The latest data from the Clinton Health Access Initiative (CHAI) reveals alarming trends in HIV services, particularly for children, as extensive cuts to U.S. foreign aid continue to undermine healthcare systems in developing countries. The findings indicate significant declines in both testing and treatment, raising urgent concerns for public health experts about the future of paediatric HIV care.
Substantial Reductions in HIV Services
According to CHAI, there has been a staggering 42 per cent decrease in individuals commencing oral HIV prevention treatment, known as PrEP, across ten countries from 2025 into early 2026 compared to the previous year. Moreover, HIV testing has dropped by 12 per cent in eight countries, while childhood enrolment in treatment programmes has seen a 15 per cent decline. Dr Doris Macharia, president of the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), emphasised the severity of this situation, stating, “Testing is the entry point into the paediatric HIV cascade. Once testing drops, every other indicator is likely to drop, especially for children.”
This troubling trend follows a year marked by the Trump administration’s abrupt freeze on foreign aid, which has severely disrupted HIV programmes in the developing world. Carolyn Amole, CHAI’s vice-president for HIV, hepatitis, and tuberculosis, expressed her concern over the lack of recovery in key health metrics, stating, “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 ramifications of the U.S. government’s shift in foreign assistance policy are profound. Although officials continue to defend the restructuring of the President’s Emergency Plan for AIDS Relief (PEPFAR), which has been pivotal in saving millions of lives since its inception under George W. Bush, the on-the-ground realities tell a different story. While there has been a slight 0.6 per cent rise in the number of adults receiving antiretroviral treatment, the overall landscape of testing, diagnosis, and prevention services has deteriorated significantly since the aid cuts began in early 2025.
Clinics report significant disruptions to early infant diagnosis programmes, compounded by shortages of testing materials and a decline in community health workers. Dr Macharia noted, “There are fewer community health workers. There are fewer mentor mothers… The continuity and linkage of mums and kids into care is not as it should be. We are losing kids in testing, in treatment and in retention.”
New Tools Amidst Systemic Weakness
In the face of these challenges, South Africa recently became the ninth African nation to introduce lenacapavir, an innovative long-acting injectable drug that offers protection against HIV for six months. While this new tool represents a significant advancement in HIV prevention, health advocates fear that the weakened health systems may hinder its effective rollout. Amole highlighted the paradox: “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.”
Asia Russell, executive director of Health GAP, contended that the latest data starkly contradict the Trump administration’s claims of minimal harm resulting from aid cuts. She stated, “This report lays bare a completely preventable disaster… 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.” The urgency for action is heightened by the fact that paediatric HIV progresses at a significantly faster rate than adult HIV, necessitating immediate intervention.
The Path Forward: Challenges and Opportunities
Public health experts assert that simply maintaining existing treatment programmes is insufficient to combat the AIDS epidemic if testing and diagnosis rates continue to decline. Russell articulated the broader implications of the current data: “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.”
CHAI has also cautioned that the Trump administration’s push for countries to take control of their own HIV supply chains may be premature, as eleven of the fourteen countries assessed face heightened risks of supply chain disruptions due to the withdrawal of U.S.-supported logistics. Amole remarked, “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 pointed to the concerning drop in the number of children receiving treatment, underscoring the critical need for improved testing. “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.” She warned that the absence of recovery indicators serves as a dire warning sign for the future of paediatric care.
Why it Matters
The decline in HIV treatment and testing services for children is not merely a statistic; it represents a systemic failure that endangers the lives of vulnerable populations. As public health infrastructures crumble under the weight of funding cuts, the potential for a resurgence of the epidemic looms large. The implications extend far beyond individual health, threatening to reverse years of progress in combating HIV/AIDS globally. Urgent action is needed to reinvigorate support for testing and treatment services, ensuring that children living with HIV receive the care they need to thrive.
