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The health of children living with HIV is deteriorating alarmingly due to significant reductions in funding for HIV services, particularly from US-based programmes. A recent report from the Clinton Health Access Initiative (CHAI) reveals drastic drops in testing, prevention, and treatment enrolment across several countries in Africa and Asia, underscoring a growing public health crisis that threatens the lives of vulnerable children.
Significant Drops in HIV Prevention and Treatment
The data compiled by CHAI indicates a stark 42 per cent decrease in individuals beginning oral HIV prevention treatment, known as PrEP, across ten countries from 2025 into early 2026 compared to the preceding year. Equally concerning is a 12 per cent fall in HIV testing among eight nations, while the enrolment of children into treatment programmes has dropped by 15 per cent. Dr. Doris Macharia, president of the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), warns that these trends highlight a “children in crisis” situation. She emphasises the critical role of testing as a gateway into essential healthcare services: “Once testing drops, every other indicator is likely to drop, especially for children.”
More than a year after the Trump administration’s abrupt halt on foreign aid, the repercussions continue to manifest. Carolyn Amole, CHAI’s vice-president for HIV, hepatitis, and tuberculosis, notes a troubling absence of recovery in key health indicators. “What I keep coming back to is that we’re not seeing a rebound. Across the board, key indicators haven’t recovered,” she states.
The Impact of Aid Cuts on Health Infrastructure
The fallout from funding cuts has led to a deterioration of HIV services that are critical for early diagnosis and treatment. Although there was a slight uptick of 0.6 per cent in adults receiving antiretroviral treatments, the overall picture is grim. HIV testing has plummeted from 21.9 million in late 2024 to just 17.2 million in 2025, as support for testing initiatives has waned following funding interruptions.
Dr. Macharia highlights additional challenges faced by clinics, including disrupted early infant diagnosis programmes, shortages of testing supplies, and a decline in community health workers who play a vital role in guiding mothers and children through treatment. “There are fewer community health workers. There are fewer mentor mothers,” she explains, emphasising that the loss of these resources severely hampers the continuity of care for mothers and their children.
A New Tool at Risk: Lenacapavir’s Introduction
Compounding these issues is the introduction of lenacapavir, a groundbreaking injectable drug that can offer protection against HIV for up to six months. South Africa recently became the ninth African nation to adopt this innovative treatment. Yet, advocates express concerns that weakened health systems may hinder its effective rollout. “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,” warns Amole.
Asia Russell, executive director of Health GAP (Global Access Project), criticises the Trump administration’s claims that the aid cuts have not resulted in significant harm. She states, “This report lays bare a completely preventable disaster. In 2026, with access to treatment, people with HIV can live a normal lifespan. But the administration has created a treatment and prevention crisis.” Russell highlights the urgency of the issue, noting that paediatric HIV progresses much more rapidly than in adults, leading to dire outcomes without timely intervention.
The Need for Comprehensive HIV Services
Public health experts assert that merely maintaining existing treatment programmes is insufficient to combat the AIDS epidemic if fewer individuals are being tested and diagnosed. Russell articulates the gravity of the situation, noting, “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.”
As CHAI warns, the rapid push for countries to assume responsibility for their HIV supply chains may be premature. An alarming 11 of the 14 countries assessed face heightened risks of supply disruptions as US-supported logistics systems are withdrawn. Amole cautions, “The direction is right: countries should own their own supply chains, but this is moving too fast and that’s where it gets dangerous.”
Dr. Macharia underscores the critical nature of the current situation, 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 absence of recovery signals a troubling trajectory: “Children were already behind before this crisis. Now they are falling even further behind.”
Why it Matters
The alarming decline in HIV services for children is not just a statistic; it reflects a profound failure in global health governance and prioritisation. Without decisive action to restore funding and support for comprehensive HIV services, countless children will face dire consequences, including premature death. The situation demands urgent attention from policymakers and health advocates alike, as the lives of the most vulnerable depend on our ability to deliver effective and accessible healthcare solutions. The ongoing neglect could set back years of progress in combating HIV, leaving a legacy of avoidable suffering and loss.
