Cuts in US overseas funding for HIV treatment and prevention have forced widespread closures of community-based services and key population programmes globally, according to research presented at the 26th International AIDS Conference (AIDS 2026) in Rio de Janeiro, Brazil. The disruption follows a 90-day foreign aid freeze and the closure of the US Agency for International Development (USAID) by the second Trump administration in January 2025, which affected thousands of partners implementing the President’s Emergency Plan for AIDS Relief (PEPFAR).
Global Survey Reveals Scale of PEPFAR Funding Cuts and Service Closures
To measure the global fallout of the policy shifts, researchers at amfAR surveyed 708 PEPFAR country-level implementing partners between April 2025 and April 2026. According to findings presented by Elise Lankiewicz at AIDS 2026, the survey received responses from 166 organisations across 46 countries, noting that some non-respondents may have shut down entirely. Among the respondents, 38% were local NGOs, 28% were international NGOs, 7% were national governments, and 3% were international private contractors, with eastern and southern Africa accounting for 55% of total responses.
Overall, 77% of respondents reported a delayed or terminated award, while 52% faced at least one cancelled award. Local providers bore a heavier burden than international NGOs, with 62% of local entities reporting a terminated award compared to 40% of international organisations. Furthermore, 87% of surveyed groups experienced staff reductions, and only two respondents managed to fully replace their lost funding. In 57% of cases, PEPFAR grants had accounted for over half of an organisation’s operating budget.
Did you know? Established in 2003, PEPFAR has provided over $120 billion to support global HIV treatment and prevention across more than 50 countries, with approximately 20 million people depending on its funded services by 2025.
Impact on Key Populations and Community Health Infrastructure
The survey data shows severe disruptions to specialized care networks, particularly for groups facing high vulnerability to infection. According to amfAR’s findings, 72% of organisations providing services to key populations—such as sex workers, gay and bisexual men, and people who inject drugs—were forced to close those specific programmes. Out of relevant respondents, 22 of 42 prevention services and 26 of 39 outreach programmes for key populations shut down completely.
Community-based healthcare delivery suffered similar losses, with 46% of providers reporting closures. Specific cuts included 17 of 41 community adherence clubs, 15 of 42 community antiretroviral pick-up points, and 23 of 37 community-led monitoring initiatives. Among prevention providers, 43% closed prevention services, 22% stopped offering HIV testing, and 21% halted treatment services entirely, while 58% reported general disruptions to care. In total, respondents documented the closure of 1,714 service points, including 1,010 public health facilities and 126 drop-in centres.
Beyond direct funding losses, 77% of organisations reported being asked to comply with new US policy restrictions as a condition for continued support. “Many of the programmes that bring people into care and keep them there have been stopped,” Lankiewicz said. “Treatment continuity now rests on a system that has lost many of its entry points.”
Decline in Paediatric HIV Treatment Raises Alarm
A separate study presented at AIDS 2026 examined public health data from 55 countries supported by PEPFAR to track paediatric treatment numbers. While successful prevention of vertical transmission over the past 15 years has shrunk the overall number of children needing care—dropping by roughly 100,000 between 2021 and 2024 as older children transitioned into adulthood—new data points to a sharper, unexpected drop.
According to Ramona Godbole of the Clinton Health Access Initiative, researchers found that 77,163 fewer children received HIV treatment in 2025 than in 2024, marking a 14% single-year decline. Six of the 21 countries reporting more than 1,500 children on treatment saw drops exceeding 15%. In South Africa, Haiti, Uganda, Kenya, and Zambia, the reduction outpaced the historical average annual rate of decline, raising concerns that funding gaps are impacting paediatric enrolment and retention.
“Ultimately, our findings are signals, not a verdict,” Godbole noted, emphasizing the need to monitor downstream impacts on vulnerable pediatric cohorts.
Frequently Asked Questions
What caused the recent disruptions to PEPFAR-funded HIV services?
The disruptions stem from a 90-day foreign aid freeze and the closure of USAID enacted by the second Trump administration in January 2025, which led to widespread cancellations and delays of PEPFAR grants.
How many implementing partners were affected by funding cuts?
According to an amfAR survey of 166 organisations across 46 countries, 77% of respondents reported delayed or terminated awards, and 52% reported cancelled awards.
Are paediatric HIV treatment numbers dropping globally?
Yes. Research presented at AIDS 2026 showed that 77,163 fewer children received HIV treatment across PEPFAR-supported countries in 2025 compared to 2024, a 14% decline that exceeds historical trends.
What services for key populations were hit the hardest?
Nearly three-quarters (72%) of organisations providing services to key populations reported forced closures, alongside widespread shutdowns of community adherence clubs and community-led monitoring programmes.
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