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A new study led by researchers from the CUNY Institute for Implementation Science in Population Health (ISPH) finds that the 2025 freeze on U.S. foreign assistance triggered disruptions to HIV services, medications, labs, and clinic operations across HIV clinics in sub-Saharan Africa and Asia-Pacific. Published in Health Affairs Scholar, the rapid survey of 76 HIV clinics and programs in 32 countries documented that nearly half reported disruptions in HIV-related service delivery after the U.S. government halted most foreign aid on January 20, 2025.
The research team, led by CUNY SPH doctoral alumna Ellen Brazier and Distinguished Professor Denis Nash, found that 47% of responding sites reported disruptions in HIV services, 28% in medication availability, 34% in laboratory services, and 47% in non-research clinic operations. Among sites reporting service disruptions, only 14% said these issues had been fully resolved by mid-2025, when the survey was conducted.
The study focused on HIV clinics participating in the International epidemiology Databases to Evaluate AIDS (IeDEA), a global research consortium that includes countries that received aid via the U.S. government’s PEPFAR (President’s Emergency Plan for AIDS Relief) program as well as countries that did not. Disruptions were more common in PEPFAR-supported countries, where over half of clinics and programs reported interruptions in HIV service delivery and essential supportive clinic operations, such as adherence support, patient tracing and record management.
Clinics most frequently cited interruptions in HIV counseling and testing, HIV treatment, pediatric HIV services, prevention of mother-to-child transmission, pre-exposure prophylaxis (PrEP) provision, and tuberculosis treatment. To cope, some sites expanded multi-month dispensing of antiretroviral therapy, introduced patient cost-sharing, increased use of telemedicine, or forged new partnerships to sustain service delivery.
The authors warn that, amid anticipated reductions in global HIV funding and shifts in U.S. foreign assistance policies ongoing government- and community-led monitoring of HIV prevention and treatment access will be essential to know who is being served—or lost—as programs adapt to the changed funding landscape and to prevent backsliding in progress toward controlling the epidemic.
