---
title: "Washington Swore to Protect Babies From HIV, Then Tore Down the Building Around Them"
description: "A year after the administration exempted mother-to-child prevention from its cuts, surveys find the promise was structurally impossible to keep"
author: "Tomasz Idle"
published: 2026-09-27T04:01:29.351Z
modified: 2026-09-27T05:13:23Z
url: https://rews.cc/a/washington-swore-to-protect-babies-from-hiv-then-tore-down-t-7d9af3
language: en
tags: ["health", "trump", "hiv", "pepfar", "world"]
publisher: "Rews (https://rews.cc)"
---

# Washington Swore to Protect Babies From HIV, Then Tore Down the Building Around Them

*A year after the administration exempted mother-to-child prevention from its cuts, surveys find the promise was structurally impossible to keep*

By Tomasz Idle · September 27, 2026 · https://rews.cc/a/washington-swore-to-protect-babies-from-hiv-then-tore-down-t-7d9af3

## In brief

- In January 2025, Tanzanian pediatrician Theopista Masenge was ordered to halt an HIV program for infants, children and pregnant women overnight
- An amfAR/Johns Hopkins survey of 166 PEPFAR-funded groups in 46 countries found 63% saw mother-to-child prevention services disrupted; 22% ended them
- The State Department called the survey “flawed” and said 20.6 million people were on US-supported HIV treatment as of September 30, 2025
- Testing declines, 4.8 million fewer served by a children’s program, and a 15% drop in children on HIV drugs across eight countries were reported
- CNN previously reported roughly $1.7 billion in approved PEPFAR funds unspent and $2 billion shifted to USAID closure costs

There is a kind of promise you can only make if you have never looked at how the thing you are promising actually works. Last September, the US government made one. Faced with alarm over its demolition of the global health system it had spent decades building, the Trump administration announced that HIV services preventing mother-to-child transmission would be ring-fenced, prioritized, protected. The babies were safe. It was the rest of the building that had to go.

Ask Dr. Theopista Masenge how a promise like that lands in the real world. In January 2025, the Tanzanian pediatrician was at a hospital in Mbeya, rolling out new treatments for children with high HIV viral loads, when the call came: stop work, now. The program she was implementing — services for HIV-exposed infants, children and pregnant women — had received a letter from the soon-to-be-dismantled US Agency for International Development ordering a complete halt.

“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 told CNN. She lost her job soon after. Almost overnight, she said, “the system that was built for almost 40 years was gone.” “Everything has been disrupted.” More than a year later, even with limited American funding restored, she says the disruptions to care for children and pregnant women persist across Tanzania.

Her experience is now a spreadsheet. A study by the Foundation for AIDS Research (amfAR), conducted with Johns Hopkins University and published in July, surveyed 166 organizations that received funding from PEPFAR — the President’s Emergency Plan for AIDS Relief, founded by George W. Bush in 2003 and credited by the World Health Organization and its own data with saving more than 26 million lives. The respondents, spread across 46 countries, represent 23% of all PEPFAR partner organizations. Despite the administration’s exemption for mother-to-child prevention, 63% reported disruptions to exactly those services. Twenty-two percent said they had ended them entirely.

The surveyed organizations also reported that 1,714 clinics once supported by PEPFAR closed last year. The reason the promise failed is not mysterious, according to Elise Lankiewicz, a senior policy associate at amfAR. “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,” she said. “There was really no way to protect very singular parts of the system while dismantling others.” You cannot spare the nursery while evicting the hospital. The nursery turns out to have plumbing.

## The metrics of success, minus the metrics

A State Department spokesperson told CNN the amfAR survey had “flawed” methodology, and offered the administration’s own accounting: “the Trump Administration has strengthened PEPFAR through clear strategic direction, promoting greater recipient-country ownership, and sharpening the program’s focus on measurable health outcomes. As a result, the number of children testing positive and on treatment for HIV has continued to decline.” The spokesperson added that as of September 30, 2025, the US government supported lifesaving treatment for 20.6 million people living with HIV in more than 50 countries, and that the focus is now “fewer new infections, mature programs transitioning to local management, and countries advancing toward long-term self-reliance.”

Here it is worth pausing on that declining number of children, because everyone agrees it declined and almost no one outside the administration agrees on what it means. According to the Elizabeth Glaser Pediatric Aids Foundation, falling pediatric numbers are not a marker of success but of children losing access to testing, monitoring and care — plus data collection so disrupted that bad outcomes are now harder to see. The foundation calls it an “HIV crisis hiding in plain sight.” “Every single indicator in the pediatric HIV cascade shows decline,” it said. Its president, Dr. Doris Macharia, put the argument in two sentences: “Where the (PEPFAR) program reaches children, it works. But the data tell us that far fewer are now being reached.”

As for the government’s suggestion that fewer children on treatment proves prevention is working, the foundation replied that this “does not explain such a dramatic and sudden drop of 54,000 children already on treatment.” Children who were already being treated do not vanish from the rolls because prevention elsewhere improved. They vanish because the van stopped coming.

The numbers from outside the government lean the same way. AmfAR’s analysis of the latest US data found HIV testing for pregnant women down 2% at the end of 2025 versus a year earlier, and testing for babies down at least 6%, with some facilities reporting far worse. KFF, the nonprofit health policy research organization, found the Orphans and Vulnerable Children Program served about 4.8 million fewer children and family members in 2025 than the year before. The Clinton Health Access Initiative, examining eight countries, found a 15% decline in children getting HIV medications, which it attributed to test-kit shortages and the folding of pediatric HIV services into general clinics “without adequate provider training and support.”

What disappears first, experts note, are the unglamorous “wraparound” services: the community health worker paid to make sure a mother keeps her appointments, the local education about how HIV passes to babies. “I would expect those are the first things that are going to drop off, especially in countries with limited funds to replace what’s been lost from PEPFAR,” Lankiewicz said.

Then there is the money that Congress approved and nobody quite delivered. “Even though PEPFAR received the regular amount of appropriations from Congress in the last year, that money is not actually moving,” Lankiewicz said. CNN has previously reported that the administration underspent roughly $1.7 billion lawmakers had approved for the program, and redirected $2 billion meant for global health to cover the cost of closing down USAID — spending the fire department’s budget on the demolition of the fire station.

Meanwhile the lights on the dashboard are going out one by one. PEPFAR’s data collection was once a resource for researchers worldwide; the administration has stopped releasing quarterly reports and withheld some data. The State Department says it has “greater confidence in data” from the fourth quarter of fiscal 2025, conceding that “earlier quarters experienced reporting and implementation challenges which limit data interpretability.” Analysts making the enemy of measurement rarely lose an argument they get to grade themselves.

Masenge, now president of the Paediatric Association of Tanzania, is less worried about drug supplies than about what is happening around them. “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,” she said. “I’m super worried about the quality of care for the children, for the mothers.”

“You don’t always see the impact on outcomes till it’s too late,” said Jennifer Kates, director of global and public health policy at KFF. “And that would be a crisis, if we get to a point in a year or so where we look back and say more babies died and more children were born with HIV.” Preventing mother-to-child transmission was the one thing the demolition crew said it would save. A promise to protect a room inside a building you are tearing down is not a policy. It is a press release with a nursery in it.