The Trump admin said it would prioritize ending mother-to-child HIV transmission. Health workers say it cut services - CNN

It was January 2025, and the health care program the pediatrician was implementing, which provided services for HIV-exposed infants, children and pregnant women, had just received a letter from the now-dismantled United States Agency for International Development (USAID) directing it to halt all operations.

“It was really, very abrupt, and I recall even the hospital managers were running up and down like, ‘What are we going to do?’” said Masenge, who lost her job not long after. Almost overnight, “the system that was built for almost 40 years was gone.”

“Everything has been disrupted,” she told CNN.

More than a year later, she said that disruptions to HIV/AIDS services for children and pregnant women remain across Tanzania, even though limited US government funding has returned.

It’s a pattern playing out across Africa, Asia and beyond as the Trump administration’s cuts to global health funding and dismantling of USAID have severely disrupted the United States’ flagship HIV/AIDS program, PEPFAR, according to a new study by the Foundation for AIDS Research (amfAR). The study, conducted with Johns Hopkins University and published in July, surveyed 166 organizations that received PEPFAR funding last year across 46 countries (representing 23% of all PEPFAR partner organizations).

Although the US government said last September that HIV services to prevent mother-to-child transmission would be prioritized and protected from funding cuts, the amfAR survey found that 63% of respondents reported disruptions to those services.

That includes 22% of surveyed organizations that said they ended those mother-to-child prevention services entirely amid the funding cuts.

“Even if the administration’s intention was to not touch these programs, PEPFAR (funding) awards generally aren’t sort of specific to doing one individual task,” said Elise Lankiewicz, a senior policy associate at amfAR. “There was really no way to protect very singular parts of the system while dismantling others.”

It comes as 1,714 health clinics once supported by PEPFAR closed last year around the world, according to the organizations surveyed.

“I’m not so worried in terms of supplies and medications, but I’m super worried about the quality of care for the children, for the mothers,” said Masenge, now the president of the Paediatric Association of Tanzania, regarding the situation in her area. “People are not going back to the facility to pick up their medication because they feel like the services have really become worse, and the early infant diagnosis is suffering similarly.”

PEPFAR, which was established by the George W. Bush administration in 2003, is credited with saving more than 26 million lives and preventing millions of infections, mostly in Africa, according to the World Health Organization and the program’s own data. It’s one of the US government’s hallmark global health programs that is now experiencing significant funding cuts, as the administration transitions to a strategy of striking new agreements with aid-recipient nations and demanding more co-financing from them.

A US State Department spokesperson told CNN that the amfAR survey has “flawed” methodology and said that “the Trump Administration has strengthened PEPFAR through clear strategic direction, promoting greater recipient-country ownership, and sharpening the program’s focus on measurable health outcomes. As a result, the number of children testing positive and on treatment for HIV has continued to decline.”

While it’s true that the number of children starting new HIV treatment fell last year, experts say that’s not necessarily a marker of success. Declines in the number of children being tested and monitored for HIV indicate that children are losing access to care and falling through the cracks, according to the Elizabeth Glaser Pediatric Aids Foundation. Meanwhile, disruptions to data gathering and reporting have made it more difficult to spot negative outcomes.

The State Department spokesperson added: “Today, we are focusing on real outcomes: fewer new infections, mature programs transitioning to local management, and countries advancing toward long-term self-reliance … FY2025 Q4 data show that as of September 30, 2025, the U.S. government supported lifesaving HIV treatment for 20.6 million people living with HIV in more than 50 countries.”

‘HIV crisis hiding in plain sight’