By Michael Gwarisa
Zimbabwe is among the countries hardest hit by recent disruptions to the United States President’s Emergency Plan for AIDS Relief (PEPFAR), with new data released ahead of the International AIDS Society (IAS) Conference on HIV Science (AIDS 2026) showing that more than 6,000 fewer children were receiving PEPFAR-supported HIV treatment by the end of 2025.
The findings were unveiled on Tuesday during the official AIDS 2026 Scientific Highlights press briefing, held ahead of the international conference, which opens later this week in Rio de Janeiro, Brazil. Researchers warned that funding disruptions and policy changes affecting PEPFAR are beginning to reshape HIV service delivery across dozens of countries, threatening decades of gains in the global HIV response.
For Zimbabwe, the findings raise fresh concerns about the sustainability of HIV services that have, for more than two decades, been heavily supported by PEPFAR. While the data do not suggest that children have necessarily stopped taking life-saving antiretroviral treatment, researchers say the reduction in direct PEPFAR support could translate into fewer health workers, reduced technical assistance, shortages of essential commodities and greater strain on health facilities.
Presenting one of the headline studies, Ramona Godbole of the Heidelberg Institute of Global Health, Heidelberg University Hospital and the Clinton Health Access Initiative, said newly released PEPFAR programme data show that globally, 77,163 fewer children living with HIV received PEPFAR-supported treatment in fiscal year 2025 compared to 2024, a decline of 14.2 percent.
The research examined 21 countries with substantial numbers of children receiving PEPFAR-supported HIV treatment. Twenty of those countries recorded declines, and in every case the reduction among children was steeper than that seen among adults.
South Africa recorded the largest decline, with nearly 31,000 fewer children receiving PEPFAR-supported treatment. Zimbabwe and Kenya followed, each reporting declines of more than 6,000 children, placing Zimbabwe among the countries experiencing the largest reductions in paediatric HIV treatment support worldwide.
Godbole said six countries registered declines of more than 15 percent in PEPFAR-supported paediatric treatment: India, South Africa, Zimbabwe, the Democratic Republic of the Congo, Eswatini and Burundi.
She stressed that the findings should not automatically be interpreted to mean children had dropped out of HIV care.
Instead, the analysis measured children receiving treatment at facilities where PEPFAR directly supports healthcare workers, commodities or technical assistance. A reduction in this support could mean health systems are facing increasing pressure to absorb services previously financed by the United States programme.
“What our analysis can and does show is that fewer children are receiving PEPFAR’s direct site-level support,” Godbole said.
She warned that the withdrawal of direct treatment support could result in longer waiting times, reduced availability of healthcare workers, interruptions in access to medicines and diminished psychosocial support for children living with HIV and their families. She called for urgent country-level investigations to establish whether children have successfully transitioned to alternative sources of care or are falling through the cracks.
The paediatric treatment analysis was accompanied by findings from the PEPFAR Pulse Study, the first large-scale survey documenting the real-world impact of recent disruptions to the world’s largest HIV programme.
Conducted between November 2025 and April 2026, the survey included 166 implementing partners across 46 countries delivering PEPFAR-funded programmes. It found that more than half (52 percent) had at least one funding award terminated, while 77 percent were required to alter their programming to comply with new United States policy restrictions in order to continue receiving funding.
According to Elise Lankiewicz amfAR’s policy associate, the disruptions resulted in the closure of 1,714 HIV service delivery sites, including 1,010 public health facilities, 325 access points and 126 drop-in centres. The study found that locally based organisations suffered the greatest impact, proving significantly more likely than international organisations to lose funding and shut down services. Even organisations that retained funding reported having to censor programme language, remove references to gender and key populations and discontinue services targeting communities most vulnerable to HIV infection.
Lankiewicz said the findings show that while HIV treatment services have largely been protected, prevention programmes and community services have suffered extensive cuts.
Among organisations providing HIV prevention, 43 percent permanently stopped at least one prevention activity, with condom distribution and pre-exposure prophylaxis (PrEP) among the services most affected. More than 80 percent of organisations previously offering community-based services, including outreach, adherence support and peer networks—reported disruptions across every service category.
“The pattern in these data is consistent,” Lankiewicz said.
“Within PEPFAR, treatment was largely protected, while prevention and the services that reach people at highest risk were cut most deeply.”
Although the survey does not provide country-specific estimates to protect the confidentiality of participating organisations, Lankiewicz said Eastern and Southern Africa experienced the largest absolute loss of funding awards because the region has historically received the largest share of PEPFAR investments.
She added that the researchers believe the survey may actually underestimate the true scale of the disruptions because organisations that had closed entirely were less likely to respond to the survey.
The findings come at a critical time for Zimbabwe, which has made significant progress in reducing HIV infections and AIDS-related deaths over the past two decades through a combination of domestic financing, donor support and community-led interventions. PEPFAR has remained one of the country’s largest HIV partners, supporting treatment programmes, laboratories, healthcare workers, prevention services and community-based organisations.
While Zimbabwe has increasingly strengthened domestic investment through the National AIDS Trust Fund, commonly known as the AIDS Levy, experts have repeatedly warned that replacing PEPFAR’s extensive technical and financial support would be extremely difficult in the short term.
Commenting on the significance of the two studies, IAS President-Elect and Associate Professor of Global Health at Jomo Kenyatta University of Agriculture and Technology, Kenneth Ngure, said they provide compelling evidence that recent changes to PEPFAR are already having consequences across the global HIV response.
“These studies provide compelling new evidence that PEPFAR disruptions have had negative, far-reaching consequences, particularly for those most vulnerable people,” Ngure said.
