Trump’s HIV funding cuts: PEPFAR’s treatment pipeline held, but prevention efforts collapsed

People attend an HIV clinic day at the TASO Mulago service center in Kampala, Uganda, on February 17, 2025. | Hajarah Nalwadda/Getty Images

When the Trump administration began dismantling US foreign aid in January 2025, global health experts warned of catastrophic consequences. Early projections suggested thousands of deaths could result from the cuts. By mid-2025, one report documented 3.4 million fewer HIV tests across nine countries in just six months. Emergency waivers later restored HIV treatment access, but many prevention and outreach programs remained suspended.

More than a year after the upheaval began, official data on PEPFAR—the world’s largest US-funded HIV program—has finally been released. The numbers initially appear reassuring: between July and September 2025, the US delivered antiretroviral drugs to approximately 20 million people, matching the same period in 2024. Maintaining this treatment pipeline is critical to keeping people with HIV alive, and the State Department emphasized this success. Jeremy Lewin, acting undersecretary of state for foreign assistance, stated at a recent conference, “The numbers are very, very good.”

Treatment held steady, but prevention efforts faltered

While treatment delivery remained stable, the data reveals significant declines in PEPFAR’s prevention and detection activities—key components of its broader HIV strategy.

• HIV testing dropped by 17%: In the last quarter of 2025, PEPFAR tested 4 million fewer people than in the same period of 2024.
• New treatment starts fell by 16%: The number of people newly starting HIV treatment declined from 463,000 to 389,000.
• PrEP use collapsed by 41% for new enrollments and 60% for follow-ups: New PrEP enrollments dropped by 270,000 people, while those returning for refills fell nearly 60%.

These declines indicate that PEPFAR is struggling to identify new infections and prevent transmission—core functions that had driven progress in reducing the epidemic for years.

What the data means for the future of HIV response

Despite the stability in treatment delivery, the erosion of prevention efforts suggests PEPFAR may be backsliding. Without robust testing and early intervention, new infections could rise, undermining years of progress. The data underscores a critical imbalance: while lifesaving drugs continue to reach those already diagnosed, the program’s ability to find and protect others is weakening.

As the global HIV response faces continued uncertainty, these findings highlight the fragility of health systems dependent on sustained international support.