A trove of new reports highlights the scope of cuts to international funding for the HIV response in limited-resource countries, and the impact those cuts are having on the organizations that deliver HIV services.
In a joint report published yesterday, KFF and the Joint United Nations Programme on HIV and AIDS (UNAIDS) found that donor government funding for HIV decreased by $2.1 billion, or 25%, in 2025 compared with the previous year. The decline reduced donor government funding for HIV to $6.2 billion, which is below pre-2008 levels, the report notes.
The $2.1 billion decline matched the amount of funding that was cut by the US government. The US cuts were driven by changes the Trump administration has made to foreign assistance, highlighted by the dismantling of the US Agency for International Development (USAID) and the shifting of foreign aid management to the State Department.
“Collectively, these actions temporarily halted, and then slowed, U.S. HIV disbursements in 2025,” the report states.
The drop in US funding is significant, because the US government, since the establishment of the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, has been the primary funder for the HIV response in low- and middle-income countries (LMICs). And the country has taken on a larger and larger role since 2011.
From 2011 to 2025, the amount of HIV response funding from other nations was cut in half, falling from $3.2 billion to $1.6 billion. Aggregate funding from all other donor governments in 2025 remained flat compared with 2024. The US accounted for 74% of total donor government funding in 2025, up from 59% in 2011. The next biggest donor was France, at $280 million.
And US funding for HIV is likely to decline even further, the report notes, with the Trump administration making clear that it plans more foreign aid cuts going forward.
Cuts could erode life-saving progress
In another report for the 26th International AIDS Conference taking place this week, UNAIDS said the unprecedented cuts resulted in substantial reductions in HIV prevention programs in sub-Saharan Africa in 2025, with data showing major declines in condom purchases, the number of people receiving pre-exposure prophylaxis (PrEP) medication, and HIV testing in countries where domestic funding for HIV response efforts is limited.
Since 2010, the estimated number of new HIV infections has fallen by 42%, and the number of people dying from AIDS-related causes is at its lowest level in more than 30 years. But UNAIDS warned the funding cuts could reverse that progress.
“While the world has turned the tide against HIV, the progress is fragile and the ground beneath our feet is still shifting,” the report states. “The international community has entered a period of profound political and financial upheaval that threatens decades of hard-won gains against HIV.”
A ‘system-wide breakdown’
The on-the-ground impact of the funding cuts is highlighted in a third report, published last week by the American Foundation for AIDS Research (AMFAR), Funders Concerned About AIDS, the Johns Hopkins Bloomberg School of Public Health, and Data Etc.
The report highlights responses from the PEPFAR Pulse study, a survey of 166 PEPFAR-funded organizations from 46 countries conducted from November 2025 through April 2026. As the primary pillar of the global HIV response, PEPFAR has been credited with saving more than 26 million lives in 50 countries. PEPFAR funding includes direct contributions to other countries and contributions to multilateral organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The international community has entered a period of profound political and financial upheaval that threatens decades of hard-won gains against HIV.
The report authors note that while publicly released PEPFAR data have shown drops in service delivery, the impact on the groups that rely on PEPFAR to provide HIV services hadn’t previously been calculated.
“Documenting what happened to PEPFAR’s service delivery partners is a key question to understand what was lost, what remains, and how these changes reshaped HIV service delivery,” they wrote.
Over 77% of the implementing partners said they had at least one award terminated or delayed in 2025, which contributed to the closure of at least 1,700 service-delivery sites, like clinics and drop-in centers, and to layoffs of over 16,000 full-time staff members. Less than 2% of the organizations were able to replace the lost funding.
Among the hardest-hit programs were HIV prevention efforts, which saw spending fall by 51% from 2024 to 2025. Forty-three percent of organizations reported stopping at least one prevention activity, including PrEP and condom programs.
Also affected were the populations most affected by HIV, including sex workers, men who have sex with men, transgender populations, and injectable-drug users. Nearly three-quarters (73%) of the organizations that had previously serving these populations reported permanently ending a service.
Survey respondents also reported that the programs the US government said would continue to receive funding—such as HIV treatment, testing, and prevention of mother-to-child HIV transmission—were affected. Sixty-three percent reported interruptions to these services, and 22% said they ended them altogether.
Masen Davis, executive director of Funders Concerned About AIDS, said the responses reveal a “system-wide breakdown that has weakened prevention, community-led organizations, and the HIV workforce.”
“PEPFAR has saved millions of lives and remains indispensable to the global HIV response,” Davis said in a amfAR press release. “This report should be understood as both an urgent warning and a practical roadmap for restoring that progress.”