A new independent report released Tuesday has exposed severe, far-reaching damage to the world’s largest global HIV relief initiative, tracing the harm directly to administrative disruptions carried out under the Trump administration that have forced clinic closures, mass staff layoffs, and widespread cuts to life-saving care across dozens of low- and middle-income countries.
Launched in 2003, the U.S. President’s Emergency Plan for AIDS Relief, better known as PEPFAR, is widely recognized as one of the most successful global public health initiatives in modern history, credited with saving at least 26 million lives from HIV/AIDS since its creation. But the report from amfAR, The Foundation for AIDS Research, details how the program was systematically undermined last year through the Trump administration’s restructuring of the U.S. Agency for International Development (USAID) and cuts to thousands of global health grant awards.
Elise Lankiewicz, policy associate at amfAR and lead contributor to the report, noted that service disruptions touched nearly every corner of the global PEPFAR network, with the most vulnerable groups – including young women, AIDS orphans, and children living with or exposed to HIV – bearing the brunt of the cuts.
To compile their findings, research teams reached out to hundreds of local and international organizations that deliver frontline HIV services with PEPFAR funding. Between November 2024 and April 2025, 166 organizations across 46 countries completed the researchers’ electronic survey, sharing detailed data on funding flows, staffing levels, and service availability. The research team acknowledges methodological limitations: the survey did not reach all PEPFAR-funded groups, and organizations that experienced the most severe disruption or those that retained full U.S. funding may have been less likely to respond, creating potential for bias in estimates of overall harm. Even so, study authors emphasize the findings offer an unprecedented, clear look into the widespread operational struggles that many PEPFAR partner groups faced over the past year.
Key takeaways from the survey paint a stark picture of systemic breakdown. More than 75% of responding organizations reported at least one grant award was terminated or experienced significant payment delays in 2024. These funding cuts directly led to the permanent closure of more than 1,700 clinics, community drop-in centers, and other HIV service delivery sites, and the elimination of more than 16,000 full-time frontline staff positions. Even though federal guidance officially required core services including HIV treatment, diagnostic testing, and prevention of mother-to-child transmission (PMTCT) to remain operational, a majority of partner organizations still reported disruptive interruptions to these critical services.
Cuts were disproportionately concentrated on services for the populations that are most disproportionately impacted by HIV globally. A majority of organizations that previously provided targeted care for sex workers, men who have sex with men, transgender people, and people who inject drugs reported permanently ending at least one service for these groups. Notably, even some organizations that did not lose funding reported cutting services for these key populations to align with revised U.S. policy priorities under the Trump administration.
HIV prevention programming saw the steepest reductions: many organizations halted free condom distribution programs and stopped providing pre-exposure prophylaxis (PrEP), the daily preventive medication that eliminates the risk of sexually transmitted HIV. Official PEPFAR expenditure data confirms the scale of this cut: total global prevention spending dropped 51% between fiscal years 2024 and 2025. The report also found that local, community-based organizations were far more likely to face grant terminations and forced site closures than large international non-governmental organizations, creating cascading instability across interconnected national HIV care systems.
The report’s authors conclude that the cumulative effect of these disruptions has led to widespread degradation of the global HIV care infrastructure built up over more than two decades of PEPFAR investment, with the deepest harm falling on the communities and local partners that are most critical to ending the global epidemic. While the study does not break out data by individual country, amfAR officials confirmed that a majority of survey responses came from organizations based in sub-Saharan Africa, the region that bears more than two-thirds of the global HIV burden.
The Trump administration has pushed back against these findings, releasing its own quarterly PEPFAR data covering July to September 2025 that presents a far more positive outlook. Administration officials noted that PEPFAR-supported programs provided continuous antiretroviral treatment to 20.6 million people across more than 50 countries, a figure they described as stable compared to the same quarter in 2024. They also highlighted an increase in PrEP access for pregnant and breastfeeding women, rising from 43,000 in 2024 to 103,000 in 2025.
But independent analysis of full-year PEPFAR data by amfAR researchers and experts from the International AIDS Society contradicts the administration’s rosy assessment, confirming substantial service disruptions across all program areas. Separate independent research, published in the journal Nature Health in June 2025, echoes the amfAR report’s conclusions. That study, which analyzed full global PEPFAR treatment data, found that nearly two million fewer people living with HIV were accessing PEPFAR-supported antiretroviral treatment in fiscal year 2025 compared to 2024 – a roughly 10% year-over-year decline.
Ramona Godbole, an author of the Nature Health study who was not involved in the new amfAR report, noted that the sharp drop in treatment access raises urgent questions about the long-term stability of the PEPFAR program. “That does raise really important questions about program stability,” Godbole said.
To reverse the damage documented in the report, amfAR has put forward a series of policy recommendations. The organization calls on the U.S. government and PEPFAR leadership to immediately reinstate full funding and support for all HIV services, not just core treatment programming. It also urges other national governments to increase domestic investment in HIV care and expand partnerships with grassroots non-governmental organizations, including groups led by members of vulnerable key populations.
Even with immediate new funding, however, amfAR’s research and policy director Jennifer Sherwood warned that rebuilding the broken care system will take significant time, and every day of delay brings avoidable harm. “Even if money is put back into the system, it will take time to get the services up and running and regain the trust of communities,” Sherwood explained. “And unfortunately, with HIV and infectious disease, each day is deadly. Each day that we don’t have those systems in place, you see new infections.”
This reporting from The Associated Press Health and Science Department receives financial support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation; the AP retains full editorial control over all content.