The global HIV/AIDS community has been waiting months for fresh data from PEPFAR — the President’s Emergency Plan for AIDS Relief — the U.S. program launched in 2003 that is credited with saving millions of lives and that receives roughly $5 billion a year in U.S. funding. After the Trump administration froze foreign aid in early 2025, experts wondered whether PEPFAR had been severely damaged or whether waivers and bipartisan support had preserved lifesaving work. Quarterly public data, which historically tracked PEPFAR’s progress and accountability, did not appear for months after President Trump returned to the White House in January 2025. A new release arrived on a Friday afternoon this spring — and interpretations diverge sharply.
State Department and administration officials emphasize resilience. They highlight that as of the end of September 2025 the U.S. supported HIV treatment for more than 20 million people in 50 countries — only a small decline from the previous year — and they point to programmatic priorities such as preventing mother-to-child transmission. One notable uptick: the number of pregnant and breastfeeding women starting PrEP (pre-exposure prophylaxis) rose from about 43,000 in the final quarter of 2024 to 103,000 in the final quarter of 2025. Jeremy Lewin, acting undersecretary of state for foreign assistance, humanitarian affairs and religious freedom, said the numbers demonstrate how resilient U.S. global health programs have been.
But activists, researchers and many HIV experts read the same data as evidence of serious and widespread disruption. Health GAP’s executive director Asia Russell called the findings “nothing less than a five-alarm fire,” citing declines in HIV testing, prevention and support services. AmfAR (the Foundation for AIDS Research), along with experts from the International AIDS Society, described “substantial disruptions across PEPFAR service areas” and warned that the results represent “a troubling inflection point.” AmfAR’s deputy director of public policy, Brian Honermann, said the State Department’s presentation obscures the depth of damage caused by the 2025 aid interruptions.
PEPFAR has long been regarded as one of the most transparent and data-driven global health programs, with quarterly public reporting that enabled close tracking of outcomes and accountability for U.S.-funded activities. That data allowed program managers and external analysts to see where interventions were working and where gaps were emerging. Honermann noted that PEPFAR’s metrics were intentionally ambitious and designed to hold the program accountable.
The new dataset reveals shifts that experts link to changes in funding and program structure after the aid freeze. Honermann and others point out that roughly 24% of frontline health workers supported by PEPFAR were no longer in place — many laid off when activities deemed not immediately life-saving were halted. Those roles included community health workers who conduct home visits and facilitators who run peer-support groups for adolescents living with HIV. The loss of these staff affects prevention, case-finding and ongoing support.
Analyses of the release indicate fewer new HIV diagnoses where services were affected. In clinics and centers where services were maintained, the number of new diagnoses dropped by about 13%; where services had been interrupted, diagnoses fell nearly 30%. Honermann said that means hundreds of thousands of people who would have been diagnosed and started on treatment are now missing from care — a consequence that harms individuals’ health and increases the risk of onward transmission.
The State Department, responding to critiques, framed its approach as deliberate and fiscally responsible. In a media note the department said it cut overall spending by 30% while preserving critical frontline HIV care and eliminating “wasteful programs,” arguing this demonstrates the effectiveness of the America First Global Health Strategy.
The clash over interpretation underscores a broader tension: officials point to aggregate treatment numbers and targeted prevention gains as proof that core services were protected; activists and technical experts say those headline figures mask serious disruptions in the systems that find, prevent and support people with HIV. Where community-based outreach, testing and peer support are weakened, treatment numbers and prevention gains can be fragile and short-lived.
As researchers continue rapid analyses of the new release, the debate is likely to shape policymaking and funding decisions for the coming year. For now, the data provide both reasons for cautious optimism and warnings about the vulnerability of HIV programs to policy and funding shocks — and they illustrate how the same dataset can fuel sharply different conclusions about the health of a flagship global health effort.