The report links widespread disruptions to the dismantling of USAID and cuts to global health grants with clinic closures, staff layoffs, and reduced HIV services, hitting key populations hardest, including sex workers, men who have sex with men, transgender people, and people who inject drugs.

Locally-based partners faced higher risk of funding termination and service closures than international organizations, destabilizing interconnected HIV service ecosystems.

Amfar surveyed 166 organizations across 46 countries slated to receive Pepfar funding in 2025; more than half faced at least one terminated award, resulting in over 1,700 closed clinics or sites and the loss of more than 16,000 full-time jobs, with prevention services severely affected.

Researchers cautioned that survey limitations—non-responses and underrepresentation of disrupted groups—may under- or over-estimate the true impact.

The study suggests these disruptions could reverse progress against HIV, providing the first real-world data on Pepfar cuts beyond prior models.

Experts warn that even if funding is restored, rebuilding service delivery and community trust will take time, and delays mean ongoing new infections.

They stress that restoring essential HIV services will be a gradual process, with each day of disruption translating into higher infection risk for vulnerable communities.

While quarterly PEPFAR data showed stable treatment numbers in 2025, combined analyses indicate substantial service disruptions and roughly a 10% drop in people on antiretroviral therapy compared with the prior year.

U.S. officials defended PEPFAR’s overall strength and progress against new cases among treated children, but researchers highlighted multi-quarter disruptions when data are viewed collectively.

A June Nature Health study estimated nearly 2 million fewer people on PEPFAR-supported ART in fiscal 2025 versus 2024, signaling broader program instability.

AmfAR recommends reinstating comprehensive HIV services, increasing national funding, and contracting with NGOs—especially those led by affected communities—to rebuild care and trust.

The report calls for a holistic restoration of the HIV service infrastructure impacted by policy changes and funding gaps.