Taking the Pulse of PEPFAR
A new study by amfAR’s Public Policy Office documents how a withdrawal of U.S. funding for HIV services around the world is impacting the fight against AIDS
PEPFAR (the U.S. President’s Emergency Plan for AIDS Relief) has been an essential part of the global HIV response by providing funding to prevention, treatment, and care programs. Since its launch in 2003, it has helped to save more than 26 million lives. Yet funding cuts in 2025 have threatened the progress it helped create.
The PEPFAR Pulse Study, conducted by amfAR’s Public Policy Office across 166 PEPFAR-funded organizations in 46 countries, helps us understand what was lost, what remains, and how these changes reshaped HIV service delivery.
The study found that at least 1,714 HIV service sites around the world, including public health facilities, mobile clinics, drop-in centers, and specialized HIV facilities, closed entirely after terminated or delayed PEPFAR payments. Almost no organizations were able to replace lost funding from other sources.
Services directed at key populations (KP), which are heavily impacted by HIV—gay men and other men who have sex with men, sex workers, people who use drugs, transgender and other gender-diverse people, and people in prison—were devastated. Among PEPFAR implementing partners, 73% stopped at least one KP service and 67% stopped outreach services.
The deepest cuts hit HIV prevention, including a 51% decrease in prevention spending from fiscal year 2024 to fiscal year 2025. Almost half (43%) of partners permanently stopped at least one prevention activity, such as distributing condoms and offering PrEP.
While the U.S. government did not include HIV treatment, testing and prevention of mother-to-child transmission of HIV in its cuts, 64% of implementing partners providing this care still reported interruption to these services as their funding for staff, commodities, and partners were impacted and nearly one in four (22%) stopped providing prevention of mother-to-child transmission services entirely.
Other disruptions were noted by the study, including a destabilization of interconnected HIV service systems and organizations that are still receiving funding instituted new policies to align with new PEPFAR priorities.
Overall, the PEPFAR Pulse Study describes a highly weakened HIV service delivery infrastructure, with the most vulnerable populations and organizations most essential to controlling the epidemic negatively impacted.
Read the full study here.
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