PEPFAR Data Release Sparks Controversy: Officials Tout Success While Experts Warn of "Five-Alarm Fire"

The HIV/AIDS world has been waiting for months to learn how PEPFAR is doing. That's the much lauded program launched by President George W. Bush in 2003 and widely credited with saving 26 million lives through its HIV diagnosis, treatment, outreach and support programs. The U.S. puts about $5 billion a year toward this work. When the Trump administration froze foreign aid, did that hobble PEPFAR — the President's Emergency Plan for AIDS Relief? Or did it rebound with waivers aimed at allowing live-saving programs to continue and strong bipartisan backing? In past years, PEPFAR data would be released four times a year, giving experts all over the world a sense of how the program was doing and whether it was hitting its targets. This year, global health specialists have been waiting — and waiting. Since President Trump returned to the White House in January 2025, no data had officially been released. Finally, some data came out on Friday afternoon. And what did it show? Depends on whom you ask. Government officials pointed to the figures, particularly the number of people on HIV treatment, as a sign of real success. "The numbers are very, very good," said Jeremy Lewin at a public event this past week. He's the acting undersecretary of state for foreign assistance, humanitarian affairs and religious freedom at the State Department. "People will be surprised at, I think, how resilient our health programs are and have been." However, as HIV experts and activists scramble to do rapid analyses, they are coming to a very different conclusion. They are raising grave concerns about the picture the data depicts. "These data show nothing less than a five-alarm fire," says Asia Russell, executive director of the advocacy group Health GAP, pointing to drops in HIV testing, prevention and support services. The Foundation for AIDS Research — amfAR — assessed the data along with experts from the International AIDS Society and found "substantial disruptions across PEPFAR service areas" that amount to "a troubling inflection point." Brian Honermann, deputy director of public policy at amfAR, says that the data presented by the State Department "obscures the true damage of the interruptions." A reliable source of numbers Within the world of global health, PEPFAR was known for providing some of the best data on the global HIV/AIDS epidemic, with detailed information coming out each quarter and a focus on U.S.-funded efforts. "PEPFAR has been the most transparent and effective global health program of the past 25 years, and it's precisely because it has invested its resources into building this data system," Honermann says. He adds that the "metrics [were] specifically honed to be ambitious but also to hold itself accountable." With the new numbers, Trump officials are highlighting one of their top priorities: Ending mother-to-child transmission of the virus. This past year the number of pregnant and breastfeeding women starting PrEP, which is medication given to prevent someone from contracting HIV, grew. That number increased from 43,000 in the final quarter of 2024 to 103,000 in the final quarter of 2025. The State Department press release also emphasized that the U.S. supported HIV treatment for more than 20 million people in 50 countries as of the end of September last year — only a slight drop from the same time a year earlier. While some outside experts note this figure is better than the dire predictions in the immediate aftermath of the aid cuts, Russell is not impressed. "For the first time in history, PEPFAR has put fewer people on [HIV] therapy than the year before. That is an absolute indictment of this administration," she says. Honermann of amfAR says the other numbers also show that a delicate system for preventing and addressing HIV cases has been severely compromised. "About 24% of the frontline health care workers are no longer there. They're no longer being supported," he says. Many of those workers were let go as programs that were not deemed life-saving were canceled — this includes community health workers going door-to-door to check on patients and facilitators who ran peer-support groups for HIV-positive teens. He says the numbers already show what happens when those health care workers are not there. In PEPFAR-funded clinics and treatment centers where services were not disrupted by the aid cuts, Honermann found that the diagnosis of new people with HIV dropped by 13%. And in places where services had been interrupted for a period of time, it went down almost 30%. "That's hundreds of thousands of people that we would have expected to see get their diagnoses and get put under treatment — and those people are now just missing," says Honermann. "That's bad for their own health and well-being, [and] it also allows the space for HIV to continue to spread."