The end of routine public reporting of PEPFAR’s quarterly impact data in early 2025 has left a critical gap in program visibility. CHAI’s 16th annual HIV Market Report provides market intelligence across 14 countries, sharing new details on the impact of funding cuts in the first half of 2025. We track HIV commodities, stock levels, and service delivery to reveal the real-time impact of funding disruptions.
What makes 2025 different
We’ve integrated country impact data throughout every chapter. The data links funding decisions to empty medicine shelves, missed HIV diagnoses, and children falling through the cracks. Each section includes critical early warning indicators and actionable recommendations for the next 6-12 months, because the trajectory we’re on demands urgent course correction.
The report builds on our previously released HIV Market Impact Memo. The new data reveals:
Children are bearing the brunt – Pediatric HIV services are collapsing at twice the rate of adult programs. Early infant diagnosis—the narrow window where timely treatment means survival—is down 20 percent. Countries report critical shortages across diagnostic and treatment commodities, with most having less than six months of stock remaining. This should be a red flag because without rapid diagnosis and treatment, 50 percent of HIV-positive children die before they turn two.
Prevention is slipping when it should be scaling – Oral PrEP initiations fell 37 percent as community outreach collapsed. Just as affordable, generic lenacapavir is promising to transform HIV prevention, the delivery infrastructure needed to reach people is being dismantled.
Diagnoses have dropped faster than total tests – Overall HIV testing dropped 8 percent, but positive diagnoses fell 22 percent. This gap reveals that testing is no longer reaching the highest-risk populations who need it most.
Treatment gains are at risk – Adult HIV treatment initiations declined 5 percent while loss-to-follow-up increased 10 percent. The safety nets for advanced HIV disease are fraying and supplies of lifesaving medicines for opportunistic infections are critically low.
Thin markets are fracturing – PEPFAR and the Global Fund are the two major consolidated purchasers of HIV commodities. As they pull back, fragmented domestic procurement threatens higher prices, weaker quality control, and increased stockouts for the low-volume, lifesaving commodities that keep people living with HIV alive.
Looking ahead: innovation and action
The gains of the past decade are fragile and reversing fast. But new tools like lenacapavir can still transform HIV prevention—if we rebuild the testing and delivery infrastructure being lost today. Protecting the fundamentals—early infant diagnosis, HIV treatment support, and advanced HIV disease care—isn’t optional. These services are essential to survival.
This report captures a critical moment
The data captured here—from January through June 2025—documents what happened after initial disruptions. With deeper funding cuts anticipated next year, what comes next could be far worse. For readers looking for an overview, our executive summary distills the report’s key findings, risks, and recommended actions into a shorter, more accessible format.
CHAI remains committed to partnering with governments, communities, donors, and suppliers to translate evidence into action. Read the 2025 HIV Market Report to see where we are, understand what’s at stake, and identify the concrete steps we can take together to avert a needless catastrophe.
About this report
The 2025 HIV Market Report draws on market intelligence from 14 CHAI-supported countries, procurement data, commodity tracking, and service delivery trends to provide comprehensive assessment of HIV access in low- and middle-income countries during a period of unprecedented funding uncertainty.
Key topics covered: HIV testing, pediatric HIV, PrEP, antiretroviral treatment (ART), advanced HIV disease (AHD), viral load monitoring, lenacapavir, PEPFAR, Global Fund, HIV market dynamics, supply chain security.
