The US Department of State released long-delayed, partial 2025 data from the President's Emergency Plan for AIDS Relief (PEPFAR) Friday. 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.   

READ: 

• Spotlight FY25 Quarter Four Public Data Release: PEPFAR Continues Support for Over 20 Million Living with HIV and More Than Doubles Number of Pregnant and Breastfeeding Women on HIV Pre-exposure Prophylaxis—US Department of State  
• PEPFAR Data Release—US Department of State 
• US figures suggest HIV aid was maintained; but data show drops in testing, diagnoses—Reuters  
• After massive cuts, U.S. says HIV work abroad is going well, but experts disagree—NPR  
• New PEPFAR Data Show Worrying Declines in Testing and Treatment for H.I.V.—New York Times 
• PEPFAR data shows drops in HIV prevention as US claims success—Devex  
• Researchers Dispute US Government’s Upbeat Data About PEPFAR’s Impact on HIV—Health Policy Watch 
• Two startlingly different views on long-awaited data on America's anti-HIV efforts—NPR  
• She used to run U.S. AIDS relief — now, foreign aid has changed—NPR 
• What We Know from the Latest PEPFAR Data: Analysis of FY 2025 Quarter 4 Results—KFF  
• The impact of the United States foreign aid freeze on HIV service delivery in PEPFAR-supported countries: a facility-level analysis of 2024-2025 programme data—amfAR pre-print 
• Decline in PEPFAR Supported PrEP—AVAC  
• PEPFAR's Chief Science Officer Resigns on Matters of Public Health Principle—Emily Bass Substack 
• Stepping Away—Reimagining Global Health Substack

Physicians for Human Rights released a new report which shows the severity of the devastation to HIV programs in South Africa as a result of the cuts to US global health programs. The report – developed with longtime AVAC partners in South Africa, APHA and Emthonjeni Counseling & Training – documents widespread interruptions to community outreach, peer education, and clinic-based services, particularly those serving key populations, while also noting that the full scale of the damage is difficult to quantify due to simultaneous cuts to data systems. Reporting from Bhekisisa reinforces these findings, highlighting that South Africa is preparing to introduce a highly effective new HIV prevention option into a system that has been hollowed out, with critical gaps in the programs needed to deliver it effectively. 

IMPLICATIONS: LEN has the potential to transform HIV prevention, but without strong, functioning systems that include testing, outreach, community engagement, surveillance and supply chains, it cannot reach those who need it most. The erosion of HIV prevention programs, especially those serving key populations (along with the erasure of data on these populations) risks wasting investments and puts the entire system tasked with delivering new innovations at risk. Overall, the findings underscore how abrupt funding cuts do not simply pause programs; they dismantle the infrastructure that underpins impact, making recovery slower, more costly, and less equitable.  

READ:  

• Wasted Investments, Looming Crisis: The Impact of U.S. Global Health Funding Cuts on HIV in South Africa—Physicians for Human Rights 
• US aid cuts undermine HIV prevention in South Africa, report finds—Reuters  
• Our anti-HIV jab will be rolled out in 6 weeks. But funding cuts hollowed out the system needed to deliver it—Bhekisisa  
• We are managing HIV with selective lenacapavir roll-out, not ending it—Health e-News  

A planned CDC report showing that COVID-19 vaccines reduced hospitalizations and emergency visits by roughly 50% among healthy adults was blocked from publication. Despite going through an internal scientific review and using traditional and validated scientific methods, CDC leadership refused to publish the issue of the highly regarded Morbidity and Mortality Week Report (MMWR), citing “methodological concerns” and prompting alarm among public health experts. At the same time, the Department of Defense announced it would end the long-standing requirement for annual flu vaccination among US military personnel. This has been a requirement for decades to protect troop readiness and is now being framed around personal choice.  

IMPLICATIONS: These actions continue the broader shift away from evidence-based vaccine policy toward politicization of public health decisions. Suppressing or delaying dissemination of scientific findings risks undermining confidence in public health institutions and weakens the data needed to guide policy and practice. Meanwhile, rolling back vaccine mandates for major populations or groups of individuals could increase illness, disrupt operations, and contribute to declining vaccination norms.  

• C.D.C. Cancels Publication of Study Showing Benefits of Covid Vaccines—New York Times 
• Annual flu vaccine no longer required for U.S. military, Hegseth says—Washington Post  
• Why I Resigned: A Reflection on Public Health, Scientific Integrity, and Moral Courage—AFT  
• COVID shots, newer vaccines in limbo after US court halts Kennedy’s advisory panel—Reuters  
• The State of US Vaccine Policy—CIDRAP