A new report reveals that funding cuts to the President's Emergency Plan for Aids Relief (Pepfar) under Donald Trump have caused 'severe and devastating' disruption globally, with thousands of staff laid off and many clinics closed. The research, presented at the 26th International Aids Conference in Rio de Janeiro, warns that US policy changes risk reversing progress in the fight against HIV/AIDS.
Widespread disruption across Pepfar programmes
Elise Lankiewicz, from the AIDS research foundation Amfar and co-lead author of the Pepfar Pulse report, said: 'Disruption was incredibly widespread. No part of the programme really escaped unscathed – and that includes areas of the programme that this administration intended to protect.'
Pepfar, credited with saving more than 26 million lives since its inception in 2003, works through partner organisations worldwide to provide testing, prevention, and treatment for HIV. However, many grants were abruptly withdrawn in 2025, with over half managed via USAID, which was dissolved by Trump in July 2025. A February 2025 waiver theoretically allowed life-saving treatment and prevention of mother-to-child transmission to continue, but implementation proved difficult.
Clinic closures and job losses
Amfar surveyed 166 organisations across 46 countries that were due to receive Pepfar funding in 2025. More than half had at least one terminated award, resulting in over 1,700 closed clinics, drop-in centres, or other sites. Prevention services were particularly hard hit, with more than 16,000 full-time staff losing their jobs.
Almost two-thirds of organisations providing services to prevent mother-to-child HIV transmission reported disruption, with a fifth ending services entirely. A fifth of organisations providing HIV care and treatment stopped at least one service. Many reported inability to obtain supplies of laboratory commodities, condoms, or drugs.
Five surveyed organisations had closed, three directly due to losing Pepfar funding. However, researchers noted this is likely an undercount, as closed organisations would not have active email accounts to receive the survey.
Impact on vulnerable populations
Services for key populations most vulnerable to HIV – such as gay or transgender people, injectable drug users, or sex workers – were most likely to end. Almost four out of five respondents said they had been asked to restrict work to comply with additional US policies, including anti-DEI executive orders and an expanded 'global gag rule'.
Lankiewicz said organisations made 'pretty dramatic shifts to their programming to align with these new policies,' including ending services tailored to specific groups like sex workers and support for victims of gender-based violence.
Real-world data confirms projections
Greg Millett, a member of the study team, said: 'Until now, much of the discussion about the impact of recent Pepfar disruptions has relied on projections and modelling. This study provides some of the first real-world data.'
The results mirror earlier analysis of US government data showing a severe drop in frontline health workers, HIV diagnoses, and prevention programmes. Millett told a press briefing: 'These disruptions threaten to reverse progress toward controlling the HIV epidemic.'
