lack of clarity and great uncertainty about the future.� More than 20 million people globally receive HIV treatment with PEPFAR support, UNAIDS said.

In South Africa's largest city, Johannesburg, and elsewhere, PEPFAR-funded facilities were still shut days after the exemptions were announced and HIV patients were referred to government hospitals and clinics.

In Johannesburg's largest township, Soweto, two workers at the PEPFAR-funded HIVSA center turned patients away. And a notice at the renowned Wits RHI Key Populations Clinic, which serves adults and children living with HIV, read: “We apologize for the inconvenience this causes."

Delays could be dangerous

Experts said the effects on HIV programs remain unclear but the consequences could be swift, even dangerous.

"We need to know a lot more before we can say people won’t die directly because of the pause to funding,� said Charles Kenny, a senior fellow at the Center for Global Development in Washington, noting that while the waiver should cover HIV drugs, HIV diagnostic tests are also critical to ensure treatment gets to those who need it.

Kenny said even short interruptions to antiretroviral treatment — which stops the virus replicating in the body — are risky.

“HIV viral loads rebound in about three weeks if you go off antiretrovirals,� he said.

Overall, even senior officials in the aid community are not sure which U.S.-funded programs are allowed to at least briefly continue operations.

The Trump administration has warned contractors and staffers with USAID — the agency responsible for dispersing America’s foreign aid — they could be disciplined if they speak to anyone outside the agency without top-level approval, and aid groups fear they may permanently lose funds if they speak publicly.

Stopping aid in war zones

A humanitarian official told The Associated Press that at least 1.2 million people could lose life-saving support because of the aid freeze. The official, who spoke on condition of anonymity because they were not authorized to speak publicly on the matter, said almost half of their organization’s funding is from USAID.

Overall, more than $100 million for the organization’s humanitarian programs in more than 30 countries worldwide has been halted, according to the official.

The block on aid came during a , where millions of people were already displaced and where outbreaks of the mpox virus were last year.

In , which is , malaria, and measles, the aid freeze means 600,000 people will be at grave risk of catching and spreading those diseases, the official said.

Even with the exemption for life-saving services, the official said their organization had been told they should not resume any USAID-funded activities until they received notification that the waiver applies to them.

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Imray reported from Cape Town, South Africa, Mutsaka reported from Harare, Zimbabwe, and Banchereau reported from Dakar, Senegal. Associated Press writers Maria Cheng in London, Ellen Knickmeyer in Washington and Jacob Zimba in Lusaka, Zambia, contributed to this story.

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The Associated Press receives financial support for global health and development coverage in Africa from the Gates Foundation. The AP is solely responsible for all content. Find AP’s for working with philanthropies, a list of supporters and funded coverage areas at .