A new report reveals that funding cuts to the President’s Emergency Plan for Aids Relief (Pepfar) have caused widespread disruption worldwide, despite US administration pledges to protect life-saving care. The research, to be presented at the 26th International Aids Conference in Rio de Janeiro, warns that changes in US policy risk reversing progress in the fight against HIV/Aids.
The study, led by the Aids research foundation Amfar, surveyed 166 organisations across 46 countries that were due to receive Pepfar funding in 2025. More than half had at least one award terminated, leading to over 1,700 closed clinics and 16,000 full-time staff losing their jobs. Services for preventing mother-to-child HIV transmission were severely affected, with a fifth ending entirely.
Organisations still receiving US funding have had to alter their work to comply with Trump administration policies targeting diversity, equity and inclusion (DEI) initiatives, reproductive rights, and gender-affirming care. Many reported ending tailored services for vulnerable groups such as sex workers or victims of gender-based violence.
Pepfar, credited with saving over 26 million lives since its launch in 2003, operated through partner organisations worldwide. However, many grants were abruptly withdrawn in 2025 after the dissolution of USAID, which managed more than half of Pepfar’s funding. Although a waiver was issued to allow continued life-saving treatment, the report notes that cuts had ripple effects throughout the system.
Greg Millett, a member of the study team, said the research provides some of the first real-world data on the disruptions, which he warned threaten to reverse progress toward controlling the HIV epidemic. Five surveyed organisations had closed, with three directly due to the loss of Pepfar funding, though researchers believe this is an undercount.
