A survey of organizations funded by the US President's Emergency Plan for AIDS Relief (PEPFAR) linked terminated grants to the closure of more than 1,700 clinics, drop-in centers and other HIV service sites. The findings became a central issue at AIDS 2026 in Rio de Janeiro, where delegates met after a year of cuts and delays to US-backed programs.

The International AIDS Society said the 26th International AIDS Conference ran in Rio and online from July 26 to 31, 2026. The organization described the meeting as a forum for researchers, policymakers, health workers and people living with HIV to address a severe funding crisis.

Survey records closures across 46 countries

The Associated Press reported that 166 organizations in 46 countries responded to a survey by amfAR, The Foundation for AIDS Research, representing nearly one-quarter of the PEPFAR-funded groups contacted. Most respondents had at least one grant terminated or payment delayed, and the terminations were associated with more than 1,700 site closures and the loss of more than 16,000 full-time workers.

The damage was uneven. Locally based organizations were more likely than international groups to lose an award and close service sites, while programs serving sex workers, transgender people, men who have sex with men and people who inject drugs reported especially broad losses. PEPFAR expenditure data cited by AP showed prevention spending fell 51 percent from fiscal 2024 to fiscal 2025.

Medical research supplies beside documents and a calculator (illustrative image)

The survey does not measure every organization supported by PEPFAR. Groups that suffered the deepest disruption, or that still depended on US funding, may have been less likely to respond. The US State Department told AP that the administration had strengthened PEPFAR through clearer direction, while its spokesperson cited a quarter of 2025 data showing standard treatment support for 20.6 million people in more than 50 countries.

Funding totals do not show which services survived

NPR reported that US support for global HIV and AIDS programs fell from $6.7 billion to $4.6 billion in 2025 and that the State Department reported spending 70 percent of available PEPFAR funds. Those figures describe different stages of government financing and do not show how much money reached each clinic or service provider.

The same NPR report said the State Department could not verify the amfAR findings and called the methodology flawed. The survey nevertheless documents how responding organizations changed staffing and services after grants were canceled or payments were delayed. AP also reported that nearly two million fewer people received PEPFAR-supported antiretroviral treatment in fiscal 2025 than in the previous year, a decline of about 10 percent based on a separate analysis of program data.

Zambia kept treatment sites open but lost supporting services

The disruption is visible in Zambia, where US assistance had supported both medicines and the systems used to deliver and monitor care. NPR documented a clinic in Kitwe that had provided free HIV medicines and treatment with funding from the US Agency for International Development before closing abruptly in January 2025.

Field reporting reproduced by 76 Crimes said Zambia kept 2,885 treatment facilities open and estimated that most of the 1.3 million people receiving HIV treatment in January 2025 continued to get medicine. Zambia's health ministry estimated that 100,000 people stopped taking medication during the disruption and 40,000 had not re-entered care at the time of that report.

Keeping medicine available did not preserve the wider network. The report described the end or reduction of contact tracing, community distribution, patient follow-up, laboratory monitoring and dedicated services for groups facing barriers in mainstream clinics. It also reported that Mpongwe recorded 28 new AIDS cases in January 2026 and another 28 in February, compared with one or two cases a month a year earlier, but that local series cannot establish a national trend.

Data gaps limit the assessment

The closures affect the systems that produce public health data, making the consequences harder to measure. When testing, electronic records and community follow-up are reduced, infections can go unrecorded and treatment interruptions may appear only after patients return to care.

NPR reported 1.2 million new HIV infections and 547,000 AIDS-related deaths worldwide in 2025, the lowest annual death total in 30 years. Winnie Byanyima, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), warned at the conference that reduced prevention would allow infections to rise and interrupted treatment would cause deaths. The available reporting does not yet show how much of any future change can be attributed to US funding decisions rather than other national and international factors.

Frequently asked questions

What did the amfAR survey find?
Respondents linked grant terminations to more than 1,700 closed clinics, drop-in centers and other service sites, along with more than 16,000 lost full-time positions.

Was the survey a complete global count?
No. It received responses from 166 organizations in 46 countries, or nearly one-quarter of the groups contacted, and the mix of respondents could affect the totals.

Did all PEPFAR-supported HIV treatment stop?
No. The US State Department said PEPFAR-supported programs provided standard treatment to 20.6 million people in more than 50 countries during one quarter of 2025, while other evidence showed broad disruption to prevention, staffing and supporting services.

Why is Zambia included?
Reporting from Zambia shows how a country can keep most treatment facilities operating while losing community workers, testing, patient tracking and specialized prevention services.