HIV funding cuts threaten to reverse progress in the global fight against AIDS, impacting vulnerable communities and health services. (AI-Generated Image)

HIV Funding Cuts: A Global Health Catastrophe

By Darius Spearman (africanelements)

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The Looming Crisis: A Return to Dark Days

The global fight against HIV/AIDS faces a severe threat. UNAIDS, the leading United Nations agency on HIV/AIDS, warns of a potential surge in AIDS-related deaths and new HIV infections. This alarming forecast comes directly from significant funding cuts by the United States. These cuts threaten to undo decades of hard-won progress, pushing the world back to a time when AIDS claimed countless lives (news.un.org).

Winnie Byanyima, the Executive Director of UNAIDS, has voiced deep concern. She stated that without continued US funding, the world could see a “real surge” in the disease. This surge could lead to deaths similar to those experienced in the 1990s and early 2000s (news.un.org). Furthermore, she projected a “tenfold increase” from the 600,000 AIDS-related deaths recorded globally in 2023. Byanyima admitted her “greatest fear is that we will return to the dark days of the epidemic” (bloomberg.com). This dire prediction highlights the immediate and devastating consequences of reduced international support for HIV programs.

The core of this crisis lies in the abrupt halt of funding for PEPFAR, the President’s Emergency Plan for AIDS Relief. This program, established in 2003 by President George Bush, has been a cornerstone of the global HIV/AIDS response (retrovirology.biomedcentral.com). PEPFAR funding constituted a staggering 60 percent of UNAIDS’s budget. Its sudden withdrawal has been described as a “deadly funding crisis” that has “knocked [the] global response totally off course” (The Guardian). This massive cut is expected to lead to an additional 6 million HIV infections and 4 million AIDS-related deaths by 2029 if the funding permanently disappears (The Guardian). PEPFAR has invested over $100 billion since its inception, providing antiretroviral therapy (ART) to more than 20.6 million people annually, including 550,000 children (retrovirology.biomedcentral.com). In addition to treatment, it supports testing, prevention, and strengthens health infrastructure in 54 countries. The Trump administration’s executive order halting nearly all United States foreign aid, including PEPFAR, has created a potential humanitarian crisis, especially in regions like Sub-Saharan Africa that rely heavily on this life-saving program (retrovirology.biomedcentral.com).

Immediate Impact on the Ground: Services Grind to a Halt

The US funding cuts, especially to PEPFAR, are causing immediate and severe consequences on the ground. Essential HIV services and the community organizations that deliver them are feeling the impact deeply. Community organizations have been particularly affected by the funding freeze (unaids.org). As a result, dedicated community healthcare workers are losing their jobs, and vital clinics are being shut down.

This disruption means that people in need of HIV testing, prevention, or daily antiretroviral medicine are unable to access these life-saving services (unaids.org). In February 2025, UNAIDS convened an emergency meeting with community organizations to monitor the impact. Reports from this meeting indicated that HIV services worldwide are facing serious challenges, with some “grinding to a halt” (unaids.org). The director of UNAIDS in Zambia noted the real-time effects of US funding cuts in developing countries, as tracked by a UNAIDS portal (bloomberg.com). For example, in Mozambique, which has the second-largest HIV epidemic after South Africa, the pause in US funding and reduction in other international funding streams have complicated efforts to maintain HIV treatment, care, and prevention (unaids.org).

Community organizations play a vital role in the HIV response. They often provide direct services and support to affected populations, reaching those who might otherwise be missed by larger health systems. For instance, “Mentor Mothers,” who are women living with HIV, have been crucial in providing adherence counseling and referrals for gender-based violence survivors (i-base.info). The loss of these roles due to funding cuts directly impacts the mental health of those served. In addition, it affects the ability of these women to support their families and access their own ART treatment (i-base.info). The disruption of these grassroots efforts means that HIV projects are stopping entirely, severely impacting the mental health and well-being of countless individuals (i-base.info).

Disproportionate Burden on Vulnerable Communities

The funding cuts have a particularly harsh and disproportionate impact on vulnerable populations. This includes girls and young women in Africa, as well as men who have sex with men. In Africa, the eastern and southern regions bear 53 percent of the global HIV burden (news.un.org). This makes any disruption to services in these areas especially devastating for our communities.

More than 60 percent of new infections on the African continent are among girls and young women (news.un.org). Closing drop-in centers for these groups without notice would be disastrous, as these centers often provide safe spaces and essential services. The cuts immediately impacted prevention services, raising concerns about new infections and deaths, particularly among these vulnerable groups (The Guardian). For example, in Ethiopia, the US government-supported Cab-La pilot program has halted (unaids.org). This new HIV prevention technology would especially benefit adolescent girls and young women who face inequalities that create barriers to accessing sexual and reproductive health services. The loss of such targeted interventions means that those most at risk are left even more exposed to the virus.

