US aid cuts shut 1,700 HIV clinics, 77,000 fewer children on treatment, studies find

Scale of the disruption

The amfAR survey of 166 organisations across 46 countries found that more than 1,700 HIV treatment clinics and service sites closed after the Trump administration slashed foreign aid and terminated thousands of PEPFAR awards. At least 16,000 health workers lost their jobs. The disruption was pervasive, affecting even areas the administration had pledged to protect, such as treatment services and prevention of mother-to-child transmission. Sixty-three percent of organisations reported disruptions to those services.

What we saw is that no part of PEPFAR was untouched by these cuts, and that includes areas that the administration intended to protect.

The survey, conducted by the Foundation for AIDS Research (amfAR), is the first large-scale assessment of the cuts' impact. It will be presented next week at the 26th International AIDS Conference in Rio de Janeiro.

Children left behind

A separate study, co-authored by Kenneth Ngure of Jomo Kenyatta University, found that US-supported paediatric HIV treatment fell by about 14% year-on-year, reaching roughly 77,000 fewer children in the year to October 2025. The decline was observed in 20 of 21 countries analysed. South Africa saw the largest absolute drop, with around 30,000 fewer children on treatment, a 45% decline. Zimbabwe, Kenya and Malawi also recorded significant decreases. The researchers noted steeper-than-predicted declines in Uganda, Haiti, Zambia, South Africa and Kenya.

These are signals, not a verdict. But children cannot wait.

Health advocate Susan Wairimu Metta, who works in Kisumu West, Kenya, said the funding cuts had a real impact on paediatric HIV care in her community. Worldwide, nearly half of all children living with HIV lack access to treatment, according to UNAIDS.

Prevention efforts gutted

Prevention spending fell by more than half in a year, and funding for condoms and lubricants was almost completely eliminated. Forty-three percent of organisations permanently stopped at least one prevention activity. About three-quarters of the surveyed groups ceased serving people most at risk of HIV, including sex workers, transgender people, gay men and people who inject drugs.

It's like bailing out a sinking ship without actually patching the hole. You can't cut out certain awards without seeing a ripple effect throughout PEPFAR.

The retreat from prevention risks reversing decades of progress against the epidemic, researchers warned.

US response and global fallout

The State Department disputed the findings, saying in a statement that the Trump administration had "strengthened PEPFAR through clear strategic direction" and that the amfAR report's methodology was flawed. Officials pointed to one quarter of 2025 data that appeared to show treatment numbers holding steady, but researchers said the full-year data reveal a larger drop.

The US is not alone in pulling back. France, Germany and the United Kingdom have also reduced foreign assistance. UNAIDS lost about 25% of its funding last year, executive director Winnie Byanyima told AFP from the African Union health summit in Accra.

There is a need for Africa to quickly adapt its systems for health in order to keep its people alive and to work towards health sovereignty.

What's at stake

PEPFAR, launched by President George W. Bush in 2003, is credited with saving 26 million lives across more than 50 countries. UNAIDS has warned that if the funding cuts become permanent, the world could see 6.6 million additional HIV infections and 4.2 million more AIDS deaths by 2029.

The findings arrive at a moment when the global AIDS response is already off track to meet the 2030 goal of ending the epidemic as a public health threat.