The Trump administration’s reductions to the President’s Emergency Plan for AIDS Relief (PEPFAR) last year have led to significant declines in HIV prevention and treatment services, according to recent studies to be presented at an international AIDS conference in Rio de Janeiro.

PEPFAR, the largest global HIV program launched in 2003 by President George W. Bush, has been credited with saving 26 million lives across more than 50 countries. However, last year the Trump administration restructured the program, requiring low-income countries to assume a greater share of costs for HIV care and imposing restrictions on funded organizations. These changes have, according to a survey conducted by the HIV charity amfAR, caused a severe reduction in services to those most at risk, including sex workers, men who have sex with men, transgender individuals, and people who inject drugs.

The amfAR survey, covering 166 organizations across 46 countries—about one quarter of those funded by PEPFAR—found that three-quarters of these groups ceased providing services to key populations. The funding changes led to the closure of approximately 1,700 service sites and the loss of over 16,000 jobs. Disruptions also affected organizations that remained operational, resulting in longer wait times, reduced staffing, and degraded data systems. Just six organizations accounted for 85 percent of site closures, underscoring the outsized impact of funding losses to a small number of recipients.

In addition to direct funding cuts, the administration expanded the Mexico City Policy in January, restricting organizations receiving U.S. funds from offering many gender, diversity, and reproductive health services. As a result, over 60 percent of the surveyed groups stopped at least one service, and 44 percent stopped serving specific populations altogether. Some organizations were forced to revise educational materials, sometimes altering meanings in ways that conflated distinct issues—for example, replacing the term “sex work” with “sex trafficking.”

A separate multinational study, also to be presented at the conference, examined the program’s impact on children living with HIV. The researchers found that PEPFAR supported treatment for roughly 77,000 fewer children last year than in the previous year, a 14 percent decrease. This decline was notably steeper in India and South Africa, which reported reductions exceeding 45 percent. The study’s authors cautioned that while this represents a concerning signal, further investigation is necessary to understand the full implications.

The U.S. State Department, which oversees PEPFAR, disputed aspects of the findings, questioning the methodology behind amfAR’s survey and asserting that the program has been strengthened under the Trump administration’s strategic direction. The department also highlighted reductions in new pediatric HIV infections, attributing the gradual decrease in children receiving treatment partly to successful prevention of mother-to-child transmission.

Nevertheless, experts warn that the current “treatment-heavy” focus may undermine long-term efforts to control the HIV epidemic, as prevention programs and key population services have contracted. The loss of interconnected services and the shutdown of numerous sites have disrupted supply chains for critical items such as antiretroviral drugs, condoms, and laboratory materials.

Dr. Beatriz Grinsztejn, president of the International AIDS Society, described the situation as a “complex and difficult moment” threatening recent gains in the global fight against HIV. Analysts and advocates emphasize the urgency of addressing these setbacks to sustain progress and mitigate the broader impact of the reductions in U.S. global HIV aid.