Soon after US President Donald Trump took office in January 2025, funding was halted for the President’s Emergency Plan for AIDS Relief (PEPFAR). The ripple effects from the funds being withdrawn have had an international impact, causing “severe and devastating” global disruption.

PEPFAR is credited with saving more than 26 million lives and changing the trajectory of the HIV epidemic since its commencement under President George W. Bush in 2003. Working with partnered organisations around the world, they work with people at risk of contracting HIV, providing protection against the virus, such as condoms or medicines and treatment if required.

A survey conducted by AIDS research foundation amFAR found that 166 organisations in 46 countries had delays or withdrawal of funding in 2025, resulting in the closure of at least 1,700 sites that had delivered HIV treatment and prevention services. More than 16,000 workers were also let go as a result.

The survey included only one quarter of PEPFAR funding recipients; it is theorised that the true numbers are significantly higher. For the organisations still in operation, the funding cuts and a raft of new requirements imposed by the administration have proved to be debilitating.

Almost two-thirds of organisations providing services to prevent mother-to-child HIV transmission have reported disruption, with 20% of them terminating services entirely. A further 20% of sites reported having to stop providing at least one service of HIV care and treatment.

Restrictions have been placed on funding for organisations that provide abortion-related reproductive healthcare services. The expanded policy now also includes restrictions for groups that acknowledge transgender identity and promote diversity, equity and inclusion (DEI) initiatives, barring them from funding.

Additionally, around half of all groups that participated in the survey reported disruptions to their supply chain in procuring condoms, lab supplies, and antiretroviral drugs for treatment. Their shipments had been delayed or halted entirely.

Elise Lankiewicz from amfAR and co-lead author of its PEPFAR Pulse report, said: “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.”

 

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“Even if a site doesn’t close, what you’re seeing is longer wait times, and fewer staff, and non-functioning data systems,” said Jennifer Sherwood, amfAR’s Director of Research and Public Policy.

Greg Millett, a member of the study team, said: “Until now, much of the discussion about the impact of recent PEPFAR disruptions has relied on projections and modelling. This study provides some of the first real-world data.”

The results of the study mirror an earlier analysis of US government data, showing a severe drop in the number of frontline healthcare workers, HIV diagnoses and prevention programs.

A second study presented at the 26th International Aids Conference in Brazil also examined the disruption caused by the funding cuts. It found that PEPFAR provided treatment for roughly 77,000 fewer children in 2025 than it had in 2024, an average 14% decline over the previous year. India and South Africa both report a decline of more than 45%.

“We unfortunately are going through a very complex and difficult moment, where all these good achievements are challenged by the new policies,” Dr Beatriz Grinsztejn, President of the International AIDS Society, said at a press briefing ahead of the conference.

The system that is left “is really a treatment-heavy model, which isn’t really conducive to controlling the HIV epidemic long-term,” said Elise Lankiewicz, a policy associate at amfAR.

For the most vulnerable affected by the disease, the disruptions occurring because of the cuts have been life-threatening. Those at particular risk are the children living with HIV, because they “can get very sick very quickly without access to drugs, and so the stakes are really high,” said Ramona Godbole, a senior manager at the Clinton Health Access Initiative.

“These disruptions threaten to reverse progress toward controlling the HIV epidemic,” Millett told a press briefing ahead of the conference.

The results of this survey are at odds with the State Department’s own assessment of PEPFAR. “We have not verified this specific report, but we can categorically say that its methodology is flawed,” the State Department told The New York Times, dismissing the bad news and claiming that slashing the program had resulted in “strengthening PEPFAR”.