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The number of South African children living with HIV who received treatment at sites supported by the US government almost halved in the year to September 2025, according to research due to be presented at the 26th International Aids Conference in Rio de Janeiro next week.While the US government did not fund antiretroviral medicines in South Africa, it financed organisations that provided vital technical assistance, paid healthcare workers salaries and helped to identify and retain children in care. The loss of this support thus poses a threat to the governments’ efforts to ensure all children living with HIV are provided with the services they need. The study is one of several due to be highlighted at the conference that lay bare the impact of US President Donald Trump’s decision to dismantle the President’s Emergency Plan for Aids Relief (Pepfar), a bipartisan programme that has since 2003 invested more than $100bn to combat the HIV/Aids pandemic. The cuts were made with little or no warning after a series of executive orders signed by Trump shortly after he was inaugurated in February 2025.The study analysed data from 21 high-burden countries and found 77,613 fewer children living with HIV received antiretroviral treatment at Pepfar-supported sites at the end of the 2025 US fiscal year compared with the year before. The US fiscal year runs from October 1 to September 30.South Africa recorded the biggest absolute decline, with the number of children on treatment at Pepfar-supported sites plunging by 30,880, a 45% drop. In five countries — South Africa, Uganda, Haiti, Zambia, and Kenya — the declines were too big to be explained by the historic downward trend in children on treatment at Pepfar-supported sites and were proportionally greater than the decline seen in adults over the same period, said the study authors.“The US state department has characterised the recent declines in the number of children on HIV treatment as consistent with historical trends. Following a year of disruption, this study has put that claim to the test … [with] additional analysis that suggests that for five countries they represent departures from historical trajectories,” said incoming International Aids Society president Kenneth Ngure, one of the paper’s co-authors. “Children cannot wait. We urgently need country-level follow-up,” he said.Desmond Tutu Health Foundation CEO Linda-Gail Bekker, who was not involved in the study, said the results are worrying, as reaching and keeping children in care is much more challenging than doing so for adults. Reducing service providers who are tailored to the needs of children is likely to exacerbate the existing lag in the diagnosis and treatment of children compared with adults. “This is important because children die more quickly without treatment, and if they live, they need many decades of sustained treatment,” she said.South Africa has committed to the UN’s 95-95-95 targets, which aim to ensure 95% of people living with HIV know their status, 95% of people who have been diagnosed are on treatment and 95% of those on treatment are virally suppressed. While it has made steady progress towards those targets for the population as a whole (95:81:92), it is off track for children (85.5:76:77), according to the Thembisa model. South Africa has the world’s biggest HIV burden, with 8-million people living with the disease. Pepfar has provided more than $8bn to South African organisations over the past two decades. Cuts to Pepfar-supported organisations began in February 2025, and last month the Trump administration indicated that it intended to fully terminate Pepfar funding for South Africa over policy disagreements. Business Day
