The Trump transition team has sent a four-page questionnaire to the State Department about America’s relationship with Africa, The New York Times reported last Friday.

Among the questions are two regarding PEPFAR (the U.S. President’s Emergency Plan for AIDS Relief), which was created by George W. Bush in 2003: 1) “Is PEPFAR worth the massive investment when there are so many security concerns in Africa?” and 2) “Is PEPFAR becoming a massive, international entitlement program?”

According to the Times, the four-page list of Africa-related questions covering national security and financial assistance, among other topics, has alarmed longtime Africa specialists who say “the framing and the tone of the questions suggest an American retreat from development and humanitarian goals” on the world’s second largest continent.

Since its inception, PEPFAR has provided tens of billions of dollars in assistance to fight AIDS and tuberculosis in Africa. TheAtlantic.com reports that in 2003, there were more than 20 million people living with AIDS in sub-Saharan Africa but only 50,000 individuals were accessing the antiretroviral (ARV) drugs needed to manage the disease. Today, thanks in large part to PEPFAR, the number of people on ARV treatment (which helps suppress the virus and reduce the risk of transmission) is 11.5 million. Additionally, the funding has prevented 2 million babies from being born with HIV by offering drugs to mothers and supported 11 million voluntary male circumcisions (circumcision has been shown to reduce the risk of men acquiring HIV from vaginal sex by as much as 50 percent).

Although the questionnaire provides only a glimpse of how President-elect Trump might approach PEPFAR funding, it marks the first time the new administration has significantly broached either the topic of HIV/AIDS or policy toward Africa. Monde Muyangawa, the director of the Africa program at the Woodrow Wilson Institute, told the Times the queries could indicate “a dramatic turn in how the United States will engage with the continent.”