Global HIV Fight at Risk: US Funding Cuts Could Trigger Catastrophic Reversal in Progress

A recent study published in *Lancet HIV* highlights a potentially devastating impact on global efforts to combat HIV by 2030, as significant funding reductions from the United States loom on the horizon. The implications of these cuts are particularly severe for countries in sub-Saharan Africa, which may find their ongoing progress jeopardized.

Since 2015, international funding has played a pivotal role in addressing the global HIV crisis, providing approximately 40% of all HIV resources in low- and middle-income countries (LMICs). In 2023, the United States alone contributed an astonishing 72.6% of total international funding for HIV, with other key contributors, including the United Kingdom, France, Germany, and the Netherlands, indicating plans to reduce their support. These reductions, projected to reach a 4.4% cut in 2025 and a staggering 19.6% in 2026, could profoundly impact the capacity of LMICs to tackle HIV effectively.

To assess the potential repercussions, researchers utilized the Optima HIV model, focusing on 26 countries, with data compiled between January 2022 and December 2024. This model evaluates current spending on prevention and testing, factoring in both domestic and international funding. Five different scenarios were constructed to forecast the effects of these funding cuts: maintaining the status quo, proportional funding cuts, reallocating prevention resources to treatment, and scenarios involving the discontinuation of the US President’s Emergency Plan for AIDS Relief (PEPFAR).

The findings are alarming. It is estimated that if funding remains at current levels, nearly 1.8 million new infections and approximately 720,230 HIV-related deaths could occur between 2025 and 2030 across these countries. However, under scenarios involving cuts or a halt in PEPFAR support, new infections could soar by an additional 2.3 to 5.1 million, with deaths rising by 410,000 to 1.4 million when compared to the status quo.

Notably, the study reveals that for several sub-Saharan African nations reliant on PEPFAR, as much as 60% of their total HIV funding comes from this program. Countries like Malawi, Mozambique, and Zimbabwe stand to be hit hardest by funding reductions, which could severely undermine their prevention and treatment programs. In a worst-case scenario, the number of new HIV infections could reach levels comparable to the peak of the epidemic in 1995, effectively nullifying two decades of progress.

Moreover, the impact could reach even further, with projections that 586,900 new infections in children could occur under the most serious funding cuts scenario—compared to 182,700 in a stable funding environment. If cuts proceed as feared, the trajectory of new infections could return to levels seen in 2010, pushing back the targeted UN goals for HIV eradication to as late as 2036.

"This research warns that without decisive action from both governments and donors, we could face a global crisis as HIV spreads unchecked," said Debra ten Brink, MD, co-author of the study.

Despite these grim projections, the researchers acknowledge limitations in their analysis, including uncertainties regarding future funding reinstatements and potential mitigation strategies that could influence outcomes. Nevertheless, the overarching conclusion remains clear: international budget cuts for HIV must be addressed urgently to prevent a resurgence in the epidemic.

The global health community must unite to devise immediate strategies that protect vulnerable countries from the looming threat of funding reductions, as the fight against HIV is one that knows no borders and must be fought with collective resolve.