Disruptions to U.S. global AIDS relief programs have significantly hampered efforts to prevent and treat HIV in dozens of countries, forcing organizations to close clinics, lay off staff, and reduce services, a new report released Tuesday indicates.

The President’s Emergency Plan for AIDS Relief (PEPFAR), which has been credited with saving at least 26 million lives since its inception in 2003, reportedly experienced disruptions last year due to what the report describes as the dismantling of the U.S. Agency for International Development and cuts to global health grants.

Elise Lankiewicz, policy associate for amfAR, The Foundation for AIDS Research, which released the report, stated that the disruptions were “very widespread,” affecting services for young women, orphans, and children.

To compile the report, researchers surveyed organizations that received PEPFAR funding for HIV services. Of the 166 groups from 46 countries that responded to the electronic survey conducted between November and April, nearly a quarter provided information on their funding, staff, and services. The report notes that certain organizations, particularly those most severely impacted or still receiving U.S. funding, may have been less likely to respond, potentially affecting the comprehensiveness of the findings.

Key findings from the survey included:

  • A majority of responding organizations experienced at least one award termination or payment delay in the past year. These terminations resulted in the closure of over 1,700 service delivery sites and the loss of more than 16,000 full-time staff members.
  • Despite U.S. government directives for continuity of HIV treatment, testing, and prevention of mother-to-child transmission services, most partners reported disruptions to these essential services.
  • Cuts disproportionately affected services for populations most impacted by HIV, including sex workers, men who have sex with men, transgender people, and people who inject drugs. Most organizations serving these key populations reported permanently discontinuing a service for them. Some organizations also reported halting services for these groups to comply with U.S. policy, even if they did not lose funding.
  • HIV prevention efforts saw a sharp reduction, with many organizations ceasing condom programs or services offering pre-exposure prophylaxis (PrEP). PEPFAR expenditure data indicates that prevention spending decreased by 51% from fiscal years 2024 to 2025.
  • Locally-based partners were more likely than international organizations to face award terminations and the closure of service delivery sites, which destabilized interconnected HIV service systems.

"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 states.

While the survey did not provide country-level data, amfAR officials noted that a majority of responses originated from African countries.

In contrast, the Trump administration has presented data suggesting stability. In April, the U.S. State Department reported that PEPFAR-supported programs provided HIV treatment to 20.6 million people in over 50 countries during the July-September 2025 quarter, which they stated was stable compared to the same period in 2024. The department also reported an increase in pregnant and breastfeeding women starting PrEP, from 43,000 to 103,000.

However, amfAR and the International AIDS Society, after combining PEPFAR data from different releases, found substantial disruptions across PEPFAR services. Research published in the journal Nature Health in June indicated that nearly two million fewer people living with HIV received PEPFAR-supported antiretroviral treatment in fiscal year 2025 compared to the previous year, representing approximately a 10% decline.

Ramona Godbole, an author of the Nature Health study, remarked that this decline "does raise really important questions about program stability."

The amfAR report recommended that the U.S. government and PEPFAR leaders reinstate support for all HIV services, not solely treatment. It also urged other national governments to increase their spending on HIV services and to contract with non-governmental organizations, including those led by individuals from key vulnerable populations.

Jennifer Sherwood, amfAR’s director of research and public policy, cautioned that restoring services and community trust will require time, even with renewed financial support. "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."