AVAC: New PEPFAR data reveal a prevention crisis beneath the surface

AVAC analysis

The US Department of State released long-delayed, partial 2025 data from the President’s Emergency Plan for AIDS Relief (PEPFAR). The administration is framing these data as proof that the HIV response is “doing very good”, despite multiple analyses indicating otherwise. A narrow reading of the data show stable treatment numbers and selective gains, such as reported increases in PrEP use among pregnant and breastfeeding women. But independent analyses from KFF, amfAR, Emily Bass, Jirair Ratevosian and AVAC show steep declines across the prevention cascade following the foreign aid freeze and stop-work orders in testing, diagnoses and PrEP initiations. Even where gains are highlighted, they are outweighed by overall losses, sharp declines in spending and disproportionate impact on key populations, young women and infants. AVAC’s review of available PEPFAR data show a 41 percent decline in overall PrEP initiations when comparing July-September 2024 to the same period in 2025. Among women who are not pregnant or breastfeeding, 53 percent fewer initiated PrEP in the last year and 54 percent fewer men. And no disaggregated data is publicly available on key populations, groups historically dependent on PEPFAR-supported prevention efforts, and who are essential to reach for epidemic control.

Days prior to the release of these data, Mike Reid, PEPFAR’s Chief Science Officer resigned out of principle.

IMPLICATIONS: These data point to a response that is “thinning at the margins”, Jirair Ratevosian wrote, where testing, prevention and early engagement in care occur. Stable treatment numbers reflect the resilience of existing systems, not the health of the full HIV response, and declines in prevention today are likely to translate into increased infections down the line. This is especially concerning as countries begin rolling out lenacapavir for HIV PrEP (LEN). Last week, US officials described their ability to scale LEN as a result of their “creative destruction” of the past year. PEPFAR, Global Fund and national PrEP programs should be introducing LEN on top of a solid foundation of robust PrEP programs. Instead, LEN is being introduced when almost half the PrEP initiations are gone, and PrEP programs are decimated. Without urgent action to restore testing and prevention programs, ensure transparency and accountability in data and prioritize key populations, the global HIV response risks backsliding at precisely the moment when it should be accelerating.

Further coverage:

• US Department of State: PEPFAR data release (media note; fact sheet)
• Reuters: US figures suggest HIV aid was maintained; but data show drops in testing, diagnoses
• The New York Times: New PEPFAR data show worrying declines in testing and treatment for HIV /free registration is required/
• Devex: PEPFAR data shows drops in HIV prevention as US claims success /free registration is required/
• Health Policy Watch: Researchers dispute US government’s upbeat data about PEPFAR’s impact on HIV
• NPR: Two startlingly different views on long-awaited data on America’s anti-HIV efforts
• NPR: She used to run US AIDS relief — now, foreign aid has changed

AVAC publishes a weekly Global Health Watch, a curated digest of key developments in global health. Access this week’s issue (24 April) here.