Foreign Aid — News & Analysis

Trump's HIV funding cuts having 'severe and devastating' impact around the world (July 21, 2026)

The Guardian reports on new research finding that no part of the United States' anti-HIV program has escaped the Trump administration's funding cuts, notwithstanding pledges to protect life-saving care. The study — the Pepfar Pulse report from the AIDS research foundation amfAR, presented at the 26th International AIDS Conference in Rio de Janeiro — describes severe and devastating disruption to the President's Emergency Plan for AIDS Relief worldwide, with thousands of staff laid off and many clinics shuttered, and warns that the policy shift risks reversing progress against HIV/AIDS. Since its creation in 2003 under George W. Bush, Pepfar is credited with saving more than 26 million lives and altering the trajectory of the epidemic, working through partner organizations that identify people at risk and provide testing, preventive measures such as condoms and medicines, and treatment where needed. Many of its grants were abruptly withdrawn in 2025; more than half had been administered through USAID, the agency Trump dissolved in July 2025. A waiver issued in February 2025 theoretically permitted programs delivering life-saving treatment or preventing mother-to-child transmission to continue. Co-lead author Elise Lankiewicz said disruption was nonetheless incredibly widespread, reaching even the areas the administration had intended to shield, because cutting a single award produces ripple effects throughout the system.

The survey covered 166 organizations across 46 countries that had been slated to receive Pepfar funding in 2025. More than half reported at least one terminated award, producing over 1,700 closed clinics, drop-in centers and other sites, with prevention services hit particularly hard. More than 16,000 full-time staff lost their jobs. Nearly two-thirds of organizations working to prevent mother-to-child transmission reported disruption, and a fifth ended those services entirely; a fifth of organizations providing HIV care and treatment stopped at least one service. Many reported being unable to obtain laboratory commodities, condoms or drugs. Five surveyed organizations had closed outright, three of them directly because of lost Pepfar funding — a figure the researchers expect undercounts the real total, since organizations that have shut down no longer maintain the email accounts through which the survey was distributed. Services aimed at the populations most vulnerable to HIV — gay and transgender people, people who inject drugs, and sex workers — were the likeliest to have been discontinued.

Beyond outright terminations, the report documents organizations reshaping their work to remain eligible. Nearly four in five respondents said they had been asked to restrict their activities to comply with additional U.S. policy requirements — most often the anti-DEI executive orders, but also an expanded global gag rule. Lankiewicz said organizations made dramatic programmatic shifts to align with the new policies, among them ending services tailored to sex workers and support for victims of gender-based violence. Greg Millett, a member of the study team, said discussion of the Pepfar disruptions had until now rested largely on projections and modeling, and that the survey supplies some of the first real-world data. The findings track an earlier analysis of U.S. government data showing steep declines in frontline health workers, HIV diagnoses and prevention programs. Speaking at a press briefing ahead of the conference, which is organized by the International AIDS Society, Millett said the disruptions threaten to reverse progress toward bringing the epidemic under control.