The Trump administration’s reductions in funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) last year led to significant declines in both HIV prevention and treatment services, particularly among high-risk populations and children, according to recent studies to be presented at an upcoming international AIDS conference in Rio de Janeiro.

A survey conducted by the HIV charity amfAR found that approximately 1,700 service sites were closed following the aid cuts, with three-quarters of organizations ceasing to serve key groups most vulnerable to HIV, including sex workers, men who have sex with men, transgender individuals, and people who inject drugs. The study also highlighted that over 60 percent of aid recipients stopped providing at least one type of service, and 44 percent discontinued care for specific populations. Some organizations were compelled to alter their educational materials to comply with new U.S. policies, sometimes resulting in significant changes to the language and emphasis of HIV prevention efforts.

The study’s findings suggest a grimmer impact than previously reported by the U.S. State Department, which presented data in April indicating treatment levels remained roughly steady between 2024 and 2025. The State Department dismissed the amfAR survey’s conclusions, labeling its methodology as flawed and reaffirming that the administration’s approach provided clearer strategic direction and increased local country ownership.

A second study led by an international team of researchers focused on treatment for children living with HIV found a 14 percent decline in the number supported by PEPFAR in 2025 compared to the prior year, equating to roughly 77,000 fewer children receiving care. This decline is significantly larger than previous years’ trends and disproportionately affects countries such as India and South Africa, which reported declines of over 45 percent in pediatric treatment. According to experts, children living with HIV are at high risk of rapid health deterioration without consistent treatment, underscoring the seriousness of the reduction.

Since its launch in 2003 under President George W. Bush, PEPFAR has been credited with saving an estimated 26 million lives through its extensive global response, operating in more than 50 countries. However, in 2025, the Trump administration reshaped the program to emphasize increased financial responsibility from recipient countries and narrowed prevention efforts, primarily focusing on reducing mother-to-child transmission.

Additionally, in January 2025, the administration expanded the Mexico City Policy to restrict organizations receiving U.S. funding from offering or promoting services related to gender diversity and reproductive health. This policy shift contributed to the widespread discontinuation of services and compelled amendments to program materials, sometimes misrepresenting key issues such as sex work by conflating it with sex trafficking.

Supply chain disruptions were also reported, affecting access to condoms, laboratory supplies, and antiretroviral drugs. amfAR policy associate Elise Lankiewicz described PEPFAR as a highly interconnected system, where cutbacks in one area have far-reaching consequences, shifting the program toward a treatment-heavy approach that may be less effective in long-term epidemic control.

While the State Department maintains that its policies have contributed to a reduction in new pediatric HIV infections, the observed sharp decline in children receiving treatment signals a need for further investigation. UNAIDS reports that nearly half of children living with HIV worldwide still lack access to appropriate therapy.

Experts emphasize that these recent declines represent warning signs rather than definitive conclusions but call for heightened attention to avoid setbacks in the global fight against HIV.