What the Latest PEPFAR Data Reveal and Why It Matters

PEPFAR-supported PrEP initiations are down by 41% in one year, with men and non-pregnant or breastfeeding women seeing drops exceeding 50% — and key populations absent from the data altogether. These trends reflect broader disruptions across the prevention cascade: fewer people are being tested, diagnosed and connected to prevention.

AVAC Policy Director Suraj Madoori and Executive Director Mitchell Warren unpack what the new PEPFAR data mean for the future of HIV prevention. “PEPFAR’s success has long depended on a continuous flow: people are tested for HIV, diagnosed and then linked to treatment if they are living with HIV or offered prevention if not,” they write. “When testing declines, as it is under PEPFAR right now, the entire cascade is disrupted.” None of this diminishes PEPFAR’s extraordinary achievements. On the contrary, it underscores what is at stake. The path forward requires a more balanced reading of the evidence.

The data come at an especially heartbreaking moment of scientific promise: highly effective long-acting prevention options like injectable lenacapavir for HIV PrEP (LEN) are finally available and offer the potential to transform how HIV is prevented. But innovations depend on strong delivery systems—robust testing, community engagement, and functioning prevention programs, along with strong data systems, to ensure innovation has impact.
 
For the latest on PrEP use and initiations, explore AVAC’s PrEPWatch Global PrEP Tracker. And for in-depth look at the situation in South Africa, check out this article from Bhekisisa: Our anti-HIV jab will be rolled out in 6 weeks. But funding cuts hollowed out the system needed to deliver it.

Since January 2025, AVAC has tracked the severe impact of the PEPFAR stop-work orders on PrEP, with many countries suspending or significantly reducing their ability to provide PrEP services.

View the latest from AVAC’s Impact Tracker, now updated with the recent PEPFAR data release.