PEPFAR Fiscal Year 2025 Data Release Shows a System Under Strain
Declines in HIV testing and prevention jeopardize progress, create opening for resurgence
The U.S. Department of State recently released program data for the President’s Emergency Plan for AIDS Relief (PEPFAR) for the final quarter of fiscal year 2025 (FY25). The topline numbers, as presented, elicit cautious optimism. More than 20 million people living with HIV continued to receive antiretroviral treatment and pre-exposure prophylaxis (PrEP) initiation among pregnant and breastfeeding women more than doubled. However, this single-quarter snapshot provides an incomplete picture.
The Global AIDS Policy Partnership (GAPP) is deeply concerned that the data, as released, masks — and, in some cases, misrepresents — the true state of U.S. supported HIV programs. The trends that matter most for long-term epidemic control are, in fact, moving in the wrong direction.
What the Data Actually Show
An independent review of full FY25 PEPFAR data, and an examination of the data year over year, illuminate trends far more troubling than the headline figures and accompanying press releases suggest. It’s worth noting that a closer look at the administration’s own data puts even the topline results in question. The State Department’s press release reports 20.6 million people on treatment, while its publicly available Panorama Dashboard shows a figure closer to 20.3 million. This incongruence casts doubt over the most optimistic narrative around the data.
The State Department’s data release covers only July through September 2025. This is a significant departure from PEPFAR’s historic practice of releasing data each quarter, enabling civil society organizations, researchers, and policymakers to track trends in real time, identify gaps early, and hold programs accountable.
“One of PEPFAR’s hallmarks has long been its commitment to transparency,” said GAPP Co-Chair Kara Saleeby. “Releasing a single quarter in isolation makes meaningful trend analysis nearly impossible and puts Congress at a disadvantage as it seeks to conduct effective oversight.”
With additional analysis, the picture sharpens considerably:
- HIV testing fell precipitously. PEPFAR-supported testing in Q4 2025 dropped to 17.2 million from 21.9 million during the same period in 2024, a decline of nearly 17% across the full year.
- Diagnoses dropped significantly. According to the amfAR analysis, HIV diagnoses fell 15% from Q4 2024 to Q4 2025, from 449,782 to 380,154.
- Prevention is being deprioritized. New PrEP initiations declined 41% in FY25 compared to FY24, reversing years of steady scale-up. With the exception of pregnant and breastfeeding women, the FY25 data provides little to no visibility into prevention access for vulnerable groups and key populations at high risk of acquiring HIV.
- Adolescent girls and young women have been particularly hard hit. The number of adolescent girls and young women who completed PEPFAR’s flagship DREAMS program collapsed by 86% in FY25 as compared to FY24, the lowest level on record and less than a quarter of those served in any prior year analyzed.
- Orphans and vulnerable children (OVC) have been abandoned entirely. OVC programs, which provided nutrition support, school fees, psychosocial care, and connections to HIV treatment for the most vulnerable children, were eliminated in January 2025. As part of the dismantling of USAID, 6.6 million orphans, vulnerable children, and their caregivers lost protection overnight.
- Key populations were absent from the reporting. Communities that face the most significant barriers to care — including men who have sex with men, sex workers, transgender people, and people who inject drugs — were not included in the data released. Their omission makes it impossible to assess the true scale of losses for the populations at highest risk of acquiring HIV, and undermines the ability to reach them with the treatment and prevention services they need.
- The health workforce contracted dramatically. Despite explicit commitments in the America First Global Health Strategy to maintain 100% of frontline health worker costs, direct service delivery healthcare workers declined by 24% between FY24 and FY25.
- Community-based services sustained the deepest losses. HIV diagnoses in community service sites fell 35%. In addition, community services conducted 41% fewer HIV tests.
“Hospitals and government health centers seem to have held relatively steady, which is important,” said GAPP Co-Chair Shannon Kellman. “But the outreach infrastructure that PEPFAR spent decades building at community sites experienced worrying declines. These are the very services that reach the people least likely to access formal health facilities.”
Treatment Stability Masks a Deeper Risk
Stable treatment numbers are a laudable achievement at a time of such significant disruption. However, treatment indicators are inherently lagging; the impact of service disruption takes time to appear in the data. Patients already on antiretrovirals often remain stable for months, even when surrounding systems weaken, in part because of multi-month drug supplies. What is less visible is what is happening upstream impacting the whole care continuum: fewer people being tested, diagnosed, starting treatment, retained in treatment, or offered prevention options. These are the dynamics that determine what treatment numbers look like three to five years from now.
“You cannot treat yourself out of an epidemic. A strategy that focuses on maintaining treatment for those already enrolled, while cutting testing, prevention, and community services for everyone else, keeps us from realizing a durable, sustainable end to the epidemic” said GAPP Co-Chair Suraj Madoori. “Instead, it is a recipe for rising incidence and, before long, rising mortality.”
This concern is made more urgent by the administration’s own stated goals around lenacapavir (LEN), an innovative long-acting injectable PrEP. LEN should be introduced on top of a robust PrEP infrastructure, not into a landscape where initiations have already collapsed by 41%. A promising tool deployed into a decimated system cannot deliver on its potential.
Transparency and Accountability Are at Risk
As the U.S. shifts to bilateral agreements with individual governments, PEPFAR’s centralized data system is being replaced by national reporting systems. The standardized, publicly accessible, facility-level data that have made PEPFAR one of the most effective global health programs in history will no longer be available. Without comparable data, cross-country analysis becomes impossible and early warning signals go undetected.
Congress Must Act
Considering these findings, the GAPP calls on the U.S. Congress to:
- Increase oversight of PEPFAR implementation, including requiring the State Department to release full quarterly data across all indicators and reconcile discrepancies in reported figures.
- Increase and protect funding for the full spectrum of PEPFAR programming, including prevention as well as treatment, and reject the 30% spending cut the Trump Administration has proposed in the President’s FY27 budget request.
- Restore and expand investment in HIV prevention and testing for all at-risk populations. Prevention is how we stop new infections and it must reach those at greatest risk. Without doing so, treatment gains will not hold.
The data released by the State Department provide a strong signal of continued impact where the administration took active steps to preserve programmatic capacity and save lives. But the harder-to-see data shows what is being lost: testing infrastructure, prevention programs, community health workers, and the transparency that made it possible to measure progress in the first place. Congress must act before these losses take hold and cannot be reversed.