PEPFAR Data Reveals Mixed Results Amidst Funding Shifts and Program Disruptions

The U.S. State Department released data on Friday regarding the President's Emergency Plan for AIDS Relief (PEPFAR), marking the first official data release since January 2025. The data covers the period up to September 2025 and shows a slight global decline in the number of people receiving HIV treatment, alongside increases in certain prevention measures.

Concurrently, reports from multiple African countries indicate that program disruptions, linked to changes in U.S. foreign aid delivery and funding delays, have had varied impacts on HIV/AIDS services, patient outcomes, and community health worker employment.

PEPFAR Data and Official Interpretations

Key Statistical Findings

The State Department data reports the following figures as of September 2025:

• People on Treatment: Over 20 million people supported by PEPFAR were on HIV treatment across 50 countries. This represents a slight drop compared to the same period a year earlier.
• Prevention for Pregnant Women: The number of pregnant and breastfeeding women starting pre-exposure prophylaxis (PrEP) increased from 43,000 in the last quarter of 2024 to 103,000 in the last quarter of 2025.
• Global Treatment Levels: Preliminary data indicates that global HIV treatment levels remained largely consistent, showing a dip of approximately 100,000 people from the previous reporting period of over 20 million.

Statements from Officials and Experts

"The numbers are very, very good. People will be surprised at how resilient our health programs are and have been."
— Jeremy Lewin, Acting Undersecretary of State for Foreign Assistance

"These data show nothing less than a five-alarm fire... for the first time in history, PEPFAR has put fewer people on therapy than the year before."
— Asia Russell, Executive Director of Health GAP

Brian Honermann, Deputy Director of Public Policy at amfAR, said the data "obscures the true damage of the interruptions." He noted a 24% reduction in frontline health care workers supported by PEPFAR and found that new HIV diagnoses dropped by 13% in clinics without service disruptions and by nearly 30% in clinics with disruptions.

Jeff Imai-Eaton, Associate Professor of Epidemiology at the Harvard T.H. Chan School of Public Health, noted that the most severe anticipated outcomes did not occur. Charles Kenny, Senior Fellow at the Center for Global Development, revised his initial dire projections, stating the situation is better than expected.

Reasons for Sustained Treatment Levels

Sources identify three primary factors that contributed to maintaining treatment levels despite funding pauses:

• U.S. Government Action: The administration restarted some programs identified as life-saving, ensuring drug distribution to countries.
• Recipient Country Efforts: Ministries of Health in aid-receiving countries reprioritized and sustained services.
• Community Health Workers: Many individuals continued working voluntarily, often without pay, to ensure patients received medication and care.

For example, Harerimana Ismail, a community health worker in Uganda, continued his work despite his U.S.-funded salary of approximately $50 per month being terminated in January 2025. He sustained himself by growing vegetables and selling potatoes.

Policy Changes and Funding Delays

New "America First Global Health Strategy"

The Trump administration is implementing a new "America First Global Health Strategy," which aims to transition from the previous aid system—based on partnerships with local and international organizations—towards direct negotiations with recipient governments. The long-term goal is to transfer financial responsibility to individual countries and reduce U.S. investment.

• Transition Timeline: The State Department set a six-month deadline until March 31 to negotiate new contracts directly with governments and develop "detailed implementation plans."
• Bridge Funding: "Bridge funding" was intended to ensure the continuity of "existing life-saving activities" during this transition. However, the second installment of bridge funding, due in December, was often late. Many organizations report a three-month extension of the bridge plan (April-June), but the arrival of these funds remains uncertain.
• Agreement with Uganda: An agreement with Uganda was signed in December to invest up to $1.7 billion over five years to combat infectious diseases, representing a 25-30% reduction compared to previous PEPFAR funding levels.

Congressional Funding and Implementation Delays

Congress allocated nearly $6 billion for global HIV/AIDS work in the previous fiscal year, maintaining funding levels similar to prior years. However, organizations implementing these programs report inconsistent and delayed receipt of funds.

