Заморозка финансирования программы PEPFAR в 2025 году привела к глобальному коллапсу борьбы с ВИЧ

The funding freeze on the US President’s Emergency Plan for AIDS Relief (PEPFAR) program that occurred in 2025 resulted in substantial disruption to HIV prevention and treatment programs across the world, particularly in prevention services and services for key populations at high risk for HIV, according to two presentations at the annual meeting of AIDS 2026 in Rio de Janeiro, Brazil. “These studies provide complementary evidence that the 2025 US funding and policy changes caused immediate, widespread disruptions to PEPFAR-supported HIV programs,” Marcel Yotebieng, MD, PhD, MPH, professor of medicine and program leader of Global HIV and Infectious Disease Research at Albert Einstein College of Medicine in New York City, told Medscape Medical News. “This research suggests that the policy changes extend well beyond temporary funding interruptions and threaten to reverse decades of progress toward HIV epidemic control,” said Yotebieng, who was not involved with either study. “If we see sustained disruption over the longer term, HIV incidence and mortality could increase, weakening health systems by eroding the ability to deliver services in high-risk areas, making future epidemic control substantially more difficult and costly.” In addition to the damage catalogued globally in these two reports, Yotebieng noted that “disruptions to HIV and TB [tuberculosis] research infrastructure and surveillance systems may slow scientific discoveries and data that inform HIV care in the US,” and Americans could also be affected by diminished global health security. “Changes including reduced international research collaborations and weakened preparedness for future infectious disease threats increase the potential need for more expensive investments to rebuild programs in the future,” Yotebieng said. “US clinicians, researchers, and public health professionals should recognize that global HIV programs remain closely connected to advances in patient care, research, and health security domestically. Ultimately, these studies reinforce that maintaining global HIV control is both a humanitarian imperative and a strategic investment in global public health.” One of the studies assessed the impact on PEPFAR’s implementing partners based on a survey from partners in 46 countries in Africa, Latin America, the Caribbean, Asia, and Eastern Europe. “We found damage across the entirety of the PEPFAR system, including nominally protected services like treatment,” Elise Lankiewicz, MPH, a senior policy associate at the American Foundation for AIDS Research (amfAR), told attendees. “However, we also found the deepest cuts to area of PEPFAR programming, like community-based services, prevention services, and key population services.” They also found a bigger impact on locally based implementing partners than on their international counterparts, she said. “We think this is important because we can’t have accountability without counting things,” Lankiewicz said. “We need data, and I think we need to have a picture of where we are now to better understand what we do next.” Lankiewicz did not go into specifics about the disruptions that occurred, some of which Medscape has previously covered, but she noted three key ways that PEPFAR has changed over the past 18 months: Specific awards have been canceled, money is moving more slowly, so some awardees have not received their funds, and some awards that were allowed to continue have been altered in terms of allowable programming. The researchers distributed an electronic survey to 708 PEPFAR country-level implementing partners between November 2025 and April 2026 to assess the impact of 2025 funding and policy changes on their awards, staffing, and services. The 166 respondents from 46 countries represented approximately 23% of the PEPFAR universe. More than a third of responses (39%) came from local nongovernmental organizations (NGOs), which make up about 21% of global partners, and about 28% came from international NGOs, which make up 23% of partners. Over half the respondents (55%) were in Eastern and Southern Africa, which makes up 57% of PEPFAR projects, and 22% were in Western and Central Africa (18% of PEPFAR funding). Another 14.5% of respondents were in Latin America and the Caribbean, with others from Asia and the Pacific, Central Asia, and Europe. More than three in four respondents (77%) reported a delayed or terminated award. The greatest impact was on services for key populations, with 37% of partners reporting a reduction in those services and 73% of partners reporting permanently stopping at least one service. Key populations in PEPFAR are those facing a higher risk for HIV infection and bigger barriers to care; they include men who have sex with men, transgender individuals, sex workers, people who inject drugs, and people in prisons and other closed settings. Five implementing partners had fully closed, but