U.S. Cuts Threaten Global AIDS Fight

UN Warns of Reversal in Decades of Progress Amid Funding Crisis

A sudden halt to U.S. funding for global AIDS programs is raising alarms at the U.N., with officials warning of a potential surge in deaths and new infections if the financial lifeline isn’t restored.

Dire Predictions

The withdrawal of U.S. funds has delivered a “systemic shock,” according to U.N. officials. Without replacement funding, they project over 4 million AIDS-related deaths and 6 million new HIV infections by 2029.

A new UNAIDS report indicates that funding shortfalls have “already destabilized supply chains, led to the closure of health facilities, left thousands of health clinics without staff, set back prevention programs, disrupted HIV testing efforts and forced many community organizations to reduce or halt their HIV activities.”

The report expressed fears that other major donors might also scale back their support, jeopardizing multilateral cooperation due to geopolitical instability, wars and climate change.

Sudden Stop

In January, $4 billion in pledged U.S. funding for the global HIV response vanished when U.S. **President Donald Trump** suspended all foreign aid and moved to close the U.S. AID agency.

**Andrew Hill**, an HIV expert at the University of Liverpool, noted that while **Trump** can allocate U.S. funds as he sees fit, a responsible government would have provided advance notice to allow affected countries to prepare.

PEPFAR’s Legacy

The U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, launched in 2003 by **President George W. Bush**, represented the largest commitment by any nation to combat a single disease.

UNAIDS described PEPFAR as a “lifeline” for nations with high HIV rates, supporting testing for 84.1 million people and treatment for 20.6 million. In Nigeria, PEPFAR funded 99.9% of the country’s HIV prevention medicine budget.

**Angeli Achrekar**, U.N. Assistant Secretary-General and UNAIDS deputy executive director, mentioned that the program is under review by the **Trump** administration, with Secretary of State **Marco Rubio** issuing a waiver to continue life-saving treatment.

“The extent to which it will continue in the future, we don’t know,” she stated, expressing cautious hope that PEPFAR will continue supporting prevention and treatment services.

The Unfillable Void

In 2024, approximately 630,000 AIDS-related deaths occurred worldwide, according to UNAIDS. This figure has remained steady since 2022, following a peak of 2 million deaths in 2004.

Even prior to the U.S. funding cuts, progress in curbing HIV was inconsistent, with half of all new infections occurring in sub-Saharan Africa.

**Tom Ellman** of Doctors Without Borders asserted that while some poorer nations are increasing their investment in HIV programs, they cannot compensate for the loss of U.S. support.

“There’s nothing we can do that will protect these countries from the sudden, vicious withdrawal of support from the U.S.,” said **Ellman**.

Experts also worry about the loss of HIV surveillance data in African countries, which was primarily funded by the U.S. According to Dr. **Chris Beyrer**, director of the Global Health Institute at Duke University, this includes hospital, patient, and electronic records.

“Without reliable data about how HIV is spreading, it will be incredibly hard to stop it,” he said.

Hopeful Developments

New hope has emerged in the form of a twice-yearly injectable that many hope could end HIV. Studies indicate that the drug from Gilead was 100% effective in preventing the virus.

At a launch event, South Africa’s health minister **Aaron Motsoaledi** pledged to ensure access to the drug for every adolescent girl who needs it, noting the past dependence upon U.S. aid was “scary.”

The U.S. Food and Drug Administration approved the drug, called Yeztugo, last month. However, the pricing from Gilead may place it beyond reach for many countries.

While Gilead will sell generic versions in 120 poor countries with high HIV rates, it has excluded nearly all of Latin America, where rates are rising. Meanwhile, in the United States, the CDC estimates that 13% of people with HIV are unaware of their infection (CDC.gov, 2024).

“We could be ending AIDS,” said **Peter Maybarduk** of Public Citizen. “Instead, the U.S. is abandoning the fight.”