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Progress at Risk: How Funding Cuts Are Undermining Africa’s HIV Response

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Released: August 27, 2026

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Emerging evidence from AIDS 2026 demonstrated how recent disruptions to PEPFAR funding and policy have affected HIV services across Africa, including clinic closures, workforce losses, reductions in HIV prevention programs, and declines in treatment support for children living with HIV. Here is my account of the implications of these findings for sustaining HIV epidemic control.

Kenneth Ngure
Kenneth Ngure, MPH, MSc, PhD
Funding Africa’s HIV Response

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For much of the past year, assessments of disruptions to the US President’s Emergency Plan for AIDS Relief (PEPFAR) have relied largely on projections and modeling. New studies presented at AIDS 2026 now provide some of the first real-world evidence from implementing partners and national programs, revealing substantial damage to HIV services. Since its establishment in 2003, PEPFAR has saved more than 26 million lives and transformed the trajectory of the HIV pandemic. However, funding interruptions and policy changes introduced during the second Trump administration have caused major disruptions to this progress. Here I highlight some of the studies.

Key Populations
The first study is a large-scale global survey of PEPFAR implementing partners that found that more than half had experienced the termination of at least 1 award, and more than 80% had been required to restrict their work to comply with additional US policies. These terminations resulted in the closure of more than 1700 service delivery sites, with locally based organizations disproportionately affected.

Services for key populations were among the most likely to be permanently discontinued. Many organizations providing HIV treatment stopped at least 1 clinical care activity, and many reported shortages of laboratory commodities, condoms, pre-exposure prophylaxis (PrEP), and antiretroviral medicines. Even organizations whose awards were not terminated reported censoring language or discontinuing services for particular populations to remain eligible for funding.

These findings are consistent with an analysis that amfAR and the International AIDS Society released last month of the US government’s own PEPFAR data, showing a 24% decline in frontline health workers, 13% to 30% declines in diagnosing HIV cases, and a collapse of HIV prevention programs as well as programs serving key populations.

Children
A second study examining PEPFAR-supported pediatric treatment found that more than 77,000 fewer children living with HIV received treatment support in fiscal year 2025 than in 2024, a 14% decline in 1 year. Among 21 countries with substantial pediatric treatment programs, all but 1 recorded a decline, and reductions among children were proportionally greater than those among adults. South Africa experienced the largest absolute decrease, with more than 30,000 fewer children receiving support, a 45% drop.

Further analysis suggests that declines in Uganda, Haiti, Zambia, South Africa, and Kenya may represent significant departures from historical trends. Although these findings are warning signals rather than definitive conclusions, they require urgent country-level investigation and the restoration of routine, publicly available, age-disaggregated PEPFAR data.

Prevention
A separate systematic review of 21 studies and reports documented the loss of more than 8000 PEPFAR-supported health workers in South Africa and threats to approximately 16,700 positions in Zimbabwe. Across several African regions, PrEP initiations declined by 31% to 64%, voluntary medical male circumcision by 65% to 88%, and condom distribution by more than 50%.

Finally, a study conducted in Nigeria showed that between the first and second quarters of 2025, the reach of HIV prevention services for key populations fell by 50.5%, HIV self-testing declined by 70.2%, and PrEP initiation dropped by 83%.

Together, these studies issue a stark warning: the infrastructure built through more than 2 decades of investment is eroding rapidly. Children, key populations and communities in sub-Saharan Africa are bearing a disproportionate burden. Urgent, sustainable solutions are needed to preserve essential HIV services, strengthen locally based organizations, protect community-led programs and prevent the reversal of hard-won progress. 

Your Thoughts
How have funding disruptions affected your ability to provide HIV prevention or services? Join the conversation by leaving a comment below.

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