the researchers hypothesize this was an undercount because their contact method was organizational emails, which may not be answered at other closed sites. The 1714 closed service delivery sites included over 1000 public health facilities, 206 private HIV-specific facilities, 47 mobile clinics, and 126 drop-in centers — safe and unstigmatizing sites for key populations that “may be the only safe access space” in places where “key populations are criminalized,” Lankiewicz said. Those closures can mean no access to services at all for those populations, and most of the closures were in countries where at least two key populations are criminalized, she said. “While domestic governments may have taken up some services dropped from PEPFAR, key population services tend to be the least likely service area for domestic governments to take up, and we can’t end the epidemic if we leave key populations behind,” Lankiewicz said. Staffing reductions were reported by 87% of partners, with 16,452 full-time equivalents in lost staff, many in places “where human resources for health are already overstretched,” she said. Further, 77% of partners were asked to comply with new US policy as a condition of continued PEPFAR funding, so even fully funded partners with no canceled awards “had to stop services outright because of both these policy restrictions and the impacts on other implementing partners,” Lankiewicz said. “So an award that got canceled for one implementing partner might have ripple effects throughout the system because of how implementing partners rely on each other’s work within the PEPFAR system.” For example, 55% of open direct service providers had a partner they relied on that lose funding. Over half the partners (64%) had to cut off a sub-grantee entirely, and 20% reported a sub-grantee closed. These tend to be the smaller, highly localized community organizations whose workers “have played a critical role in bringing people into the HIV service delivery system,” Lankiewicz said. During a separate presentation, Joram Sunguti Luke, MD, MPH, senior technical advisor with Pathfinder, presented the impact of PEPFAR funding cuts specifically in sub-Saharan Africa. “We found immediate disruptions across all six WHO building blocks,” with the largest decline in HIV prevention services and substantial drops also in antiretroviral therapy (ART) initiation and viral load monitoring, Luke told attendees. “We also assessed modeling projects that predicted large increases in HIV incidence and mortality if funding cuts persisted,” he said. “This is important because, without strategic financial transition plans, decades of progress that we’ve achieved since 2003 risk being reversed, especially for women, children, and key populations.” PEPFAR has driven HIV control in sub-Saharan Africa for over two decades until the funding freeze in January 2025, so the researchers conducted a systematic review of empirical and modeling papers, as well as gray literature on the funding freeze and on HIV outcomes that were published between February and November 2025. A search of PubMed, Embase, Google Scholar, and research lists yielded 21 eligible studies and reports. They found more than 8000 healthcare workers were retrenched in South Africa, and 16,700 jobs were at risk in Zimbabwe. Prevention services were hardest hit, including an 88% drop in voluntary male circumcision, a 68% decline in viral load testing, a 64% drop in preexposure prophylaxis, a 55% drop in condom distribution, and a 30% drop in ART initiation. Lab disruptions affected viral load and GeneXpert testing, and centers ran out of stock of antiretrovirals, HIV test kits, early infant diagnostic tests, and tuberculosis commodities. More than 27 HIV and 20 TB clinical trials were suspended, nearly one third of organizations closed or downsized, and key populations clinics and drop-in centers closed in multiple countries, and DREAMS programs were suspended in at least 10 countries, affecting adolescent girls and young women. “All modeling studies predicted increases in new HIV infections as well as mortality if the status quo remained,” Luke said. On the basis of modeling studies, funding disruptions were projected to lead to 552,500 additional infections and 330,400 HIV-related deaths in a single country if disruptions continued. “We recommend bridge financing, strengthening of commodity security, and that the workforce involved in HIV care should be protected and absorbed into the national system to push on them against such headwinds,” he said. Lankiewicz and Luke both had no disclosures. Lankiewicz’s presentation was funded by amfAR, Funders Concerned About AIDS, Johns Hopkins, and Data Etc. No external funding was noted for Luke’s presentation. Yotebieng had no disclosures. Tara Haelle has covered science and medicine for nearly two decades and is the author of Vaccination Investigation and The Informed Parent: A Science-Based Resource for Your Child’s First Four Years. She is based in Dallas.