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What really happened after Trump slashed HIV funding

The official numbers are finally here.

When the Trump administration began dismantling US foreign aid in January 2025, many global health experts feared that the consequences would be catastrophic, with models projecting thousands of deaths as a direct consequence of the cuts.

Across nine countries, 3.4 million fewer people were tested for HIV in just the first half of 2025, according to one report. Emergency waivers eventually restored HIV treatment, but much of the program’s prevention and outreach work remained off-limits.

It has now been more than a year since that upheaval began, and we finally have official data on what it did to PEPFAR, one of the biggest and most successful US-funded HIV programs in the world.

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At first glance, the numbers offer some relief. The US still delivered HIV treatment, in the form of antiretroviral drugs, to about 20 million people from July through September 2025, the only period for which the administration has released data. That was roughly the same number of people receiving treatment as in the same period a year earlier. That is good news, and it is far better than the dire consequences many predicted.

Maintaining the treatment pipeline keeps people with HIV alive, and the State Department has framed the data that way. Jeremy Lewin, the acting undersecretary of state for foreign assistance at the State Department, said, at a conference earlier this month, “the numbers are very, very good.”

But other numbers tell a different and less positive story. A closer look at the data suggests that PEPFAR was far less successful at doing the rest of the work that keeps HIV from spreading: finding people who don’t yet know they’re positive, and stopping new infections before they happen.

The data show that fewer people were tested for HIV, fewer people newly started treatment, and far fewer started or stayed on PrEP, the drugs that help prevent infection in the first place.

PEPFAR was always more than a drug-delivery program. Part of its mission was to find new infections and help stop the virus from spreading further. And for years, that broader strategy helped push the epidemic in the right direction.

Despite the reassuring headline numbers, the data suggests that PEPFAR may be backsliding on that mission now.

PEPFAR tested about 4 million fewer people for HIV in the last quarter of 2025 than in the same period a year before, a 17 percent drop. The number of people newly starting on HIV treatment also fell, from about 463,000 to 389,000, a decline of 16 percent. And PrEP, the daily pill that prevents HIV........

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