Hundreds of HIV treatment clinics have shuttered and over 16,000 health workers have lost jobs as the Trump administration's funding cuts ravage the global fight against AIDS, according to new research on the scale of disruption to America's flagship anti-HIV program.
The President's Emergency Plan for AIDS Relief, or Pepfar, has been operating since 2003 and is credited with saving more than 26 million lives worldwide. But a survey of organizations across 46 countries reveals that funding terminations have created what researchers call "severe and devastating" fallout that contradicts administration assurances that lifesaving care would be protected.
Researchers from the AIDS foundation Amfar surveyed 166 organizations that were slated to receive Pepfar funding this year. More than half reported at least one terminated award. The result: more than 1,700 closed clinics, testing sites, and drop-in centers. Prevention services bore the brunt of the impact.
"Disruption was incredibly widespread," said Elise Lankiewicz, co-lead author of Amfar's Pepfar Pulse report. "No part of the programme really escaped unscathed, and that includes areas of the programme that this administration intended to protect."
The Trump administration dissolved much of USAID in July after issuing a waiver in February that theoretically exempted programs providing treatment or preventing mother-to-child HIV transmission. But organizations found the cuts impossible to parse or navigate cleanly.
Nearly two-thirds of organizations providing mother-to-child transmission prevention reported disruption, with a fifth stopping services entirely. A fifth of HIV care and treatment providers ceased at least one service. Shortages of lab supplies, condoms, and medications have become widespread.
The groups hit hardest were those serving vulnerable populations. Services for gay and transgender people, injection drug users, and sex workers were most likely to be eliminated, the research found. Five organizations surveyed had closed completely, three directly from Pepfar funding loss, though researchers suspect the true number is higher since shuttered groups would no longer receive survey outreach.
Beyond direct funding terminations, organizations still receiving support face pressure to reshape their work. Almost four in five respondents said they were required to restrict programming to comply with Trump administration policies, particularly executive orders targeting diversity, equity, and inclusion initiatives. Some organizations ended services tailored to vulnerable populations and victim support programs as a result.
"They made pretty dramatic shifts to their programming to align with these new policies," Lankiewicz said.
Researchers presented the findings at the International AIDS Conference in Rio de Janeiro this week. The data comes as earlier U.S. government figures showed severe drops in frontline health workers, HIV diagnoses, and prevention program activity.
Greg Millett, a member of the research team, noted that the survey offers rare real-world evidence of the impact. "Until now, much of the discussion about recent Pepfar disruptions has relied on projections and modelling," he said at a press briefing. "These disruptions threaten to reverse progress toward controlling the HIV epidemic."
Author James Rodriguez: "The survey confirms what aid workers have been warning privately for months: you cannot cleanly excise funding from a global health system without everything downstream bleeding out."
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