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PEPFAR Funding Under Scrutiny Amidst Proposed cuts
Washington D.C. – In a significant development for global health, teh U.S. Congress has voted down a proposed $400 million cut to the PresidentS Emergency Plan for AIDS Relief (PEPFAR), a program already slated for a budget reduction from $4 billion to $2.9 billion. This decision comes as new modeling suggests drastic consequences for HIV prevention and treatment efforts worldwide should funding levels falter.
the fate of PEPFAR funding has been a central concern, with various scenarios of budget reductions analyzed for their potential impact on the HIV epidemic. A recent study, presented at the 13th International AIDS Society conference on HIV Science, explored three potential funding trajectories compared to the current status quo.
- Scenario 1: Funding continues at 2024 levels.
- Scenario 2: Prevention and community testing funding is cut by 24% by 2026, while treatment and health facility testing are sustained by domestic funding.
- Scenario 3: Prevention and testing funding are cut by 24%, with the immediate discontinuation of PEPFAR.
The second scenario, involving cuts to prevention and community testing, is projected to result in an estimated 71,500 to 1.7 million new HIV infections and 5,000 to 61,000 additional deaths between 2025 and 2030. These figures are contingent on the effectiveness of mitigation strategies implemented to offset the impact of the funding reductions.
The third scenario, which includes the complete cessation of PEPFAR funding, paints a more dire picture.This scenario could lead to between 4.4 million and 10.8 million new HIV infections and an additional 770,000 to 2.9 million deaths over the same period, again depending on the success of mitigation efforts.
The analysis also highlights that key populations and children are expected to bear a disproportionate burden from any funding cuts. In countries outside Africa, the rate of new HIV infections in key populations could be 30% to 60% higher compared to other populations. Furthermore, if PEPFAR funding were to be discontinued, an estimated 880,000 new HIV infections and 120,000 deaths among children in low- and middle-income countries are projected between 2025 and 2030.
The recent congressional vote to reject the additional $400 million cut offers a reprieve, underscoring the ongoing debate and the critical role PEPFAR plays in the global fight against HIV/AIDS. The program’s future funding levels remain a crucial factor in determining the trajectory of the epidemic and the health outcomes for millions worldwide.
References:
Moiana Uetela D et al. The impact of the U.S. funding interruption on HIV services and the HIV epidemic in Mozambique. 13th international AIDS Society Conference on HIV Science, Kigali, abstract OAS0102LB, 2025.
View the abstract on the conference website.
Rees K et al. Termination of the USAID APACE award in Johannesburg, South Africa: Impact on the number of people living with HIV tested, diagnosed and initiated on anti-retroviral therapy (ART) (January-March 2023-2025). 13th International AIDS Society Conference on HIV Science, Kigali, abstract PoLB25, 2025.
View the abstract on the conference website.
tenBrink D et al. If funding falls short: projecting the impact of international HIV budget cuts across 26 countries. 13th International AIDS Society Conference on HIV Science, Kigali, abstract OAC0602, 2025.
