The Trump administration said it would prioritize ending mother-to-child HIV transmission. Health workers say it cut services

HIV Care Disruptions Threaten Progress for Mothers and Children

Sandego.net – Health services intended to protect pregnant women, newborns and children from HIV have been disrupted in Tanzania and many other countries after major changes to US global health funding.

For Dr. Theopista Masenge, a pediatrician working in Mbeya, Tanzania, the consequences arrived suddenly. In January 2025, she was introducing new treatment options for children with high HIV viral loads when the program she worked on was instructed to stop operating. The initiative supported HIV-exposed infants, children and pregnant women.

“It was really, very abrupt, and I recall even the hospital managers were running up and down like, ‘What are we going to do?’”

Masenge lost her position soon afterward. She described the interruption as the collapse of a care structure developed over decades.

“Everything has been disrupted.”

More than a year later, she says gaps remain in services for children and pregnant women in Tanzania, despite the return of some limited US government support. Her experience reflects wider concerns across Africa, Asia and other regions following cuts to global health programs and the dismantling of the US Agency for International Development.

Prevention Programs Hit by Broader Funding Changes

The United States’ PEPFAR program, its flagship international HIV/AIDS initiative, has been particularly affected. Created in 2003 during the George W. Bush administration, PEPFAR is credited by the World Health Organization and the program’s own figures with saving more than 26 million lives and preventing millions of HIV infections, largely in Africa.

A July study from the Foundation for AIDS Research, known as amfAR, and Johns Hopkins University examined responses from 166 organizations in 46 countries that received PEPFAR funding in the prior year. Those respondents represented 23% of PEPFAR partner organizations.

Although the US government said in September that services preventing HIV transmission from mothers to babies would be protected, 63% of respondents said those services had been disrupted. Twenty-two percent said they had stopped mother-to-child transmission prevention work altogether during the funding cuts.

The findings underline a practical difficulty in preserving one part of a health system while reducing the financing that supports its staff, testing, data systems, referrals and routine patient care.

“Even if the administration’s intention was to not touch these programs, PEPFAR (funding) awards generally aren’t sort of specific to doing one individual task,” said Elise Lankiewicz, a senior policy associate at amfAR. “There was really no way to protect very singular parts of the system while dismantling others.”

The surveyed organizations also reported that 1,714 clinics previously supported by PEPFAR closed worldwide last year. A clinic closure can affect far more than medication distribution. Families may lose access to follow-up visits, infant testing, counseling and monitoring that helps health workers identify problems before they become more serious.

Concerns Over Care Quality and Infant Diagnosis

Masenge, now president of the Paediatric Association of Tanzania, said her main concern is not simply whether medicines remain available. She fears that the quality and consistency of care for mothers and children have weakened.

“I’m not so worried in terms of supplies and medications, but I’m super worried about the quality of care for the children, for the mothers.”

She said some patients no longer return to facilities to collect treatment because they believe the services have deteriorated. She also warned that early infant diagnosis has suffered. Early testing is especially important because infants exposed to HIV need timely assessment and, when necessary, treatment and continued medical support.

“People are not going back to the facility to pick up their medication because they feel like the services have really become worse, and the early infant diagnosis is suffering similarly.”

The Trump administration is shifting its approach toward agreements with aid-recipient countries and is seeking greater co-financing from those governments. The stated aim is to increase local ownership and help countries move toward long-term self-reliance.

A State Department spokesperson criticized the amfAR survey’s methodology as flawed and said the administration had strengthened PEPFAR by setting clearer strategic direction, emphasizing recipient-country responsibility and focusing on measurable health outcomes. The spokesperson said the number of children testing positive for HIV and receiving treatment has continued to decline.

Fewer Children Starting Treatment Raises Questions

The number of children beginning HIV treatment did fall last year. But specialists caution that a lower total does not automatically show that fewer children need care. A decline can also occur when fewer children are tested, monitored or successfully connected to treatment services.

The Elizabeth Glaser Pediatric AIDS Foundation has highlighted the risk that children could lose access to care and go undetected when testing and monitoring decline. Disruptions in data collection and reporting create another challenge: health systems may have less ability to recognize harmful trends quickly.

The State Department said its focus is on reduced new infections, stronger locally managed programs and countries moving toward self-reliance. It said fourth-quarter fiscal year 2025 figures showed that, as of September 30, 2025, the US government supported life-saving HIV treatment for 20.6 million people living with HIV.

For health workers on the ground, the concern is whether those broader goals can be reached without leaving vulnerable families behind during the transition. Preventing transmission from a mother to her child depends on a connected chain of services: prenatal care, testing, treatment, delivery support, infant diagnosis and reliable follow-up. When any part of that chain is interrupted, the effects can extend well beyond one clinic or one funding cycle.