A newly released report is painting a troubling picture of how changes made by the Trump administration to a major global AIDS relief program have set back efforts to fight HIV in dozens of countries — resulting in clinic closures, mass layoffs, and reduced services for millions of people.
The program at the center of the report, known as PEPFAR — the President’s Emergency Plan for AIDS Relief — has been credited with saving at least 26 million lives since it launched in 2003. However, last year the program was significantly weakened following the dismantling of the U.S. Agency for International Development and the elimination of thousands of global health grants.
“The disruptions were very widespread,” said Elise Lankiewicz, a policy associate with the nonprofit amfAR, The Foundation for AIDS Research, which released the report Tuesday. She noted that services targeting young women, orphans, and children were among those hit hardest.
To conduct the study, researchers reached out to organizations that received PEPFAR funding to deliver HIV services last year. Nearly one in four — 166 groups operating across 46 countries — completed an electronic survey carried out between last November and April, sharing details about their funding levels, staffing, and services.
Researchers acknowledged the survey did not capture all PEPFAR-funded groups, and certain types of organizations — including those most severely disrupted or those still receiving U.S. funding — may have been less likely to participate. That gap could mean the findings either underestimate or overestimate the overall level of disruption. Even so, the results offer a meaningful look at the challenges many groups faced over the past year.
Among the report’s major findings:
— The majority of organizations experienced at least one funding award terminated or a payment delayed. Those terminations led to the closure of more than 1,700 clinics, drop-in centers, and other service locations, along with the loss of more than 16,000 full-time workers.
— Even though the U.S. government directed that HIV treatment, testing, and prevention of mother-to-child transmission should continue, most partner organizations still reported interruptions to those very services.
— Funding cuts fell hardest on programs serving populations most affected by HIV. Most organizations that previously provided services to groups such as sex workers, men who have sex with men, transgender individuals, and people who inject drugs reported permanently discontinuing at least one service for those groups. Some organizations that did not lose funding still stopped serving certain key populations in order to comply with U.S. policy directives.
— HIV prevention efforts have been dramatically scaled back. Many organizations halted condom distribution programs or stopped offering PrEP — preventive medications that protect against sexually transmitted HIV. According to PEPFAR expenditure data, prevention spending dropped 51% between fiscal years 2024 and 2025.
— Locally based partner organizations were far more likely than international groups to have awards terminated and service sites shut down. The funding disruptions also destabilized the broader, interconnected systems built to deliver HIV care.
The report summarized its findings starkly: “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.”
While the survey does not break down results by individual country, amfAR officials noted that the majority of responses came from organizations based in African nations.
The Trump administration has offered a more optimistic account of what has transpired since the federal changes took effect. In April, the U.S. State Department released PEPFAR data covering one quarter of 2025 — July through September. Officials stated that PEPFAR-supported programs provided standard HIV treatment to 20.6 million people in more than 50 countries, which they described as stable compared to the same period in 2024. They also reported that PEPFAR helped start 103,000 pregnant and breastfeeding women on PrEP, up from 43,000 the year before.
However, researchers from amfAR and the International AIDS Society combined that quarter’s figures with data from all four quarters and identified significant disruptions across PEPFAR services.
Separate research published in the journal Nature Health in June also examined global HIV treatment using PEPFAR data. That study found that nearly two million fewer people living with HIV were receiving PEPFAR-supported antiretroviral treatment in fiscal year 2025 compared to the prior year — roughly a 10% decline.
“That does raise really important questions about program stability,” said Ramona Godbole, one of the authors of that study, who was not involved in the latest report.
AmfAR’s report put forward several recommendations aimed at restoring care. It called on the U.S. government and PEPFAR leadership to reinstate support for all HIV services — not just treatment. The report also urged other national governments to increase their own spending on HIV programs and to work with nongovernmental organizations, including those run by members of vulnerable populations.
But Jennifer Sherwood, amfAR’s director of research and public policy, cautioned that even if funding is restored, rebuilding the systems and regaining community trust will take considerable 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.”
