The Trump administrator said he would prioritize eliminating mother-to-child transmission of HIV. Health workers say it has reduced services

Dr. Theopista Masenge was at Mbeya Hospital, Tanzania, rolling out new treatments for children with high HIV viral loads when she received the call: Stop working now.

It was January 2025, and health The care program the pediatrician was implementing, which provided services to infants, children, and pregnant women exposed to HIV, had just received a letter from the now-defunct United States Agency for International Development (USAID) ordering it to halt all operations.

“It was really, really abrupt, and I remember even the hospital directors were like, ‘What are we going to do?’ » said Masenge, who lost his job shortly after. Almost overnight, “the system that had been built for almost 40 years was gone.”

“Everything has been disrupted,” she told CNN.

More than a year later, she said disruptions to HIV/AIDS services for children and pregnant women persisted across Tanzania, even though limited U.S. government funding had returned.

It’s a trend playing out across Africa, Asia and beyond, as the Trump administration’s cuts to global health funding and the dismantling of USAID have severely disrupted the United States’ flagship HIV/AIDS program, PEPFAR, according to a new study from the Foundation for AIDS Research (amfAR). The study, conducted with Johns Hopkins University and released in July, surveyed 166 organizations that received PEPFAR funding last year in 46 countries (representing 23% of all PEPFAR partner organizations).

Although the US government said last September that HIV services aimed at preventing mother-to-child transmission would be prioritized and protected from funding cuts, the amfAR survey found that 63% of respondents reported disruptions to these services.

This includes 22% of organizations surveyed who reported ending these mother-child prevention services entirely due to funding cuts.

“Even if the administration’s intent was to leave these programs alone, PEPFAR (funding) grants are generally not specific to an individual task,” said Elise Lankiewicz, senior policy associate at amfAR. “There was really no way to protect very particular parts of the system while dismantling others.”

This comes as 1,714 health clinics formerly supported by PEPFAR closed their doors last year around the world, according to the organizations surveyed.

“I’m not so worried in terms of supplies and medicines, but I’m very worried about the quality of care for the children, for the mothers,” Masenge, now president of the Pediatric Association of Tanzania, said of the situation in her region. “People are not returning to the facility to collect their medications because they feel that services have really deteriorated and that early infant diagnosis is suffering in the same way. »

PEPFAR, established by the George W. Bush administration in 2003, is credited with saving more than 26 million lives and preventing millions of infections, mostly in Africa, according to the World Health Organization and the program’s own data. It is one of the U.S. government’s signature global health programs that is currently experiencing significant funding cuts., as the administration shifts to a strategy of striking new deals with aid recipient countries and demanding more co-financing from them.

A spokesperson for the US State Department told CNN that the amfAR investigation presented “flawed” methodology and said that “the Trump administration has strengthened PEPFAR through clear strategic direction, promoting greater ownership by recipient countries and a greater emphasis on measurable health outcomes.” As a result, the number of children testing positive and receiving treatment for HIV has continued to decline.

While it’s true that the number of children starting new HIV treatment declined last year, experts say that’s not necessarily an indicator of success. According to the Elizabeth Glaser Pediatric Aids Foundation, the decline in the number of children tested and monitored for HIV indicates that children are losing access to care and falling through the cracks. At the same time, disruptions in data collection and reporting have made it more difficult to detect negative results.

The State Department spokesperson added: “Today, we are focused on real results: fewer new infections, mature programs transitioning to local management, and countries moving toward long-term self-sufficiency… Data for the fourth quarter of fiscal 2025 show that as of September 30, 2025, the U.S. government supported life-saving HIV treatment for 20.6 million people living with HIV in more than 50 countries.

The Elizabeth Glaser Pediatric AIDS Foundation has called the decline in pediatric diagnoses and treatment “an HIV crisis hiding in plain sight.”

“Every indicator of the pediatric HIV cascade shows a decline,” the foundation said. Its president, Dr Doris Macharia, added: “Where the (PEPFAR) program reaches children, it works. But the data tells us that far fewer are now being reached.”

Despite the US government’s exclusions for continued “lifesaving” work for pregnant and lactating women, amfAR’s analysis of the latest US government data found that HIV testing among pregnant women decreased slightly, by 2%, at the end of 2025 compared to the same period a year earlier. Infant testing declined further, by at least 6%, although some health care facilities reported much worse metrics for infant testing.

Meanwhile, respondents to the amfAR survey reported that the Orphans and Vulnerable Children Program, aimed at helping high-risk children access HIV care and other general health services, has also been severely disrupted. KFF, a nonprofit health policy research organization, found that the number of children and family members benefiting from this program decreased by about 4.8 million in 2025 compared to the previous year.

Another recent analysis from the Clinton Health Access Initiative found that the number of children taking medications used to treat HIV decreased by 15% in 2025 compared to the previous year in eight countries studied. The organization said this reflects the negative impacts of the shortage of HIV testing kits, as well as “the continued integration of pediatric HIV services into general health settings without adequate provider training and support.”

Beyond basic medications and care, PEPFAR once provided many “wraparound services” designed to prevent infections, encourage marginalized people to visit clinics and prevent people from abandoning their treatment plans, according to HIV/AIDS experts who spoke to CNN.

“I would expect those to be the first things that are going to go down, especially in countries with limited funds to replace what was lost from PEPFAR,” said amfAR’s Lankiewicz.

When it comes to preventing mother-to-child transmission, these wraparound services include things like paying for community health care. health care workers should follow up with mothers about scheduling appointments or provide community education about how HIV can be transmitted to babies. What is preserved will depend on the ability of each country’s government to maintain and pay for the services, experts said.

“On top of that, we have this problem with money not flowing. So even though PEPFAR received the regular amount of appropriations from Congress last year, that money is not actually circulating,” Lankiewicz added.

CNN previously reported that the Trump administration underspent about $1.7 billion that Congress had already approved for the flagship HIV/AIDS program, and that it redirected $2 billion in funding intended for global health programs to cover the cost of closing USAID.

Changes in PEPFAR implementation and spending reductions have affected not only health services but also data collection.

PEPFAR’s robust data collection was once a valuable resource for researchers and health stakeholders. healthcare providers around the world. But the Trump administration stopped releasing the program’s quarterly reports and withheld some data.

The State Department said earlier this year that the U.S. government had “greater confidence in the data” from the fourth quarter of fiscal 2025, but added that “previous quarters have had reporting and implementation issues that limit the interpretability of the data.”

Experts warn that the upheaval in data makes it harder to get a comprehensive view of health service disruptions and their end results.

“You don’t always see the impact on outcomes until it’s too late,” said Jennifer Kates, director of public and global health policy at KFF. “And it would be a crisis if, in a year or so, we got to a point where, looking back, we say more babies are dying and more children are being born with HIV. »

For example, the U.S. government has suggested that the decline in the number of children being treated for HIV indicates that programs to prevent infections are working in the first place. But the Elizabeth Glaser Pediatric AIDS Foundation said “this does not explain such a dramatic and sudden decline in the number of children already on treatment.”

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