The ongoing fallout from substantial cuts to US-funded health programmes is severely impacting children living with HIV, leaving many undiagnosed and without necessary treatment. This alarming trend has been highlighted in a new report from the Clinton Health Access Initiative (CHAI), which indicates a dramatic decline in critical HIV prevention and care services across multiple regions in Africa and Asia.
Decline in HIV Services
New data reveals that over the past year, there has been a staggering 42 per cent decrease in the number of individuals commencing oral HIV prevention treatment—known as PrEP—across ten countries. This drop, observed from 2025 into early 2026, signifies a troubling trend for public health, particularly among vulnerable populations. Additionally, HIV testing has plummeted by 12 per cent in eight countries, while the enrolment of children into treatment programmes has decreased by 15 per cent. Dr Doris Macharia, president of the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), characterises the situation as a “crisis,” noting that reduced testing inevitably leads to further declines in treatment uptake.
The grim statistics emerge more than a year after the Trump administration’s abrupt cessation of foreign aid, which has disrupted vital HIV services worldwide. Carolyn Amole, CHAI’s vice-president for HIV, hepatitis, and tuberculosis, expressed concern over the lack of recovery in vital health indicators, stating, “What I keep coming back to is that we’re not seeing a rebound.”
Impact of Policy Changes
The Trump administration’s overhaul of US foreign assistance, particularly the President’s Emergency Plan for AIDS Relief (PEPFAR), has drawn criticism for jeopardising the progress made in combating HIV/AIDS. While officials assert that the programme remains operational, health experts caution that the overall decline in testing, diagnosis, and prevention services masks a deeper crisis. Despite a slight increase in the number of adults receiving antiretroviral treatment—up by only 0.6 per cent—key services have seen a steep decline since early 2025, when funding cuts took effect.
Ms Macharia highlighted the repercussions of these cuts, noting disruptions to early infant diagnosis programmes and shortages in testing supplies. The reduction in community health workers, who play a crucial role in supporting mothers and children through treatment, has further exacerbated the situation. “The continuity and linkage of mums and kids into care is not as it should be,” she lamented.
New Challenges Amidst Promising Developments
The introduction of new HIV prevention tools, such as lenacapavir—a long-acting injectable drug—provides a glimmer of hope in the fight against the epidemic. South Africa recently became the ninth African nation to adopt this innovative treatment, which offers protection against HIV for up to six months. However, advocates fear that weakened health systems could hinder the rollout of such advancements.
Asia Russell, executive director of Health GAP, critiqued the administration’s claims that the cuts have not inflicted significant harm, stating, “This report lays bare a completely preventable disaster.” She warned that, without timely and adequate treatment, the prognosis for children with HIV is dire. “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,” Russell emphasised, highlighting the urgency of addressing this public health crisis.
The Need for Comprehensive Solutions
Public health experts agree that simply maintaining existing treatment programmes is insufficient to combat the AIDS epidemic effectively. The consistent decline in testing and diagnosis raises alarm bells about the future of HIV prevention efforts. Ms Russell concluded, “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.”
Furthermore, CHAI warns that the rapid transition of responsibility for HIV supply chains to national governments may be premature. Eleven out of fourteen countries examined are at risk of supply issues as US-supported logistics are withdrawn, creating a precarious situation for ongoing treatment efforts.
Dr Macharia voiced her concerns, stating, “It would be very easy to assume there are fewer children because programmes are succeeding, but if testing is down, then we are simply losing opportunities to identify children needing help in the first place.” The decline in enrolment and diagnosis is particularly troubling, given that children were already lagging in care prior to these disruptions.
Why it Matters
The data presented in this report underscores a critical public health emergency. The ramifications of funding cuts extend far beyond statistics; they represent a life-and-death struggle for countless children living with HIV. As the world grapples with the consequences of these policies, it becomes imperative to advocate for a return to robust funding and support for comprehensive HIV services. Without immediate action, the progress made over the last two decades in combating this epidemic could be irrevocably lost, placing vulnerable populations at greater risk than ever before.
