PEPFAR Pediatric HIV Treatment Drops as Trump Administration Cuts Funding

The global fight against HIV is facing a moment, according to experts, as the impact of U.S. foreign aid shifts becomes clear. New analyses presented ahead of the international AIDS conference in Rio de Janeiro reveal that the President’s Emergency Plan for AIDS Relief (PEPFAR)—a program historically credited with saving 26 million lives since 2003—has experienced widespread degradation of its service infrastructure.

Pediatric Treatment Declines Across 20 Countries

The most immediate human cost of these shifts is visible in pediatric care. According to Reuters, U.S.-supported pediatric HIV treatment fell by 14% globally in the year leading up to October 2025. Researchers analyzed data from 21 countries, finding that treatment numbers for children declined in 20 of 21 countries analyzed.

The impact has been particularly sharp in regions where community-based support systems were once the primary safety net. Susan Wairimu Metta, a health advocate in Kisumu West, Kenya, noted that the withdrawal of funding hit hardest during the initial stop work orders issued by the U.S. government. The funding cuts have had a real impact on paediatric HIV care in Kenya, she said, noting that families now face new charges for tests that were previously free.

Clinic Closures and Staff Layoffs

A survey of 166 organizations conducted by amfAR provides a granular look at the operational collapse. Between last November and April, researchers found that funding terminations or delays forced the closure of at least 1,700 service delivery sites. The disruptions resulted in the loss of more than 16,000 full-time staff members.

“The disruptions were very widespread,”

Elise Lankiewicz, policy associate at amfAR

The study highlights a high level of institutional fragility, noting that just six organizations accounted for 85% of the total site closures. This concentration suggests that the loss of a single major award can shutter hundreds of service points simultaneously, leaving patients without immediate alternatives.

Policy Shifts and Service Restrictions

The administration’s policy changes, including an expansion of the Mexico City Policy in January 2025, have fundamentally altered the scope of what U.S.-funded groups can provide. More than 60% of organizations reported stopping at least one service to comply with new requirements regarding gender, diversity, and reproductive health.

These restrictions have hit the most vulnerable populations hardest.

Conflicting Data on Program Stability

There is a stark divide between the findings of independent researchers and the U.S. State Department. While the new studies suggest a broad decline in reach, the State Department has maintained that the program remains resilient. A spokesperson for the department stated that the administration has strengthened PEPFAR through clear, strategic direction, and categorized the methodology of the amfAR report as flawed.

The State Department points to data from July through September 2025, which indicated that PEPFAR-supported programs were providing treatment to 20.6 million people—a figure they describe as stable compared to 2024. However, researchers point out that this single-quarter snapshot does not account for the systemic degradation observed over the full year. As Dr. Beatriz Grinsztejn, president of the International AIDS Society, noted, the situation remains precarious: We unfortunately are going through a very complex and difficult moment, where all these good achievements are challenged by the new policies.

As the international community gathers in Rio, the central question remains whether local governments and other donors can fill the widening gaps in HIV service delivery. For now, many community-based systems that once prevented children and high-risk populations from falling through the cracks remain unreplaced.