• Allegations of Fund Withholding: Experts and officials, who requested anonymity due to fear of retaliation, suggest the State Department is deliberately withholding some of the congressionally appropriated funds. Dr. K.J. Seung of Brigham and Women's Hospital, analyzing government spending data, concluded that much of the money is "stuck at the State Department."
• CDC Funding Dynamics: Following the dismantling of USAID, the CDC's HIV/AIDS work became a primary pillar of the program. Projects under the CDC have reportedly faced a particularly high degree of funding uncertainty. An anonymous CDC official stated: "What the financial data shows is not an accident or an administrative delay... the State Department is simply not transferring enough of it to CDC to keep these programs running."

Dr. Caspian Chouraya, who oversees HIV/AIDS programs in 12 African countries for the Elizabeth Glaser Pediatric AIDS Foundation, reported that funding delays have necessitated discussions with legal advisors regarding potential layoffs. He stated that uncertainty about funding has made it difficult to plan and maintain essential services. For instance, funding for programs in Cote d'Ivoire arrived in March, after activities had already been scaled back.

Official Responses

• State Department: The State Department rejected assessments that the transition is wasteful, stating that funds are being "directed more strategically [and] with greater accountability" and are flowing "as they have always been," while ensuring "continuity of lifesaving" services. Regarding specific tragic cases, a State Department statement said: "The United States has not cut health funding, including PEPFAR, for Zambia. If there are such tragic cases happening around the world, it's not because we're not spending enough money. It's because the rest of the world is not spending enough money." The State Department also stated that PEPFAR continues to provide HIV testing, care, and treatment services, emphasizing that "the most effective way to prevent HIV-related orphanhood is to keep parents alive."
• CDC: The CDC stated it is using "available resources" and directed further questions to the State Department.
• Senator Patty Murray (D-Wash.): Expressed "serious concern" regarding the delays and uncertainty, stating it is the administration's "legal responsibility to ensure PEPFAR continues to serve people and save lives — without interruption."

Impacts on Services and Patient Outcomes

Program Disruptions in Africa

Reports from South Africa, Mozambique, and Zambia indicate that funding shifts have destabilized long-effective HIV/AIDS programs.

Zambia Incident: Three brothers, Joseph (17), Gift (15), and Alumbwe (12), became orphans in early 2025 after both parents died from HIV/AIDS. According to the brothers, their parents lost access to medication after the U.S. revised foreign aid, disrupting PEPFAR-funded services. Pastor Billiance Chondwe reports that the number of newly orphaned children he assists rose from 11 to 25 in recent months, which he attributes to loss of access to HIV medications following closure of PEPFAR-funded clinics.

• Data from amfAR: Analysis found an almost 20% drop in PEPFAR expenditures in Zambia between 2024 and 2025 and the loss of more than 5,000 PEPFAR staff in the country. In Copperbelt Province, thousands of HIV-positive individuals lost access to their medications.

Affected Services

Despite stable treatment numbers, specialists express concerns about other aspects of the HIV response:

• Testing and Counseling: The number of people receiving U.S.-supported HIV testing and counseling decreased from over 80 million to just under 70 million in one year.
• Quality of Services: Reports include patients receiving expired drugs due to supply chain issues and facing prolonged wait times at hospitals (4-9 hours).
• Prevention Programs: Distribution of condoms and programs for high-risk populations (e.g., sex workers, men who have sex with men) have dwindled.
• Support Services: Support groups for teenagers with HIV and phone reminders for appointments and medication refills have ceased due to funding cuts.

Long-Term Impact: Orphanhood Trends

Research published in The Lancet Global Health by Aleya Khalifa and Dr. David Serwadda indicates that the number of children who have lost a parent in southern Uganda significantly declined from nearly 25% in the early 2000s to 6% in 2022. This reduction was largely driven by foreign aid programs targeting HIV.

The study, which tracked over 90,000 children from 1995 to 2022, found that children with HIV-positive mothers are now only twice as likely to be orphaned, a substantial decrease from the previous 20-fold likelihood.

Dr. David Serwadda reported that significant reductions in foreign aid last year disrupted HIV treatment programs in Africa, including Uganda, leading to instances where healthcare workers could not deliver drugs due to unpaid wages. He expressed concern about potential increases in HIV transmission and deaths if patients lose treatment, but views country-level ownership as potentially more sustainable, while expressing apprehension about the transition phase.