A stark report from the Clinton Health Access Initiative (CHAI) reveals alarming trends in the treatment of children living with HIV, as significant reductions in US-funded health programmes continue to take their toll. The data indicates a sharp decline in both testing and treatment enrolment across multiple regions, raising urgent concerns about the future of paediatric HIV care.
A Grim Snapshot of HIV Services
In a disheartening turn of events, CHAI has reported a staggering 42 per cent decrease in the initiation of oral HIV prevention treatment, known as PrEP, across ten countries from 2025 into early 2026. This decline follows a broader pattern of diminishing support, with HIV testing plummeting by 12 per cent in eight nations and a 15 per cent reduction in children enrolling for treatment. Dr Doris Macharia, president of the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), emphasised the gravity of the situation: “Testing is the entry point into the paediatric HIV cascade. Once testing drops, every other indicator is likely to drop, especially for children.”
The fallout from cuts to HIV funding initiated by the Trump administration over a year ago has left healthcare systems in a state of disarray, with little sign of recovery. Carolyn Amole, CHAI’s vice-president for HIV, hepatitis, and tuberculosis, stated, “What I keep coming back to is that we’re not seeing a rebound. Across the board, key indicators haven’t recovered.”
The Impact of Policy Changes
The drastic shifts in HIV funding stem from the Trump administration’s abrupt suspension of foreign aid, which has significantly disrupted essential services worldwide. In defence of these changes, Trump’s officials have argued that nations should assume greater responsibility for their own HIV efforts, pivoting towards bilateral agreements rather than traditional aid models. This shift has raised alarm bells among health experts who caution that while adult treatment numbers may have remained stable, the mechanisms for testing and prevention are deteriorating.
Secretary of State Marco Rubio recently assured Congress that the programme remains operational, while Jeremy Lewin, acting undersecretary for foreign assistance, touted positive figures from PEPFAR, the President’s Emergency Plan for AIDS Relief. However, these claims have been met with scepticism. The actual numbers tell a different story: HIV testing supported by PEPFAR dropped from 21.9 million in late 2024 to 17.2 million in the same period in 2025.
A Crisis for Children
The consequences of these funding cuts are particularly dire for children living with HIV, who are often diagnosed later and subsequently fall out of care. With fewer community health workers available to support families, the continuity of care has been severely compromised. “We are losing kids in testing, in treatment, and in retention,” Dr Macharia lamented. The alarming reduction in treatment for children highlights a critical gap in the healthcare system, where the absence of timely diagnosis can lead to devastating outcomes.
As new preventative measures emerge, such as lenacapavir—a long-acting injectable drug that offers protection for six months—advocates fear that weakened health systems may hinder effective distribution and implementation. Amole pointed out, “At the exact moment we have a tool that could genuinely change the trajectory of the epidemic, the delivery foundation we’d built it on has been badly weakened.”
The Broader Implications
Asia Russell, executive director of Health GAP, described the current situation as a “preventable disaster,” stressing that the Trump administration’s narrative downplays the severity of the aid cuts. “Without treatment, there is first a mortality spike at six months, and then by two years, 50 per cent of HIV-positive children will die,” she warned. This stark reality underscores the urgent need for renewed investment in testing and treatment services to avert a growing crisis.
Experts agree that merely maintaining existing treatment programmes is insufficient to reverse the tide of the AIDS epidemic. Russell stated, “What these data show us is the deliberate unraveling of the elements of HIV prevention and treatment service delivery that are essential to actually finish the job and defeat this pandemic.”
This situation is exacerbated by the rapid withdrawal of US-supported logistics systems, leaving many countries vulnerable to supply chain issues. CHAI has highlighted that eleven of the fourteen countries studied face an elevated risk of such disruptions, with Amole cautioning that while the goal of self-sufficiency is commendable, the pace of change is dangerously swift.
Why it Matters
The ongoing decline in HIV testing and treatment for children signals a disastrous escalation in the global health crisis. As funding cuts continue to erode vital services, the most vulnerable populations are left exposed, with potentially catastrophic consequences. The world stands at a crossroads: without immediate intervention and a commitment to restoring funding, an entire generation of children living with HIV could be lost to a preventable tragedy. Now more than ever, it is imperative for the international community to rally together, ensuring that no child is left behind in the fight against this devastating epidemic.
