US HIV Program Overhaul Sparks Oversight Fears

The United States is moving its global HIV/AIDS work away from the long-running President's Emergency Plan for AIDS Relief (Pepfar) framework, a transition that public health experts say could weaken oversight and slow progress. The change comes as Pepfar appears to be nearing its final report and after the resignation of its chief science officer, according to the source material.

S. effort is expected to rely more on individual country partnerships rather than the established Pepfar structure. Analysts cited in the source material said this shift could make it harder to monitor programs consistently and to maintain service delivery across settings. Experts also raised concerns that bilateral agreements may not replicate Pepfar’s comprehensive data collection and accountability mechanisms, which have been used to track performance and continuity of care.

Independent analyses of Pepfar data described in the source material point to declines in several core HIV services even as the number of people on treatment remained relatively steady. The total number of individuals receiving HIV treatment globally fell by 0.3%. Over the same period referenced, HIV testing dropped by 17%, initiations of pre-exposure prophylaxis (PrEP) declined by 33%, and the healthcare workforce delivering HIV services decreased by 24%.

Infant-related indicators showed sharper reductions, according to the same analyses. Infant testing fell by 6% at continuously reporting facilities and by 60% at intermittently reporting facilities. Infant diagnoses also declined, dropping by 12% at continuously reporting facilities and by 31% at intermittently reporting facilities.

The U.S. State Department reported additional declines in pediatric services over a multi-year window. Pediatric HIV treatments decreased from 643,627 in 2022 to 508,703 in 2025. Pediatric testing also fell, from 1.7 million to 1.1 million over the same period.

Experts quoted in the source material warned that reduced visibility into program performance could make it harder to identify gaps quickly, particularly where economic pressures are already straining health systems. They said that if data reporting becomes less standardized across countries, it may be more difficult to compare results, verify coverage, and ensure that people who start treatment remain in care.

For governments and health providers that have relied on Pepfar’s reporting and monitoring practices, the transition raises questions about how progress will be measured and how service disruptions will be detected. The source material did not specify the full design or timelines of the new country partnership model, leaving uncertainty about how oversight, workforce support, and pediatric and infant services will be safeguarded during the shift.