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The collapse of USAID left a vacuum that only exacerbated the HIV epidemic. Yet rather than addressing the fallout, the administration chose to prioritise optics, hiding the true scale of suffering in developing nations.
At its height, USAID was one of the major pillars sustaining global healthcare; that is until Trump ran for president a second term. Before that happened, the US used to pour billions into its annual budget while maintaining a presence in over 100 countries. As a facilitator of thousands of technical healthcare projects, one of the biggest initiatives USAID was funding was PEPFAR.
This program aimed to transform HIV/AIDS from a death sentence to a manageable chronic condition for millions across the world, especially in sub-Saharan Africa. In fact, since its inception the program operated in 55 countries classified as low-income or low-to-middle income and saved over 25 million lives.
Unfortunately, after Trump came into power, he replaced the nation’s traditional foreign aid model with the America First Global Health Strategy (AFGHS). Revolving around the US’s national interest and private sector growth, it sought to only use foreign aid transactionally with a big emphasis on self-reliance for recipient nations.
Thus, it was no surprise that PEPFAR was one of the programs that was hit the hardest. The AFGHS essentially stripped the complexity of the program to its essentials, with a focus on life-saving treatments only. Hence, it’s not wrong to think that such cuts have essentially restarted the HIV/AIDS epidemic in these countries. Yet, the Trump administration is trying to make us all think otherwise.
On April 20, the administration released the first dataset on PEPFAR, covering Quarter 4 of 2025 that went on to paint a narrative of stability within the program. Most prominently, the report argued that the US government had successfully sustained anti-retroviral therapy (ART) for 20.6 million people suffering from HIV/AIDS, a figure nearly identical to 2024 numbers.
Maternal health was also an apparent success point as the number of pregnant and breastfeeding women starting PrEP, more than doubled in late 2025. To add to this, the report attributes the 20% drop in children receiving treatment to the reduction of mother to child transmission, via the success in maternal health.
But this is not where the story ends, because around the same time as the report’s release, a smoking gun of a study was published. The study divided 31,746 treatment facilities and community service sites into two main groups: continuous facilities and intermittent/community sites. The latter refers to big state-run hospitals which kept up with treatments and data reporting. It was in these sites that treatment stayed stable as reported by the Trump administration.
However, the small rural clinics which are the intermittent/community sites, were the ones that were hit the hardest by the USAID cuts and policy changes. In these sites, HIV diagnoses crashed by up to 35%. Overall, across PEPFAR new initiates into ART dropped by 16%, HIV testing dropped by 17%, and PrEP initiations fell by 33%.
