HIV Treatment Disruptions in Tanzania

Dr. Theopista Masenge found herself in a hectic situation at a hospital in Mbeya, Tanzania, as she was implementing new treatments aimed at children with high viral loads of HIV. Then, out of the blue, she received a directive to stop her work immediately.

This occurred in January 2025, and at that time, she was part of a healthcare program focused on providing services for infants exposed to HIV, children, and pregnant women. A shocking letter had arrived from the now-closed United States Agency for International Development (USAID), announcing the cessation of all operations.

“It was very abrupt. I even remember the hospital managers running around, unsure of what to do next,” Masenge reflected, mentioning that she lost her job shortly after. “It’s hard to believe, but almost overnight, a system that had been in place for nearly 40 years vanished.”

She expressed to CNN, “Everything has been disrupted.” Over a year later, Masenge noted that disruptions to HIV/AIDS services, particularly for children and pregnant women, still linger across Tanzania, despite a limited return of U.S. government funding.

This trend isn’t confined to Tanzania; it’s unfolding throughout Africa, Asia, and other regions. The funding cuts and dismantling of USAID under the Trump administration have significantly impacted the U.S.’s premier HIV/AIDS initiative, PEPFAR, as detailed in a recent study by the Foundation for AIDS Research (amfAR). This study, executed with Johns Hopkins University and released in July, involved a survey of 166 organizations across 46 countries that had previously received PEPFAR support.

While the U.S. government announced last September that HIV services aimed at preventing mother-to-child transmission would be prioritized and shielded from cuts, the amfAR survey revealed that 63% of participants experienced disruptions in those services.

In fact, 22% of the organizations surveyed indicated they had completely ceased mother-to-child prevention services due to funding constraints.

“Even if the administration didn’t intend to affect these programs directly, PEPFAR awards are generally not specific to one task,” noted Elise Lankiewicz, a senior policy associate at amfAR. “It’s challenging to protect specific components while dismantling others.”

Last year, 1,714 health clinics previously supported by PEPFAR shut down worldwide, according to the surveyed organizations.

“I’m not overly concerned about the supplies and medication; it’s the quality of care for the children and mothers that worries me,” Masenge, who now leads the Pediatric Association of Tanzania, commented on her local situation. “People aren’t returning to collect their medications because they believe the service quality has deteriorated significantly, and early infant diagnosis is similarly suffering.”

PEPFAR, initiated by the George W. Bush administration in 2003, is credited with saving over 26 million lives and preventing countless infections, especially in Africa, based on data from the World Health Organization and the program itself. However, this crucial U.S. global health program faces significant funding cuts as the administration shifts towards new aid agreements and demands more financing from recipient nations.

A spokesperson from the U.S. State Department criticized the amfAR survey’s approach, arguing that “the Trump administration has strengthened PEPFAR” by promoting greater ownership by recipient countries and focusing on measurable health outcomes—in fact, the number of children testing positive for HIV and in treatment has continued to decline.

Indeed, while there was a decline in the number of children beginning new HIV treatment last year, experts caution that this may not signify an overall success. Reduced testing and monitoring indicate that children are losing access to care, according to the Elizabeth Glaser Pediatric AIDS Foundation. The disruptions to data collection and reporting have complicated efforts to identify negative trends.

The State Department official further stated, “Today, we are focusing on real outcomes: fewer new infections and countries moving towards long-term self-sufficiency.” By the end of September 2025, the U.S. government supported life-saving HIV treatment for 20.6 million individuals in over 50 countries.

The Elizabeth Glaser Pediatric AIDS Foundation has termed the drops in pediatric diagnosis and treatment as an “HIV crisis hiding in plain sight.”“Every single indicator in the pediatric HIV cascade shows decline,” the foundation noted, with its president, Dr. Doris Macharia, emphasizing that while the PEPFAR program effectively reaches children, far fewer are being reached now.

Despite assurances from the U.S. government regarding continued support for “life-saving” efforts concerning pregnant and breastfeeding women, amfAR’s recent analysis found a slight 2% decline in HIV testing among pregnant women at the end of 2025 compared to the previous year. Alarmingly, testing for infants plummeted by at least 6%, with some facilities reporting even worse outcomes.

Furthermore, the amfAR survey participants pointed out significant disruptions to the Orphans and Vulnerable Children Program, which is designed to assist high-risk children with HIV care and general health services. According to KFF, a nonprofit health policy research organization, around 4.8 million fewer children and family members were served by this program in 2025 compared to the prior year.

A recent analysis by the Clinton Health Access Initiative indicated a 15% drop in the number of children receiving medications for HIV in 2025 across eight studied countries, attributing this decline to shortages of test kits and the inadequate integration of pediatric HIV services into general health facilities.

Aside from medications and basic care, PEPFAR previously provided many additional “wraparound services” aimed at preventing infections and encouraging marginalized individuals to seek care, according to HIV/AIDS experts. It’s expected these services will be among the first to vanish, especially in underfunded regions.

When discussing mother-to-child transmission prevention, such wraparound services often involved community health workers who followed up with mothers on appointment scheduling, alongside educational initiatives about HIV transmission. The survival of these services largely hinges on the financial capabilities of each country’s government, experts argue.

“Moreover, there’s this continual issue of funding not being distributed efficiently. Even though PEPFAR received its expected appropriations from Congress last year, that money doesn’t seem to be flowing out effectively,” Lankiewicz added.

Previously, CNN reported that the Trump administration had underutilized approximately $1.7 billion already approved for the flagship HIV/AIDS program while also redirecting $2 billion intended for global health to cover the costs associated with closing USAID.

The implementation changes to PEPFAR, coupled with funding cuts, have significantly impacted not just health services but also data collection processes.

PEPFAR used to provide robust data crucial for researchers and healthcare providers worldwide, but the Trump administration has ceased releasing quarterly reports and has withheld certain data sets.

Earlier this year, the State Department expressed confidence in the data from the fourth quarter of fiscal year 2025. They noted, however, that “earlier quarters faced reporting and implementation challenges that limit data interpretability.”

Experts caution that the chaos around data reporting complicates efforts to grasp the full extent of health service disruption and outcomes.

As Jennifer Kates from KFF said, “You don’t always see the impact on outcomes until it’s too late. It would be truly alarming if, after a year or more, we look back and find more babies died or more children were born with HIV.”

For instance, the U.S. government claims that a decrease in the number of children undergoing treatment for HIV suggests that preventive measures are working. Yet, the Elizabeth Glaser Pediatric AIDS Foundation maintains that this doesn’t adequately explain the stark 54,000 drop in children already receiving treatment.

Regarding the drop in infant testing rates, Kates highlighted that it leaves researchers and program implementers uncertain about the current situation for newborns. “If detection efforts decline, how will we even know what’s happening with babies?” she questioned.