Cuts to the U.S. President’s Emergency Plan for AIDS Relief have forced the closure of at least 1,714 HIV service sites worldwide, with locally based organizations in sub-Saharan Africa absorbing the deepest damage, according to a comprehensive study released on July 22 ahead of the 26th International AIDS Conference in Rio de Janeiro. The PEPFAR Pulse Study, conducted by amfAR’s Public Policy Office with the Johns Hopkins Bloomberg School of Public Health, surveyed 166 PEPFAR-funded organizations across 46 countries and found that the disruptions have narrowed the program’s reach precisely among the populations and communities where epidemic control depends on sustained, on-the-ground service delivery.
Key Takeaways
- At least 1,714 HIV service sites — including 1,010 public health facilities, 325 access points, and 126 drop-in centers — closed entirely after terminated or delayed PEPFAR funding.
- Prevention spending fell 51% between fiscal years 2024 and 2025; 43% of PEPFAR implementing partners permanently stopped at least one prevention activity, including condom distribution and PrEP access.
- A separate analysis found that 77,163 fewer children living with HIV received PEPFAR-supported treatment in fiscal year 2025 compared to 2024 — a decline of 14.2%.
- In South Africa, 12 specialized clinics serving key populations closed, displacing more than 60,000 patients into already-strained public health facilities.
- UNAIDS warned that if the cuts become permanent, the world could see 6.6 million more HIV infections and 4.2 million more AIDS-related deaths by 2029.
What Did the PEPFAR Pulse Study Find?
The PEPFAR Pulse Study represents the first comprehensive assessment of how funding disruptions have reshaped HIV service delivery across the program’s global footprint. Among the 166 organizations surveyed, 52% reported losing at least one funding award. Seventy-seven percent said they had been instructed to scale back activities to comply with new policy requirements imposed by Washington. Twenty-one percent of treatment providers reported permanently discontinuing at least one clinical care service.
The closures were not evenly distributed. Local organizations — the community-based groups that operate clinics in rural villages, urban neighborhoods, and hard-to-reach populations — were far more likely than international groups to lose funding and shut down sites. The 1,714 closed sites include 1,010 public health facilities, 325 community access points, and 126 drop-in centers that served as entry points for people seeking testing, treatment, and prevention services. Elise Lankiewicz, amfAR’s policy associate and co-lead author of the study, described the pattern as “not a collapse, but a narrowing of PEPFAR services concentrated among the populations and programming that, in the long term, often decide whether epidemic control is won or lost.”
Prevention took the hardest hit. Spending on prevention activities fell 51% between fiscal years 2024 and 2025. Nearly half of all partner organizations — 43% — permanently stopped at least one prevention activity, including distributing condoms and offering PrEP, the daily medication that prevents HIV infection. Among organizations serving key populations — including gay men, sex workers, people who use drugs, and transgender individuals — 73% stopped at least one specialized service, and 67% halted outreach entirely.
How Are Children Being Affected?
A second study, analyzing newly released PEPFAR treatment data for fiscal year 2025, found that 77,163 fewer children living with HIV received PEPFAR-supported treatment compared to the prior year — a decline of 14.2%. The researchers limited their analysis to site-level service delivery and technical assistance directly supported by PEPFAR funding to isolate the program’s specific impact from broader health system trends.
Five countries showed the sharpest declines: Uganda, Haiti, Zambia, South Africa, and Kenya. In each, the drop in PEPFAR-supported pediatric treatment marked a departure from preceding years of steady or improving coverage, suggesting the declines are directly associated with funding changes rather than pre-existing trends. Children living with HIV are already among the hardest populations to reach and retain in care, requiring specialized formulations, caregiver engagement, and follow-up systems that are disproportionately dependent on the kind of community-based programming that the cuts have dismantled.
What Does This Mean for Black Communities Across Africa?
Sub-Saharan Africa remains the epicenter of the global HIV epidemic. The region is home to approximately two-thirds of all people living with HIV worldwide, and PEPFAR has been the single largest external funding source for treatment, prevention, and care infrastructure across the continent since the program’s launch in 2003. The program is credited with saving more than 26 million lives, the vast majority of them in African nations where HIV prevalence intersects with poverty, limited healthcare infrastructure, and systemic underinvestment in public health.
In South Africa — the country with the world’s largest HIV-positive population — Harvard T.H. Chan School of Public Health researchers warned that the loss of PEPFAR support threatens to reverse years of gains. Twelve specialized clinics serving key populations have closed, displacing more than 60,000 patients who must now register at state health facilities where longer wait times, weaker follow-up systems, and stigma may reduce retention in care. South Africa formally launched lenacapavir, a long-acting injectable PrEP medication, in June 2026 at approximately 360 public clinics — but the community-based demand creation, testing, counseling, and follow-up infrastructure required to deliver it at scale is precisely the infrastructure that the PEPFAR cuts have damaged.
The U.S. State Department has disputed the studies’ conclusions, stating that PEPFAR has grown “stronger” under clearer strategic direction and pointing to one quarter of fiscal year 2025 data showing treatment numbers held steady. Researchers countered that the partial-year snapshot obscures the full-year decline, which becomes apparent only when all four quarters of data are combined.
What Happens Next?
The findings will be formally presented at the 26th International AIDS Conference, which opens July 26 in Rio de Janeiro under the theme “Rethink. Rebuild. Rise.” The conference, convened by the International AIDS Society, is expected to draw researchers, policymakers, healthcare professionals, and community advocates from more than 100 countries.
The stakes extend well beyond the conference halls. UNAIDS Executive Director Winnie Byanyima has warned that if the funding cuts become permanent, modeling projects 6.6 million additional HIV infections and 4.2 million additional AIDS-related deaths by 2029. Separate modeling from Harvard suggests over one million additional infections could accumulate over the next 20 years in South Africa alone if support is not restored. For communities across sub-Saharan Africa that built their health systems around PEPFAR’s presence, the question is no longer whether the cuts have caused harm but whether the damage can be reversed before the epidemiological consequences become irreversible.
FAQs
What Is PEPFAR?
The President’s Emergency Plan for AIDS Relief is a U.S. government program launched in 2003 that provides funding for HIV prevention, treatment, and care in more than 50 countries. PEPFAR is credited with saving more than 26 million lives and has been the single largest external funding source for HIV services across sub-Saharan Africa.
How Many HIV Treatment Sites Have Closed?
The PEPFAR Pulse Study found that at least 1,714 HIV service sites closed entirely after terminated or delayed PEPFAR payments. The closures include 1,010 public health facilities, 325 community access points, and 126 drop-in centers across 46 countries.
How Have Children Been Affected by the Cuts?
A separate study found that 77,163 fewer children living with HIV received PEPFAR-supported treatment in fiscal year 2025 compared to 2024, a decline of 14.2%. The sharpest declines occurred in Uganda, Haiti, Zambia, South Africa, and Kenya.
What Could Happen if Funding Is Not Restored?
UNAIDS projects that permanent cuts could lead to 6.6 million additional HIV infections and 4.2 million additional AIDS-related deaths by 2029. Harvard researchers estimate over one million additional infections in South Africa alone over the next 20 years without restored support.
The PEPFAR Pulse Study documents what happens when a program built to save millions of lives is scaled back in the communities where those lives depend on it — and the data arriving in Rio de Janeiro next week will determine whether the global response treats the damage as temporary disruption or structural loss.
