US aid cuts drove sharp HIV service drops in Africa, study finds

US funding cuts caused sharp and lasting declines in HIV prevention, testing and treatment services at organisations serving some of the people most vulnerable to the virus in Uganda and Zimbabwe, according to new research.

HIV prevention services at four nongovernmental organisations fell by about one-third to almost two-thirds from 2024 levels. Use of pre-exposure prophylaxis, or PrEP, which helps prevent HIV infection, dropped by as much as 72%, according to the study by researchers at the London School of Economics and Duke University published in The Lancet Global Health. Testing fell by as much as 64%.

The declines followed stop-work orders issued after the US froze foreign aid in January 2025, disrupting programs supported by the President’s Emergency Plan for AIDS Relief, or PEPFAR, and the US Agency for International Development.

The findings reinforce evidence of a broader setback in HIV prevention. Global Fund data published last month showed the number of people receiving PrEP in countries where it invests fell 21% in 2025, even as the number receiving antiretroviral treatment continued to rise.

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Treatment at the organisations studied in Uganda and Zimbabwe was also hit despite a US humanitarian waiver intended to preserve lifesaving services. Antiretroviral therapy dropped 22% to 32%, with the researchers finding that the waiver softened the impact, but failed to prevent a substantial decline.

“The safety net that was supposed to preserve life-saving treatment did not hold,” lead researcher Henry Cust said. “The services and community trust that took decades to build were dismantled overnight.”

The findings aren’t representative of national declines in Uganda and Zimbabwe. The organisations studied had their US funding terminated or sharply cut and focused primarily on so-called key populations — groups at particularly high risk of acquiring HIV and often poorly served by mainstream health systems, including sex workers, men who have sex with men, transgender people, prisoners and people who inject drugs.

The State Department disputed the findings, saying it hadn’t verified the report, but considered its methodology flawed. The Trump administration is shifting the focus of US global health programs from the number of services funded to outcomes such as reducing new infections and increasing countries’ responsibility for their own health systems, the department said in an emailed response to questions.

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The department said US-supported HIV treatment reached 20.6 million people as of September 2025, broadly in line with previous years. It also cited 35 bilateral health agreements providing $14.6 billion in US assistance alongside $10.1 billion in recipient-country investment as evidence of its continued commitment to global health.

The researchers analysed service data from January 2023 through March 2026.

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