Around 77 000 fewer children worldwide received HIV treatment supported by the US in the year to October 2025 than in the previous fiscal year, according to a study that found declines after the Trump administration’s cuts and changes to foreign aid.
The study refers only to US-supported care, and some of the children may have received treatment through national governments or other donors.
The analysis of US government data found US-supported pediatric HIV treatment fell by around 14% year on year, although the researchers said more detailed country-level data were needed to assess the full impact.
“These are signals, not a verdict. But children cannot wait,” said Kenneth Ngure, professor of global health at Jomo Kenyatta University of Agriculture and Technology and a co-author of the study, presented at the AIDS 2026 conference in Rio de Janeiro on Tuesday.
Gaps in HIV response
Other studies, including by UNAIDS, have also shown gaps in the HIV response since the cuts.
The US State Department said it had not reviewed the study in detail but its methodology was flawed.
They said the decline was a sign of the success of the program, as fewer children were getting infected with HIV, and the numbers on treatment had been going down for four years.
But the authors said that the declines last year were steeper than this historical trend in five countries: Uganda, Haiti, Zambia, South Africa and Kenya.
Decline in US-backed treatment
To reach their conclusions, Ngure and team analysed data provided by the President’s Emergency Plan for AIDS Relief (PEPFAR), the international US HIV programme. They found a decline in US-supported pediatric treatment in 20 of 21 countries analysed.
Other agencies and national governments may have stepped in to keep children on treatment – a stated aim of the US – and the decline in coverage is also slightly lower if “central support”, or US funding for national or sub-national level work, rather than at clinics, is included: around 55 000 fewer children were reached last year under that metric.
The countries were chosen because they all had more than 2 000 children receiving PEPFAR-supported HIV treatment, the team said.
South Africa saw the largest absolute decline of around 30 000 fewer supported children, or 45%, followed by Zimbabwe, Kenya and Malawi.
South Africa, the country which has the most people living with HIV in the world, already funds the majority of its response. The US has said it will no longer support efforts in the country.
‘Falling through the cracks’
Health advocate Susan Wairimu Metta, who works with HIV-affected communities in Kisumu West, Kenya – the Kenyan area with the highest HIV prevalence rates outside Nairobi – said she recognised the picture painted by the new study.
“The funding cuts have had a real impact on paediatric HIV care in Kenya,” she said.
She said a decline in the availability of community support groups as well as new charges for tests that were previously free made it harder for families to stay fully engaged in care. This has led to a rise in the number of children presenting with advanced HIV in her region, she said.
The worst impact was during the initial period last year when the U.S. issued “stop work” orders as it began to dismantle parts of its international aid program, she said, but the situation has improved since then, in part because the Kenyan government has trained staff to help fill gaps.
“But many of the community-based support systems that prevented children from falling through the cracks have still not been fully replaced,” she added.
- Around 77,000 fewer children worldwide received US-supported HIV treatment in the year to October 2025, marking a 14% decline linked to cuts in foreign aid under the Trump administration.
- The study, using PEPFAR data, found declines in US-supported pediatric HIV care in 20 of 21 countries analyzed, with South Africa experiencing the largest drop (about 30,000 children, 45%).
- US officials disputed the study's findings, suggesting the decline reflects fewer new infections and a longer-term downward trend in treatment numbers.
- Health advocates in Kenya reported that funding cuts led to reduced community support and new testing charges, increasing cases of advanced HIV among children.
- Although national governments and other donors may have partially filled gaps, community-based support systems remain weakened, risking children "falling through the cracks."
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But the authors said that the declines last year were steeper than this historical trend in five countries:
To reach their conclusions,
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“But many of the community-based support systems that prevented children from falling through the cracks have still not been fully replaced,” she added.
