According to a study published in The Lancet HIV, recent and planned international budget cuts could result in 4.4-10.8 million new HIV infections by 2030 in low- and middle-income countries, with 0.8-2.9 million HIV-related deaths within 5 years.
Currently, five countries provide over 90% of international HIV funding: The United States (73%), the United Kingdom (9%), France (4%), Germany (3%), and the Netherlands (2%).
The study noted that “the announced cuts represent a 4.4% reduction in total global international HIV funding in 2025 and a further 19.6% cut in 2026, a total reduction of 24%.”
In February, the United Kingdom announced a reduction of its official development assistance budget from 0.5% of gross national income to 0.3% by 2027, its lowest level since 1999. The Netherlands plans to cut foreign aid by €2.4 billion, and Germany intends to halve its global humanitarian aid budget. France is expected to reduce its aid by €2.1 billion, according to the Observatoire de l’Europe.
The study analyzed data from 26 countries and extrapolated findings to all low- and middle-income countries, stated that “the temporary suspension of US President’s Emergency Plan for AIDS Relief (PEPFAR) support issued by the US Government on January 20, 2025, with a 90-day review period, has the potential to profoundly disrupt the global HIV response if it is continued on a permanent basis.”
Sub-Saharan Africa at Greatest Risk
Sub-Saharan Africa and vulnerable populations, including people who inject drugs, sex workers, children, and men who have sex with men, are expected to face the most severe consequences of funding cuts.
“It appears that even with the most optimistic estimates there will be an almost 50% increase in numbers of new infections over the next 5 years in sub-Saharan Africa, but with a 127.3%-283.3% increase in new infections being perfectly plausible,” according to a commentary accompanying the study.
US Role in HIV Prevention
After attending the Conference on Retroviruses and Opportunistic Infections 2025 in San Francisco, Jean-Michel Molina, MD, PhD, head of the Infectious Diseases Department at the Saint-Louis Hospital in Paris, France, expressed concerns about the US disengagement from the fight against AIDS. He spoke during a press briefing organized by the ANRS Emerging Infectious Diseases.
“Globally, 90% of the treatments used for pre-exposure prophylaxis [PrEP] are funded by the United States, particularly through the PEPFAR program. From what we understand, PrEP will only be funded for pregnant women. All other programs will be discontinued. This is catastrophic and raises concerns about the rapid resurgence of HIV incidence in several countries. Not to mention the challenges people living with HIV will face in accessing antiretroviral treatments,” Molina said.
Progress at Risk
By 2026, if foreign aid is significantly reduced or if PEPFAR funding is cut entirely without an equivalent replacement, new infections and deaths could return to levels not seen since 2010, potentially reversing all the progress made since 2000.
The researchers added that even if HIV treatment support was restored after 12-24 months, their estimates suggested that the number of new HIV infections could stabilize at levels similar to those observed in 2020. This setback requires an additional 20-30 years of investment to end HIV/AIDS as a public health threat.
“There is an urgent need for innovative, country-led financing strategies and an integration of HIV services into broader health systems; however, this can’t happen overnight. Long-term strategic planning is required for countries to transition from internationally supported to domestically financed programs. Our study highlights how important international collaboration and investment have been in maintaining progress against HIV,” said study author Nick Scott, PhD, of the Burnet Institute in Melbourne, Australia, in a press release.
“For decades, the United States has funded HIV treatment in more than 40 countries. Countries may have relied too heavily on the United States’ endless investment to fund treatment for their own citizens,” Molina added.
This story was translated from Medscape’s French edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.