Undoing Decades of Progress

The global HIV response has made significant progress over the past two decades. This progress is now gravely threatened by current funding shortfalls. PEPFAR, launched over two decades ago, is estimated to have saved around 26 million lives (news.un.org). This remarkable achievement underscores the importance of sustained investment in global health initiatives.

Numbers of new HIV infections and AIDS-related deaths have continued to decrease globally (thepath.unaids.org). This positive trend brought the AIDS response closer to achieving Sustainable Development Goal (SDG) 3.3, which aims to end AIDS as a public health threat by 2030. Improved access to treatment has averted an estimated 20.8 million deaths globally (thepath.unaids.org). However, despite this progress, challenges remain. In 2022, about 9.2 million people living with HIV globally were not receiving antiretroviral therapy. Furthermore, about 2.1 million people were receiving treatment but were not virally suppressed (thepath.unaids.org). The UN-agreed target to end AIDS as a public health threat by 2030 and dramatically reduce new HIV infections is currently not on track (The Guardian). This setback means that the vision of an AIDS-free future is slipping further away, impacting our communities disproportionately.

The current situation is particularly painful when considering past opportunities. UNAIDS Executive Director Winnie Byanyima lamented that “we already lost 12 million people we should not have lost if ARVs [antiretrovirals] had been shared immediately around the world instead of held on to by the pharmaceutical companies making money” (The Guardian). This historical context adds a layer of urgency to the present crisis. It reminds us that health is a human right, and no one should die from preventable causes. Yet, with these cuts, many vulnerable people have already lost support, including young girls and men who have sex with men, who often face stigma and discrimination (The Guardian). The potential for millions more infections and deaths means that the hard-won gains of the past are now at severe risk of being reversed.

Seeking New Paths: Diversifying Funding and Reimagining Aid

UNAIDS is calling for increased and diversified funding sources beyond traditional donors. This call also includes a critical re-evaluation of the entire aid model. Byanyima questioned the role of other donors, such as rich countries in the Middle East, other G-7 countries, or philanthropists with deep pockets, in supporting developing countries on HIV/AIDS (bloomberg.com). This highlights the need for a broader, more equitable distribution of responsibility in global health funding.

The current situation also brings into sharp focus the need for debt justice and tax justice. The amount of money flowing from the Global South to the North has been greater than what has gone the other way for a long time (The Guardian). This imbalance underscores a fundamental flaw in the global financial system. The aid model, Byanyima argues, is too unpredictable and “cannot stand anymore” (The Guardian). The future, she insists, needs to be less about charity and more about international solidarity. This shift in perspective is crucial for building sustainable solutions that empower nations rather than foster dependency.

In response to the US funding cuts, some countries are mobilizing domestic resources to maintain priority HIV programs. For example, Kenya and Rwanda have reported efforts to use their own resources to continue programs previously funded by the US (unaids.org). Additionally, countries like Haiti are working with partners to develop sustainability roadmaps, including diversifying procurement sources and funding (unaids.org). Civil society organizations are also working to mobilize alternative sources of funding from both domestic and international partners (unaids.org). These efforts demonstrate resilience and a commitment to continuing the fight against HIV/AIDS, even in the face of significant challenges. However, domestic efforts alone cannot fully compensate for the massive withdrawal of international support, making a global, unified response more critical than ever.

A Call to Action for Global Solidarity

The warnings from UNAIDS are clear and urgent. The US funding cuts to the global HIV response, particularly to PEPFAR, threaten to reverse decades of progress. This could lead to millions of additional infections and deaths, especially impacting vulnerable communities in Africa and other parts of the world. The human cost of these decisions is immense, affecting access to life-saving treatments, prevention services, and the vital work of community organizations.

This crisis is not merely a financial one; it is a moral challenge that calls for global solidarity. The aid model, which has proven unpredictable, must evolve towards a more stable and equitable system. It is imperative that other nations, philanthropists, and international bodies step up to fill the funding gaps. Furthermore, there is a pressing need to address systemic issues like debt and tax justice that disproportionately affect nations in the Global South. Our collective future depends on ensuring that health remains a human right, accessible to all, and that the progress made against HIV/AIDS is not tragically undone.

ABOUT THE AUTHOR

Darius Spearman has been a professor of Black Studies at San Diego City College since 2007. He is the author of several books, including Between The Color Lines: A History of African Americans on the California Frontier Through 1890. You can visit Darius online at africanelements.org.