Sustaining Progress in the Fight Against HIV
In January, the Trump administration ordered a broad pause on all US funding for foreign aid, which has significant effects on US funding for HIV. The United States has been the world’s biggest donor to international HIV assistance, providing 73% of funding in 2023.
A large part of this is the US President’s Emergency Plan for AIDS Relief (PEPFAR), which oversees programs in low- and middle-income countries to prevent, diagnose and treat the virus. These programs have been significantly disrupted.
What’s more, recent funding cuts for international HIV assistance go beyond the US. Five countries that provide the largest amount of foreign aid for HIV – the US, the United Kingdom, France, Germany and the Netherlands – have announced cuts of between 8% and 70% to international aid in 2025 and 2026.
Together, this may mean a 24% reduction in international HIV spending, in addition to the US foreign aid pause.
What is HIV?
HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. HIV can be transmitted at birth, during unprotected sex or through blood-to-blood contact such as shared needles.
If left untreated, HIV can progress to AIDS (acquired immunodeficiency syndrome), a condition in which the immune system is severely damaged, and which can be fatal.
Our Study
We wanted to estimate the impact of recent funding cuts from the US, UK, France, Germany and the Netherlands on HIV infections and deaths. To do this, we used our mathematical model for 26 low- and middle-income countries. The model includes data on international HIV spending as well as data on HIV cases and deaths.
We set up each country model in collaboration with national HIV/AIDS teams, so the data sources reflected the best available local knowledge. We then extrapolated our findings from the 26 countries we modelled to all low- and middle-income countries.
Sending Progress Backwards
If funding cuts continue, the world could face higher rates of annual new HIV infections by 2030 (up to 3.4 million) than at the peak of the global epidemic in 1995 (3.3 million).
Sub-Saharan Africa will experience by far the greatest effects due to the high proportion of HIV treatment that has relied on international funding.
Conclusions
The range in our estimates reflects low- and middle-income countries committing to far more domestic funding for HIV in the best case, or broader health system dysfunction and a sustained gap in funding for HIV treatment in the worst case.
Some funding for HIV treatment may be saved by taking that money from HIV prevention efforts, but this would have other consequences.
The range also reflects limitations in the available data, and uncertainty within our analysis. But most of our assumptions were cautious, so these results likely underestimate the true impacts of funding cuts to HIV programs globally.
FAQs
Q: What is the impact of recent funding cuts on HIV infections and deaths?
A: Our study estimates that there could be 4.43 million to 10.75 million additional HIV infections between 2025 and 2030, and 770,000 to 2.93 million extra HIV-related deaths.
Q: How will this affect sub-Saharan Africa?
A: Sub-Saharan Africa will experience by far the greatest effects due to the high proportion of HIV treatment that has relied on international funding.
Q: What are the implications for other regions?
A: We estimate vulnerable groups such as people who inject drugs, sex workers, men who have sex with men, and trans and gender diverse people may experience increases in new HIV infections that are 1.3 to 6 times greater than the general population.
