The US Trump administration's cuts to global health funding have severely disrupted the United States' flagship HIV/AIDS program, PEPFAR, in Africa, Asia, and beyond. A new study by the Foundation for AIDS Research (amfAR) found that 63% of respondents reported disruptions to mother-to-child transmission services, including 22% that ended those services entirely. The study surveyed 166 organizations that received PEPFAR funding across 46 countries.
The disruptions have had a significant impact on HIV/AIDS services for children and pregnant women. In Tanzania, health workers were abruptly told to stop work on a program providing services for HIV-exposed infants, children, and pregnant women. Dr. Theopista Masenge, a pediatrician who lost her job, said that the system built over 40 years was gone, and disruptions to HIV/AIDS services remain across Tanzania.
The US government had said that HIV services to prevent mother-to-child transmission would be prioritized and protected from funding cuts. However, the amfAR survey found that it was not possible to protect specific parts of the system while dismantling others. PEPFAR, established in 2003, is credited with saving over 26 million lives and preventing millions of infections, mostly in Africa.
The disruptions have resulted in 1,714 health clinics once supported by PEPFAR closing around the world. Health workers are worried about the quality of care for children and mothers. In Tanzania, people are not returning to facilities to pick up medication, and early infant diagnosis is suffering. The situation is similar in other countries, with respondents to the amfAR survey reporting disruptions to the Orphans and Vulnerable Children Program.
The US State Department has disputed the amfAR survey's methodology, saying that the Trump Administration has strengthened PEPFAR through clear strategic direction and a focus on measurable health outcomes. However, experts say that declines in pediatric diagnosis and treatment are not necessarily a marker of success. The Elizabeth Glaser Pediatric Aids Foundation has called the drops in pediatric diagnosis and treatment an "HIV crisis hiding in plain sight."
The disruptions have also affected data gathering and reporting, making it harder to spot negative outcomes. Despite US government carve-outs for "life-saving" work to continue in relation to pregnant and breastfeeding women, HIV testing for pregnant women declined slightly, and testing for babies declined by at least 6%. The number of children getting on medications used to treat HIV also declined 15% in 2025 compared to the year before.
The impact of the disruptions will be long-lasting, with many fearing that the progress made in fighting HIV/AIDS will be undone. The US government's focus on striking new agreements with aid-recipient nations and demanding more co-financing from them has raised concerns that the most vulnerable populations will be left behind.
Key points
- US funding cuts to PEPFAR have disrupted mother-to-child transmission services, despite assurances that they would be prioritized.
- The disruptions have resulted in 1,714 health clinics closing around the world.
- HIV testing for pregnant women and babies has declined, and the number of children getting on HIV medications has also decreased.
