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

Dr. Theopista Masenge was at the hospital in Mbeya, Tanzania, rolling out new treatments for children with high HIV viral loads when she got the call: Stop work, now.

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.”

The Elizabeth Glaser Pediatric Aids Foundation has called the drops in pediatric diagnosis and treatment an “HIV crisis hiding in plain sight.”

“Every single indicator in the pediatric HIV cascade shows decline,” the foundation said. Its president, Dr. Doris Macharia, added: “Where the (PEPFAR) program reaches children, it works. But the data tell us that far fewer are now being reached.”

Despite US government carve-outs for “life-saving” work to continue in relation to pregnant and breastfeeding women, amfAR’s analysis of the latest US government data found that HIV testing for pregnant women declined slightly, by 2%, at the end of 2025 compared with the same time period a year before. Testing for babies declined further, by at least 6%, although some health facilities reported far worse metrics for infant testing.

Meanwhile, respondents to the amfAR survey reported that the Orphans and Vulnerable Children Program, aimed at helping high-risk children access HIV care and other general health services, has also been severely disrupted. KFF, a nonprofit health policy research organization, found that the number of children and family members served by that program fell by about 4.8 million in 2025 compared with the year before.

Another recent analysis by the Clinton Health Access Initiative found that the number of children getting on medications used to treat HIV declined 15% in 2025 compared with the year before across eight countries that it studied. The organization said that reflects the negative impacts of HIV test kit shortages, as well as “ongoing integration of pediatric HIV services into general health facilities without adequate provider training and support.”

Beyond medications and basic care, PEPFAR once provided many “wraparound services” designed to prevent infections, encourage marginalized people to come to clinics and keep people from falling off their treatment plans, according to HIV/AIDS experts who spoke to CNN.

“I would expect those are the first things that are going to drop off, especially in countries with limited funds to replace what’s been lost from PEPFAR,” amfAR’s Lankiewicz said.

When it comes to preventing mother-to-child transmission, those wraparound services include things like paying community health care workers to follow up with mothers about scheduling appointments or providing community education about how HIV can be transmitted to babies. What is preserved will depend on the ability of each country’s government to upkeep and pay for services, experts said.

“On top of that, then we have this issue with money not flowing. So even though PEPFAR received the regular amount of appropriations from Congress in the last year, that money is not actually moving,” Lankiewicz added.

CNN has previously reported on the Trump administration underspending roughly $1.7 billion that Congress has already approved for the flagship HIV/AIDS program, as well as redirecting $2 billion in funding intended for global health programs to cover the cost of closing USAID.

Irene Angwenyi/USAID Kenya

Changes to the implementation of PEPFAR and spending cuts have affected not only health services but also data collection.

PEPFAR’s robust data collection was once a valuable resource for researchers and health care providers around the world. But the Trump administration has stopped releasing the program’s quarterly reports and withheld some of the data.

The State Department said earlier this year that the US government had “greater confidence in data” from the fourth quarter of fiscal year 2025 but added that “earlier quarters experienced reporting and implementation challenges which limit data interpretability.”

Experts warn that the data upheaval makes it harder to see the full picture of health service disruptions and final outcomes.

“You don’t always see the impact on outcomes till it’s too late,” said Jennifer Kates, director of global and public health policy at KFF. “And that would be a crisis, if we get to a point in a year or so where we look back and say more babies died and more children were born with HIV.”

For example, the US government has suggested that declines in the number of children being treated for HIV indicate that programs to prevent infections in the first place are working. But the Elizabeth Glaser Pediatric AIDS Foundation has said that “does not explain such a dramatic and sudden drop of 54,000 children already on treatment.”

When it comes to the decline in the number of infants being tested for HIV, Kates said, it could lead to researchers and program-implementers being in the dark.

She asked, “If there’s not as much detection going on, are we going to even know what is happening for babies?”

