Key facts
- Funding cuts to the President's Emergency Plan for Aids Relief (Pepfar) have caused severe disruption globally.
- Thousands of staff have been laid off and many clinics closed as a result of the funding changes.
- Organisations are altering their programming to comply with US policies targeting DEI, reproductive rights, and gender-affirming care.
- A report surveyed 166 organisations across 46 countries, with over half experiencing terminated awards.
- More than 1,700 sites closed and over 16,000 staff lost their jobs, with prevention services heavily impacted.
- Services for key populations vulnerable to HIV were most likely to be ended.
Funding cuts to the President’s Emergency Plan for Aids Relief (Pepfar) under Donald Trump have caused severe and devastating disruption globally, according to a new report. The research, set to be presented at the 26th International Aids Conference in Rio de Janeiro, Brazil, warns that changes in US policy risk reversing progress in the fight against HIV/Aids.
According to the Pepfar Pulse report by Aids research foundation Amfar, no part of the US anti-HIV programme has escaped unscathed. Thousands of staff have been laid off and many clinics closed. Organisations still receiving US funding are also altering their work to comply with policies targeting diversity, equity and inclusion (DEI) initiatives, reproductive rights, and gender-affirming care.
Elise Lankiewicz, co-lead author of the report, stated that the disruption was widespread and affected areas the administration intended to protect. Pepfar, established in 2003, is credited with saving over 26 million lives. It operates through partner organisations that provide testing, protection, and treatment for HIV.
However, many grants were abruptly withdrawn in 2025, with over half previously managed by USAID, an agency dissolved by Trump. A waiver issued in February 2025 theoretically allowed life-saving treatment and mother-to-child transmission prevention programmes to continue, but Lankiewicz noted the difficulty in cutting one award without systemic ripple effects.
Amfar surveyed 166 organisations across 46 countries. More than half reported terminated awards, leading to over 1,700 closed sites and the loss of more than 16,000 full-time staff. Prevention services were particularly hard hit. Nearly two-thirds of organisations preventing mother-to-child HIV transmission reported disruption, with a fifth ceasing services entirely. A fifth of organisations providing HIV care and treatment also stopped at least one service, with many unable to obtain necessary supplies.
Five surveyed organisations closed, three directly due to losing Pepfar funding, though researchers believe this is an under-count. Services for key populations most vulnerable to HIV, such as gay or transgender people, drug users, and sex workers, were most likely to end. Almost four out of five respondents reported being asked to restrict their work to align with new US policies, including anti-DEI executive orders and an expanded “global gag rule”.
Greg Millett, a study team member, highlighted that the study provides the first real-world data on Pepfar disruptions, moving beyond projections. The findings align with earlier analysis of US government data showing significant drops in frontline health workers, HIV diagnoses, and prevention programmes, threatening progress toward controlling the epidemic.