Disruption Caused by Changes in the U.S. HIV/AIDS Program A 2025 report by the Kaiser Family Foundation (KFF) analyzes recent data from PEPFAR (President's Emergency Plan for AIDS Relief), the flagship U.S. global HIV/AIDS program, raising critical questions in the field of international health cooperation. Launched in 2003, PEPFAR is credited with saving approximately 26 million lives over more than two decades, establishing itself as a successful model of international health cooperation. However, in recent years, the program has entered a new phase, undergoing shifts in policy direction and operational methods. The KFF report, 'What We Know from the Latest PEPFAR Data: Analysis of FY 2025 Quarter 4 Results,' provides a detailed analysis of Monitoring, Evaluation, and Reporting (MER) data for the fourth quarter of fiscal year 2025 (July 1 – September 30, 2025). This period immediately followed the inauguration of the second Trump administration, during which PEPFAR experienced several changes under a new policy direction of 'America First Global Health Strategy,' including stop-work orders, funding cancellations, and a shift from disease-specific programs to an integrated approach. As of April 2026, this data reflects the situation approximately six months prior, yet it remains a crucial reference for understanding PEPFAR's trajectory. The data presented in the report shows distinct changes in key indicators, with the most notable figures related to PrEP (Pre-Exposure Prophylaxis). The number of people newly initiating PrEP in FY 2025 Q4 decreased by 41% compared to FY 2024 Q4, reverting to FY 2022 levels. PrEP is a medication taken preventatively by individuals at high risk of HIV infection before exposure to the virus, capable of preventing HIV infection by up to 99%, making it a cornerstone of global HIV spread prevention strategies. The sharp decline in new PrEP initiations raises concerns that it could lead to an increase in new HIV infections in the future. HIV testing volumes also showed a downward trend. The number of people who received HIV tests through PEPFAR-supported programs in FY 2025 Q4 decreased by 17% compared to FY 2024 Q4. HIV testing is the first step in early detection, linking infected individuals to treatment, and preventing further transmission. A decrease in testing volume increases the likelihood of a rise in undiagnosed infections, which could, in the long term, elevate the risk of HIV transmission within communities. Conversely, the number of patients receiving antiretroviral therapy (ART) remained relatively stable, which can be interpreted as a positive sign of the continuity of existing treatment programs. PEPFAR's changes have extended beyond HIV/AIDS response, impacting other health areas such as tuberculosis and cervical cancer screenings. The report points to a transition from disease-specific programs to an integrated, disease-agnostic approach. Theoretically, an integrated approach can strengthen entire health systems and increase efficiency, but the disruption and resource reallocation during the transition process can temporarily weaken the response to specific diseases. Specifically, stagnation or decline was observed in indicators such as tuberculosis screening and cervical cancer screening, which may be transitional phenomena arising from program restructuring. PEPFAR Data Analysis: Declining Key Indicators and Their Causes The global health policy of the second Trump administration explicitly championed 'America First,' re-evaluating its approach to international aid and cooperation. The administration emphasized the efficiency of aid, U.S. strategic interests, and the self-reliance potential of recipient countries, leading to reduced funding or stricter conditions for some programs. While these policy changes were intended to reduce the burden on U.S. taxpayers and enhance aid effectiveness in the short term, they have sparked debate about their long-term impact on the health response capabilities of developing countries and global health security. International health experts point out that PEPFAR's achievements are not merely the result of unilateral U.S. aid but rather the culmination of decades of accumulated partnerships, strengthened local health systems, and a data-driven approach. From its inception, PEPFAR has implemented rigorous data collection and monitoring through its MER system, a critical component ensuring the program's transparency and accountability. The KFF report raises concerns about the uncertainty of whether this transparency in data monitoring and reporting will be maintained in the future. If data disclosure is reduced or delayed, it could become difficult to assess the program's actual performance and identify problems early. These shifts in global health policy also offer certain implications for South Korea. Over the past few decades, South Korea has successfully built its healthcare system alongside economic development and has gai
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