西奥皮斯塔·马森格医生当时正在坦桑尼亚姆贝亚的医院里，为艾滋病毒载量高的儿童推广新的治疗方法，这时她接到一个电话：立即停止工作。

2025 年 1 月，这位儿科医生正在实施的医疗保健计划（为接触过 HIV 的婴儿、儿童和孕妇提供服务）刚刚收到一封来自现已解散的美国国际开发署 (USAID) 的信函，指示其停止所有运营。

“事情发生得太突然了，我记得当时连医院的管理人员都忙得团团转，不知所措，”马森格说道，她不久后也失去了工作。几乎一夜之间，“建立了近40年的体系就不复存在了。”

“一切都被打乱了，”她告诉 CNN。

一年多后，她表示，尽管美国政府已恢复有限的资金援助，但坦桑尼亚各地针对儿童和孕妇的艾滋病毒/艾滋病服务仍然受到干扰。

根据艾滋病研究基金会（amfAR）的一项最新研究，这种模式正在非洲、亚洲及其他地区上演。特朗普政府削减全球卫生资金并解散美国国际开发署（USAID）的做法，严重扰乱了美国旗舰艾滋病防治项目——总统防治艾滋病紧急救援计划（PEPFAR）。这项与约翰·霍普金斯大学合作开展、于7月发布的研究，调查了去年在46个国家接受PEPFAR资助的166个组织（占PEPFAR所有合作伙伴组织的23%）。

尽管美国政府去年 9 月表示，将优先保障预防母婴传播的 HIV 服务，并防止削减资金，但 amfAR 的调查发现，63% 的受访者表示这些服务受到了干扰。

其中包括 22% 的受访机构表示，由于资金削减，他们完全停止了母婴预防服务。

“即使政府的本意是不触及这些项目，但PEPFAR（总统防治艾滋病紧急救援计划）的拨款通常也不是专门用于执行某一项特定任务，”amfAR高级政策助理伊莉丝·兰基维茨说。“实际上，在拆解其他部分的同时，根本无法保护系统中某些非常特殊的部分。”

据接受调查的组织称，去年全球共有 1714 家曾受 PEPFAR 支持的诊所关闭。

“我倒不太担心物资和药品供应，但我非常担心孩子和母亲们的医疗质量，”坦桑尼亚儿科协会现任主席马森格在谈到她所在地区的情况时说道。“人们都不愿意回医院取药了，因为他们觉得那里的服务质量真的下降了很多，婴儿早期诊断也同样受到了影响。”

由乔治·W·布什政府于2003年设立的“美国总统防治艾滋病紧急救援计划”（PEPFAR）据世界卫生组织和该计划自身数据显示，已挽救了超过2600万人的生命，并预防了数百万例感染，其中大部分发生在非洲。作为美国政府标志性的全球卫生项目之一，PEPFAR目前正面临大幅资金削减，因为本届政府正转向与援助受援国达成新的协议并要求其提供更多共同资金的战略。

美国国务院发言人告诉CNN，amfAR的调查方法存在“缺陷”，并表示“特朗普政府通过明确的战略方向、促进受援国更大的自主权以及更加注重可衡量的健康结果，加强了PEPFAR项目。因此，艾滋病毒检测呈阳性并接受治疗的儿童人数持续下降。”

虽然去年开始接受艾滋病毒新治疗的儿童人数确实有所下降，但专家表示，这并不一定意味着治疗取得了成功。伊丽莎白·格拉泽儿科艾滋病基金会指出，接受艾滋病毒检测和监测的儿童人数下降表明，儿童正在失去获得医疗服务的机会，并被遗漏。与此同时，数据收集和报告的中断也使得发现不良后果变得更加困难。

美国国务院发言人补充道：“今天，我们关注的是实际成果：新增感染病例减少，成熟的项目过渡到本地管理，以及各国朝着长期自力更生的目标迈进……2025财年第四季度的数据显示，截至2025年9月30日，美国政府已为50多个国家的2060万艾滋病毒感染者提供了拯救生命的艾滋病毒治疗。”

