Trump Administration's PEPFAR Funding Cuts Cause Widespread Disruption to Global HIV Services, New Report Finds
Key Insights
A new amfAR (search) survey of 166 organizations across 46 countries reveals that PEPFAR (search) funding cuts led to the closure of more than 1,700 clinics and loss of over 16,000 full-time staff.
Despite waivers intended to protect HIV treatment and prevention of mother-to-child transmission, a majority of partners reported disruptions to these essential services.
HIV prevention spending fell 51% from fiscal years 2024 to 2025, with many organizations permanently ending services for key vulnerable populations including sex workers and men who have sex with men.
The Trump administration's sweeping cuts to the President's Emergency Plan for AIDS Relief (PEPFAR (search)) have caused "severe and devastating" disruption to global HIV services, forcing the closure of more than 1,700 clinics and the loss of over 16,000 full-time staff across dozens of countries, according to a new report from amfAR (search), The Foundation for AIDS Research.
The findings, released Tuesday and set to be presented at the 26th International AIDS Conference in Rio de Janeiro, Brazil, provide some of the first real-world data on the impact of funding disruptions that began in 2025. Researchers surveyed 166 organizations across 46 countries that had been due to receive PEPFAR (search) funding, revealing widespread degradation of the infrastructure built to deliver HIV services worldwide.
"Disruption was incredibly widespread. No part of the programme really escaped unscathed – and that includes areas of the programme that this administration intended to protect," said Elise Lankiewicz, policy associate at amfAR (search) and co-lead author of the PEPFAR (search) Pulse report.
Essential Services Disrupted Despite Protections
PEPFAR (search), credited with saving at least 26 million lives since its inception in 2003, saw many of its grants abruptly withdrawn in 2025. More than half had been managed via USAID (search), the agency dissolved by the Trump administration in July 2025. A waiver issued in February 2025 theoretically allowed programs providing life-saving treatment or preventing mother-to-child HIV transmission to continue, but the reality on the ground proved starkly different.
The survey found that even though the U.S. government directed services providing HIV treatment, testing, and prevention of mother-to-child transmission to continue, a majority of partners still reported disruption to those services. Almost two-thirds of organizations providing services to prevent mother-to-child HIV transmission reported disruption, with one-fifth ending services entirely. A fifth of organizations providing HIV care and treatment stopped at least one service, and many reported being unable to obtain supplies of laboratory commodities, condoms, or drugs.
"The reality is it's incredibly hard to cut one award without there being ripple effects throughout the system," Lankiewicz said.
Prevention and Key Populations Hardest Hit
HIV prevention has been sharply reduced. From fiscal years 2024 to 2025, prevention spending fell 51%, according to PEPFAR (search) expenditure data. Many organizations stopped condom programs or services offering pre-exposure prophylaxis (PrEP), preventive medicines to guard against sexually transmitted HIV.
Cuts were concentrated on services for populations most impacted by HIV. Most organizations previously serving sex workers, men who have sex with men, transgender people, and people who inject drugs reported permanently ending a service for these groups. Even among organizations that did not lose funding, some reported stopping services for key populations to comply with U.S. policy.
Almost four out of five respondents said they had been asked to restrict their work to comply with additional U.S. policies – typically anti-diversity, equity and inclusion (DEI) executive orders, as well as an expanded "global gag rule." Lankiewicz noted that organizations "made pretty dramatic shifts to their programming to align with these new policies," including ending services tailored to specific populations and support for victims of gender-based violence.
Structural Damage and Treatment Declines
Locally-based partners were much more likely than international organizations to have an award terminated and to close service delivery sites. Five surveyed organizations had closed entirely, three as a direct result of losing PEPFAR (search) funding. Researchers cautioned this is "likely a significant under-count, since closed organizations would no longer have active email accounts by which to receive the survey."
Separate research published in the journal Nature Health in June specifically examined treatment globally using PEPFAR (search) data. It found that nearly two million fewer people living with HIV were receiving PEPFAR-supported antiretroviral treatment (search) in fiscal year 2025 compared with the previous fiscal year – approximately a 10% decline.
"That does raise really important questions about program stability," said Ramona Godbole, an author of that study who was not involved in the amfAR (search) report.
Greg Millett, a member of the amfAR (search) study team, emphasized the significance of the findings: "Until now, much of the discussion about the impact of recent PEPFAR (search) disruptions has relied on projections and modelling. This study provides some of the first real-world data."
Contrasting Government Narrative
The Trump administration has presented a more optimistic picture. In April, the U.S. State Department released PEPFAR (search) data for one quarter in 2025 showing that PEPFAR-supported programs provided standard HIV treatment for 20.6 million people in more than 50 countries, which officials described as stable from the same period in 2024. They also reported that PEPFAR started 103,000 pregnant and breastfeeding women on PrEP, up from 43,000 the previous year.
However, researchers from amfAR (search) and the International AIDS Society combined that quarter's data with another data release encompassing all four quarters and found substantial disruptions across PEPFAR (search) services.
Recommendations and Warnings
AmfAR (search)'s report made numerous recommendations to help restore care, including that the U.S. government and PEPFAR (search) leaders should reinstate support for all HIV services, not just treatment. It also called on other national governments to increase spending on HIV services and contract with nongovernmental organizations, including those led by people in key vulnerable populations.
Jennifer Sherwood, amfAR (search)'s director of research and public policy, warned that even if funding is restored, rebuilding will take time. "And unfortunately, with HIV and infectious disease, each day is deadly," she said. "Each day that we don't have those systems in place, you see new infections."
Millett underscored the broader implications: "These disruptions threaten to reverse progress toward controlling the HIV epidemic."
The majority of survey responses came from African countries, though the survey does not provide data at the country level. The report concludes that "taken together, these results describe widespread degradation of the infrastructure built to deliver HIV services worldwide, with the deepest damage falling on the populations and partners most essential to controlling the epidemic."