The Trump administration’s disruptions to a global AIDS relief program have forced organizations to close clinics, lay off staff and cut services, seriously impeding efforts to prevent and treat the disease in dozens of countries, a new report released Tuesday shows.
The President’s Emergency Plan for AIDS Relief, known as PEPFAR, is credited with saving at least 26 million lives since its inception in 2003. But last year, it was impaired by the dismantling of the U.S. Agency for International Development and cuts to thousands of global health grants.
“The disruptions were very widespread,” with services for young women, orphans and children impacted, said Elise Lankiewicz, policy associate for the nonprofit amfAR, The Foundation for AIDS Research, which released the report.
Researchers contacted groups that got PEPFAR funding to deliver HIV services last year. Nearly a quarter — 166 groups from 46 countries — responded to an electronic survey conducted between last November and April, providing information on their funding, staff and services.
The survey didn’t reach all PEPFAR groups and certain types of organizations — like those that were most severely disrupted or still receiving U.S. funding — may have been less likely to respond. That could result in an underestimate or an overestimate of disruptions, depending on which organizations were missed. Nevertheless, the findings are a window into the struggles that some groups faced last year.
Some key findings were:
—Most organizations had at least one award terminated or payment delayed last year. Terminations led to the closure of more than 1,700 clinics, drop-in centers and other service delivery sites, and to the loss of more than 16,000 full-time staff members.
—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 a disruption to those services.
—Cuts were concentrated on services for populations most impacted by HIV. Most organizations previously serving groups such as 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 didn’t lose funding, some reported stopping a service for one of these key populations to comply with U.S. policy.
—HIV prevention has been sharply reduced, with many organizations stopping condom programs or services offering what’s called PrEP, preventive medicines to guard against sexually transmitted HIV. From fiscal years 2024 to 2025, prevention spending fell 51%, according to PEPFAR expenditure data.
—Locally-based partners were much more likely than international organizations to have an award terminated and to close service delivery sites. Funding disruptions also destabilized interconnected HIV service systems.
“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,” the report says.
The survey doesn’t provide data at the country level, but amfAR officials point out that the majority of responses came from African countries.
When asked about the report, a State Department spokesperson said in an email that the Trump administration has “strengthened PEPFAR through clear, strategic direction.”
“As a result, the number of children testing positive and on treatment for HIV has continued to decline,” the spokesperson said.