伊丽莎白·格拉泽儿童艾滋病基金会称，儿童艾滋病诊断和治疗的下降是“一场显而易见的艾滋病危机”。

该基金会表示：“儿科艾滋病毒感染级联中的每一项指标都显示呈下降趋势。”其主席多丽丝·马查里亚博士补充道：“（PEPFAR）项目在覆盖到儿童的地方确实有效。但数据显示，现在能够获得帮助的儿童人数已经大大减少。”

尽管美国政府已明确规定，与孕妇和哺乳期妇女相关的“拯救生命”工作可以继续进行，但amfAR对美国政府最新数据的分析发现，到2025年底，孕妇的艾滋病毒检测率与上年同期相比略有下降，降幅为2%。婴儿的检测率下降幅度更大，至少为6%，尽管一些医疗机构报告的婴儿检测指标远低于此。

与此同时，amfAR的调查受访者报告称，旨在帮助高危儿童获得艾滋病治疗和其他一般健康服务的孤儿和弱势儿童项目也受到了严重干扰。非营利性卫生政策研究机构KFF发现，与上一年相比，该项目在2025年服务的儿童及其家庭成员数量减少了约480万。

克林顿健康倡议组织最近的另一项分析发现，在其研究的八个国家中，到2025年，接受艾滋病毒治疗药物的儿童人数将比上一年下降15%。该组织表示，这反映了艾滋病毒检测试剂盒短缺的负面影响，以及“在缺乏足够的医护人员培训和支持的情况下，将儿科艾滋病毒服务持续整合到普通医疗机构中”。

据接受 CNN 采访的 HIV/AIDS 专家称，除了药物和基本护理外，PEPFAR 还曾提供许多“全方位服务”，旨在预防感染，鼓励边缘群体到诊所就诊，并防止人们中断治疗计划。

“我预计这些项目会最先减少，尤其是在资金有限、无法弥补因 PEPFAR 项目而损失的项目的国家，”amfAR 的 Lankiewicz 说。

在预防母婴传播方面，这些配套服务包括支付社区卫生工作者费用，让他们跟进母亲的产检预约，或开展社区教育，普及艾滋病毒如何传染给婴儿的知识。专家表示，这些服务能否保留，取决于各国政府是否有能力维持和支付相关费用。

“除此之外，我们还面临资金流动不畅的问题。尽管去年国会按常规拨款额度向PEPFAR拨款，但这些资金实际上并没有到位，”兰基维茨补充道。

CNN此前曾报道，特朗普政府未按国会批准的用于旗舰艾滋病防治项目的约17亿美元预算进行支出，并将用于全球卫生项目的20亿美元资金挪作他用，以支付关闭美国国际开发署的费用。

艾琳·安格温伊/美国国际开发署肯尼亚分署

PEPFAR 实施方式的改变和支出削减不仅影响了医疗服务，也影响了数据收集。

PEPFAR强大的数据收集系统曾是世界各地研究人员和医疗保健提供者的宝贵资源。但特朗普政府已停止发布该项目的季度报告，并扣留了部分数据。

美国国务院今年早些时候表示，美国政府对 2025 财年第四季度的数据“更有信心”，但补充说，“之前的几个季度在报告和实施方面遇到了挑战，这限制了数据的可解释性”。

专家警告说，数据混乱使得人们更难看清医疗服务中断的全貌和最终结果。

“你往往要等到为时已晚才能看到对结果的影响，”凯撒家庭基金会全球和公共卫生政策主任詹妮弗·凯茨说。“如果我们一年左右后回顾过去，发现死亡的婴儿更多了，感染艾滋病毒的儿童也更多了，那将是一场危机。”

例如，美国政府认为，接受艾滋病毒治疗的儿童人数下降表明，预防感染的项目正在发挥作用。但伊丽莎白·格拉泽儿童艾滋病基金会表示，这“无法解释为何接受治疗的儿童人数会突然急剧下降5.4万人”。

凯茨表示，婴儿接受 HIV 检测的数量下降，可能会导致研究人员和项目实施者对情况一无所知。

她问道：“如果检测力度不够，我们还能知道婴儿身上发生了什么吗？”