U.S. funding cuts have gutted global AIDS program, report finds

Cuts to a major U.S.-funded AIDS program have forced clinics to close, staff to lose their jobs, and HIV services to collapse across dozens of countries, according to a report released Tuesday.

The report was produced by amfAR, The Foundation for AIDS Research.

It examines the fallout from disruptions to PEPFAR, the President’s Emergency Plan for AIDS Relief. Launched in 2003, PEPFAR is credited with saving at least 26 million lives. Last year, the program was hit hard when the Trump administration dismantled the U.S. Agency for International Development and cut thousands of global health grants.

“The disruptions were very widespread,” said Elise Lankiewicz, a policy associate at amfAR. Services for young women, orphans and children were among those affected, she said.

Researchers surveyed organizations that had received PEPFAR funding to deliver HIV services last year. Of those contacted, 166 groups from 46 countries responded. The survey did not reach every funded organization, and some of the hardest-hit groups may not have replied — meaning the true scale of the damage could be worse, or in some cases less severe, than the findings suggest.

Most organizations had at least one funding award cancelled or delayed, the report found. Those cancellations led to the closure of more than 1,700 clinics and service centers, and the loss of more than 16,000 full-time jobs.

The U.S. government had directed that HIV treatment, testing and mother-to-child transmission prevention should continue uninterrupted. But most surveyed groups reported disruptions to those services anyway.

Cuts fell hardest on services for groups most affected by HIV, including sex workers, gay and bisexual men, transgender people and people who inject drugs. Most organizations that had served these groups reported permanently ending at least one service for them. Some cut services even without losing funding, in order to comply with new U.S. policy.

Prevention efforts were sharply reduced. Many organizations stopped distributing condoms or offering PrEP, a medicine that prevents HIV infection. Spending on prevention fell 51% between the 2024 and 2025 fiscal years, according to PEPFAR’s own expenditure data.

Locally based organizations were far more likely than international groups to lose funding and close clinics, the report found.

“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 Trump administration has offered a more positive account of the program’s status. In April, the State Department reported that PEPFAR provided standard HIV treatment to 20.6 million people in more than 50 countries between July and September 2025 — stable compared with the same period a year earlier. The number of pregnant and breastfeeding women started on PrEP more than doubled, to 103,000, officials said.

But researchers at amfAR and the International AIDS Society combined that quarter’s data with figures covering a full year and found substantial disruptions across PEPFAR services.

A separate study published in June in the journal Nature Health, examining PEPFAR treatment data globally, found that nearly two million fewer people living with HIV were receiving PEPFAR-supported antiretroviral treatment in fiscal year 2025 compared with the previous year — a decline of about 10%.

“That does raise really important questions about program stability,” said Ramona Godbole, an author of that study who was not involved in the amfAR report.

AmfAR’s report calls on the U.S. government and PEPFAR leaders to reinstate support for all HIV services, not just treatment. It also urges other national governments to increase spending on HIV programs and to contract directly with local organizations, including those led by people from the most affected communities.

Even if funding is restored, rebuilding will take time, said Jennifer Sherwood, amfAR’s director of research and public policy. Services will need to be restarted and community trust rebuilt.

“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.”