When Dr. Theopista Masenge received a sudden directive to halt her HIV program in Tanzania’s Mbeya region in January 2025, she witnessed the abrupt collapse of a system built over four decades. The order came from the United States Agency for International Development (USAID), which the Trump administration has now dismantled.
Study documents widespread service interruptions
A study commissioned by the Foundation for AIDS Research (amfAR) and conducted with Johns Hopkins University surveyed 166 organizations that received PEPFAR funding in 2025 across 46 countries. The respondents represent 23% of all PEPFAR partners. According to the survey, 63% reported disruptions to services aimed at preventing mother‑to‑child HIV transmission, and 22% said those services were completely terminated.
“Even if the administration’s intention was to protect these programs, PEPFAR awards are not earmarked for single tasks,” said Elise Lankiewicz, senior policy associate at amfAR. “There was no way to shield a narrow portion of the system while dismantling other parts. “
Impact on clinics and patients
The study also noted that 1,714 health clinics previously supported by PEPFAR closed worldwide last year. In Tanzania, Dr. Masenge—now president of the Paediatric Association of Tanzania—observes fewer mothers returning for medication and a decline in early infant diagnosis. “I’m not worried about supplies, but the quality of care is deteriorating,” she said.
Other data points echo these concerns. The Elizabeth Glaser Pediatric AIDS Foundation reports that every indicator in the pediatric HIV cascade has declined. While the State Department claims the number of children testing positive and on treatment continues to fall, experts warn that reduced testing and monitoring signal children falling through the care net.
Government response and contested numbers
A U.S. State Department spokesperson called the amfAR methodology “flawed” and asserted that the Trump administration has strengthened PEPFAR through clearer strategic direction, greater recipient‑country ownership, and a focus on measurable outcomes. The spokesperson cited FY2025 Q4 data showing U.S. support for lifesaving HIV treatment for 20.6 million people in more than 50 countries.
Nevertheless, the same spokesperson acknowledged that funding for “life‑saving” work for pregnant and breastfeeding women remains, while overall PEPFAR appropriations have not been fully disbursed. “Money is not flowing,” Lankiewicz added, noting that despite Congress approving the regular budget, the funds have not reached implementing partners.
Broader consequences and future outlook
Beyond medication, PEPFAR once funded wrap‑around services—community health worker outreach, education, and support for vulnerable families. Experts predict these ancillary services are the first to disappear when funding dries up, especially in low‑resource settings.
Additional analyses highlight related declines: the Orphans and Vulnerable Children Program served roughly 4.8 million fewer children and families in 2025 than the prior year, according to KFF; the Clinton Health Access Initiative found a 15% drop in pediatric HIV medication uptake across eight studied countries; and testing for pregnant women fell by 2% year‑over‑year, with infant testing down at least 6%.
What this means for families
For families in Tanzania and other affected nations, the loss of services translates into higher risk of HIV transmission to newborns and reduced access to essential care. The disruption underscores a shift in U.S. foreign‑health strategy toward demanding greater co‑financing from partner nations, a move that may leave the most vulnerable without the safety net they previously relied upon.
While the Trump administration emphasizes “greater recipient‑country ownership” and “measurable health outcomes,” the on‑the‑ground reality reported by health workers suggests a growing HIV crisis hidden in plain sight.
Original reporting: KTVZ (Central Oregon) — read the source article.
