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• Posted March 27, 2025

U.S. Foreign Aid Cuts Could Devastate Global Progress Against HIV/AIDS

HIV could explode worldwide in the wake of U.S. cuts to foreign aid, resulting in millions of AIDS deaths and soaring rates of infection, a new analysis says.

President Donald Trump has floated the notion of ending the President’s Emergency Fund for AIDS Relief (PEPFAR), a program created under President George W. Bush that combats HIV and AIDS in the developing world.

The Trump Administration paused all foreign aid funding on Jan. 20, ostensibly for a 90-day review and evaluation, with only limited exception. Authorization for PEPFAR lapsed Tuesday, according to CBS News, and the world is now watching and waiting to see what will come next.

Such funding cuts could undo decades of progress made to end HIV/AIDS as a public health threat, researchers argue in a study published March 26 in The Lancet HIV. 

That study came at the same time Britain's Prince Harry withdrew from an AIDS/HIV charity he led in Africa for 19 years.

If U.S. aid is cut, researchers estimate that new HIV infections could surge to as many as 10.8 million additional cases, and HIV-related deaths to 2.9 million, by the year 2030.

“The United States has historically been the largest contributor to global efforts to treat and prevent HIV, but the current cuts to PEPFAR and USAID-supported programs have already disrupted access to essential HIV services including for antiretroviral therapy and HIV prevention and testing,” co-lead researcher Debra ten Brink, a senior research officer at Australia's Burnet Institute, said in a news release. 

“Looking ahead, if other donor countries reduce funding, decades of progress to treat and prevent HIV could be unravelled,” ten Brink said. “It is imperative to secure sustainable financing and avoid a resurgence of the HIV epidemic which could have devastating consequences, not just in regions such as sub-Saharan Africa, but globally.”

Five nations provide more than 90% of total international HIV funding, and the U.S. pays nearly three-quarters of that, researchers said in background notes.

To estimate the potential effects of cuts to HIV funding, researchers projected infection and death rates in 26 countries that currently receive funds to hold the line against the virus.

As much as a 6-fold increase in new infections could occur, with between 4.4 million and 10.8 million additional new HIV infections by 2030.

The cuts could also result in between 770,000 to 2.9 million HIV-related deaths by 2030, results show.

“There could be an even greater impact in sub-Saharan Africa, where broader prevention efforts, such as distributing condoms and offering pre-exposure prophylaxis (PrEP – a medication that reduces the risk of getting HIV) are at first risk to be discontinued,” co-lead researcher Rowan Martin-Hughes, a senior research officer with the Burnet Institute, said in a news release.

“This is in addition to disruptions in testing and treatment programs [that] could cause a surge in new HIV infections, especially in some of the areas where the greatest gains have been made, such as preventing mother-to-child transmission of HIV and pediatric HIV deaths,” Martin-Hughes added.

Between 2010 and 2023, countries that receive foreign aid made significant progress against HIV, with an average 8% annual decrease in new infections and a 10% decrease in HIV-related deaths, researchers noted.

Researchers said if foreign aid is greatly reduced, new infections and deaths could be expected to rise back to levels not seen since 2010, potentially undoing all progress made since 2000.

Even a temporary cut in funding of one to two years could represent a setback that would require an additional 20 to 30 years of investment before HIV/AIDS is ended as a public health threat, researchers wrote.

The U.S. action dovetailed with news that a management dispute prompted Prince Harry to step down as a patron of Sentebale, a charity he set up to help young people with HIV and AIDS in the African nations of Lesotho and Botswana. 

Reuters noted that he co-founded the charity in 2006 in memory of his mother Princess Diana who helped combat stigma surrounding HIV/AIDS. 

More information

The U.S. Department of Health and Human Services has more on HIV/AIDS.

SOURCES: The Lancet, news release, March 26, 2025; Reuters, March 26, 2025