The Trump administration’s disruption of the President’s Emergency Plan for AIDS Relief (PEPFAR) has resulted in the closing of 1,700 HIV/AIDS service delivery sites around the world, affecting populations most vulnerable to HIV infection, according to survey results released in advance of AIDS 2026, the 26th International AIDS Conference in Rio de Janeiro, Brazil.
PEPFAR Disruptions
Findings presented at a news conference showed that 77,163 fewer children living with HIV in 21 countries received PEPFAR-supported treatment in 2025, when the disruptions began, than in 2024. In five countries — Uganda, Haiti, Zambia, South Africa, and Kenya — the decline in PEPFAR-supported treatment was a sharp departure from preceding years, suggesting that the drop-off might be associated with changes to PEPFAR.
“Our findings document not a collapse but a narrowing of PEPFAR services concentrated among the populations and programming that, in the long term, often decide whether epidemic control is won or lost,” said Elise Lankiewicz, Ph.D., M.P.H., a policy associate for amfAR, The Foundation for AIDS Research, the group that conducted the survey.
History of PEPFAR
Started in 2003 during the George W. Bush administration, PEPFAR, fueled by a total of more than $100 billion in U.S. funding, has been credited with saving more than 20 million lives, most of them in sub-Saharan Africa, and turning the tide of the AIDS epidemic. In 2025, the Trump administration disrupted the program in two ways.
When it shuttered the United States Agency for International Development, it closed the agency responsible for implementing many PEPFAR programs, along with partner organizations in other countries. The administration also froze all foreign aid. PEPFAR was eventually granted a waiver from that freeze, but the interruption affected many programs, and funding for prevention was slashed.
According to amfAR, PEPFAR expenditures for prevention were cut by 51% from 2024 to 2025. The administration has also moved to change PEPFAR so the Centers for Disease Control and Prevention would no longer be involved, with funds going directly to countries that have signed bilateral agreements with the U.S.
Impact on Treatment
Although the disruption was greater in programs geared toward prevention, amfAR’s survey showed that among the 85 programs providing treatment, 18 (21%) stopped at least one HIV clinical care activity.
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Organizations had some success in finding alternatives to PEPFAR money. Just under half (49, or 44%) of the programs that had at least one delayed or canceled award from PEPFAR identified other funding after they lost U.S. funding, according to the amfAR report. But almost all (47 of 49) indicated that the alternative funder provided less support than PEPFAR had.
The decline in the number of children with HIV on treatment has become a point of contention. In April, the State Department said the decrease has been misrepresented and is actually “a sign of the tremendous progress that has been made reducing the incidence of mother-to-child transmission of HIV and is consistent with historical trends.”
At a virtual press conference, Ramona Godbole, M.A., M.H.S., a researcher at the Heidelberg Institute of Global Health, didn’t totally dismiss that assertion after presenting data showing a decrease in PEPFAR-supported treatment of children with HIV. “A decline in PEPFAR-supported pediatric treatment isn’t inherently bad news,” Godbole said. “It usually means fewer babies are being born with HIV because our prevention of mother-to-child transmission has worked.”
Godbole and her colleagues’ analysis of data that came from PEPFAR shows a steeper decline from 2024 to 2025 than in the recent past in Uganda, Haiti, Zambia, South Africa, and Kenya. The steepest decline in the absolute number of children with PEPFAR-supported treatment occurred in South Africa.
The amfAR report notes that the administration has reinstated the policy — known as the Mexico City policy — that bars foreign nongovernmental organizations that receive U.S. funds from providing or promoting abortion even when they do so with non-U.S. funds. In January 2026, the administration also required that aid recipients not provide gender-affirming care or have diversity, equity, and inclusion programming, according to amfAR, which has significant implications for access to care and support.
Of the 1,714 service sites closed because of PEPFAR award cancellations, 1,010 were public health facilities, 325 were access points, and 126 were drop-in centers, amfAR reported.
The disruption of PEPFAR services has significant implications for the global response to HIV/AIDS.
