A new analysis of the President’s Emergency Plan for AIDS Relief’s (PEPFAR) fiscal year 2025 data by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) reveals alarming declines across every indicator in the pediatric HIV cascade.
HIV testing among children fell 34% and treatment initiations declined 13%. Most starkly, 54,000 fewer children are currently on treatment, a 10% drop in a single year.
“We do not know how many of these children have died, aged into adult care, or fallen through gaps in systems that are no longer intact,” said Dr. Doris Macharia, EGPAF’s president. “That is why we are urging Congress to require full, quarterly PEPFAR data releases with age and sex disaggregation across all indicators. Children cannot be protected by systems that do not see them.”
Pediatric treatment failure progresses rapidly and is often invisible until a child is severely ill. This makes it even more concerning that viral load testing declined 16%, leaving 64,000 fewer children with documented viral suppression. Yet among those who did receive a test, the suppression rate improved to 90.2%. The program works when it reaches children, but it is reaching far fewer of them.
The U.S. government has suggested that declines in pediatric treatment numbers may reflect the success of programs to prevent mother-to-child transmission (PMTCT). PMTCT progress is real, and EGPAF has been proud to be part of it. But PMTCT gains do not explain such a dramatic and sudden drop of 54,000 children already on treatment. This, alongside simultaneous declines in testing, diagnosis, and viral load monitoring across all pediatric age groups, indicates that children are losing access to care.
This data covers only a single quarter, July through September 2025. PEPFAR’s historic strength has been consistent, disaggregated, quarterly reporting that allows governments, implementers, and civil society to track trends, identify gaps, and respond in real time. That visibility is now at risk.
As PEPFAR transitions to bilateral agreements with partner country governments, centralized data infrastructure is being replaced by national reporting systems with no comparable standardization, making cross-country analysis impossible and early warning signals harder to detect precisely when they matter most.
A recent national poll found that 81% of voters across party lines support funding to protect children affected by AIDS, making clear that the political will exists. What is needed now is the data transparency to act on it.
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