PEPFAR Disruptions Have Had Serious Global Consequences, Studies Show Ahead of AIDS 2026
Studies revealing the real-world impact of disruptions to the US President’s Emergency Plan for AIDS Relief (PEPFAR) were announced ahead of AIDS 2026, the 26th International AIDS Conference, which will take place in Rio de Janeiro, Brazil, and virtually from 26 to 31 July.
Convened by IAS, the International AIDS Society, AIDS 2026 will take place at a crucial time in the HIV response. In the face of an unprecedented funding crisis and major cutbacks to HIV programmes, the conference will unite people living with HIV, researchers, policy makers, healthcare professionals, funders, media and communities under the theme Rethink. Rebuild. Rise.
At a media conference on Tuesday evening, researchers shared their findings ahead of the conference.
“Science is moving fast, giving us more powerful HIV prevention and treatment tools. But these advances cannot save lives if they never reach the people who need them. That requires robust, stable financing and steadfast political commitment,” Beatriz Grinsztejn, IAS President, AIDS 2026 Co-Chair and Director of the HIV/AIDS Clinical Research Unit at the Evandro Chagas National Institute of Infectious Diseases, Fiocruz, in Rio de Janeiro, said.
PEPFAR Disruptions Have Had Serious, Far-Reaching Consequences
PEPFAR has saved more than 26 million lives since 2003 and changed the trajectory of the HIV pandemic. During the first Trump administration, the programme made significant progress towards the global 95-95-95 targets. Since the start of the second Trump administration, however, the programme has undergone major disruptions.
Two presentations at AIDS 2026 will demonstrate the real-world impact of these disruptions.
The first is based on the PEPFAR Pulse Study, described as the first large-scale survey of PEPFAR implementing partners to document the scale and scope of disruptions globally. The survey reached 166 implementing partners in 46 countries.
Researchers said the results were deeply concerning. More than half (52%) of all implementing partners had at least one terminated award, while 77% had been asked to restrict their work to comply with an additional US policy.
Terminations led to 1,714 closed service sites, including 1,010 public health facilities, 325 access points and 126 drop-in centres. Locally based partners were particularly affected.
Partners were most likely to have permanently stopped providing services for key populations, who are among the groups most vulnerable to HIV. Among partners providing HIV treatment, more than one in five (21%) had permanently stopped at least one HIV clinical care activity.
Many partners reported they were unable to obtain condoms (23%), laboratory commodities (23%), PrEP (22%) or antiretroviral drugs (20%).
Among partners with no terminated awards, the majority had censored language (61%), stopped a service (61%) or stopped services to specific populations (44%) to continue receiving funding.
According to presenter Elise Lankiewicz of amfAR, the results make it clear that US funding and policy changes have caused PEPFAR-wide disruptions, with a disproportionate impact on local organisations and the populations most vulnerable to HIV.
Speaking at the media briefing, Lankiewicz gave an overview of the findings.
“As a whole, our findings document not a collapse, but a narrowing of PEPFAR services concentrated among the populations and programming that in the long term often decide whether epidemic control is won or lost.”
Study Finds Less Paediatric Treatment Being Funded Through PEPFAR Programme
The second study, based on a rapid analysis of newly released PEPFAR data for fiscal year 2025, examined shifts in PEPFAR-supported paediatric treatment following a year of disruption. To obtain an accurate picture, the study team limited the analysis to PEPFAR-supported treatment, meaning site-level service delivery and technical assistance.
The team found that globally, 77,163 fewer children living with HIV received PEPFAR-supported treatment in fiscal year 2025 compared with 2024, a decline of 14.2%.
The researchers also examined data from 21 countries with substantial numbers of children living with HIV receiving PEPFAR-supported treatment.
Among those countries, all but one reported a decline in the number of children receiving site-level treatment support from PEPFAR, with proportional declines among children living with HIV exceeding those among adults.
South Africa recorded the largest absolute decline, with 30,880 fewer children receiving treatment support from PEPFAR, a 45% drop.
The team also conducted an analysis suggesting that declines in five countries, Uganda, Haiti, Zambia, South Africa and Kenya, represent potential departures from historical trajectories.
According to presenter Ramona Godbole of Heidelberg Institute of Global Health, Heidelberg University Hospital, and the Clinton Health Access Initiative, these findings warrant urgent country-level investigation and the restoration of public dissemination of routine age-disaggregated PEPFAR data.
“These studies provide compelling new evidence that PEPFAR disruptions have had negative, far-reaching consequences, particularly for those most vulnerable people,” Kenneth Ngure, IAS President-Elect and Associate Professor of Global Health at Jomo Kenyatta University of Agriculture and Technology in Juja, Kenya, said.
