Editor’s note: This story was first published on March 26, 2025.
We could see up to 10.8 million cases of HIV more than expected in the next five years if planned cuts for HIV international financing are produced.
This increase in infections in low and medium -sized income countries would contribute up to 2.9 million deaths related to 2030.
These disturbing figures come from a new modeling study published on March 26 in the magazine HIV Lancet. Researchers wanted to analyze the potential impact of cuts to international financing for HIV/AIDS Programs, which work to avoid transmission and deaths related to infection.
As of February 2025, the five main donors of this financing: United States, the United Kingdom, France, Germany and the Netherlands, have announced significant cuts to foreign aid that threaten HIV programs worldwide. The study predicts how these cuts would affect low and medium -income countries (LMIC), That since 2015 They have trusted international sources for 40% of their HIV program funds.
“These findings are an alerting reminder that progress in the fight against HIV is not guaranteed, it is the result of a political will and sustained investment,” he said Dr. Ali ZumlaProfessor of Infectious Diseases and International Health at the University College London who did not participate in the research.
But also, “the projected increase in new infections and deaths is not an inevitability; it is a consequence of taking the options today,” Zumla told Live Science in an email. “If these fund cuts are advancing, we risk unraveling decades of hard progress, leaving millions vulnerable and pushing the global objectives of HIV out of reach.”
Related: We could finish the AIDS epidemic in less than a decade. Here is how.
Unprecedented cuts to help
From 2023Five donors have supplied more than 90% of international funds for HIV programs, and the United States provides more than 72% of the total. Specific populations with high risk of HIV, including people who inject drugs, men who have sex with men, sex workers and their clients, and transgender people and diverse gender, Particularly trusting these sources of international financing for access to HIV prevention and tests.
Much of the United States financing comes from the President’s emergency plan for AIDS relief (Pepfar), which is largely implemented by the International Development Agency (USAID). However, Pepfar and USAID were beaten by an unprecedented financing break and personnel reduction in January, after a Executive order Of President Donald Trump.
Pepfar then received a temporary exemption to continue some services, including those of antiretroviral therapy (art), medications that prevent HIV from progressing AIDS. These treatments must be taken consistently or the virus will recover.
“The generalized deployment and the absorption of antiretroviral therapy financed by international sources have been one of the most important factors that reduce death -related deaths in low -income environments,” he said Justin ParkhurstAssociate Professor of Global Health Policy at the London School of Economics and Political Science that did not participate in the study. Art also reduces the number of new infections by suppressing virus in people who live with HIV, thus avoiding transmissionHe told Live Science in an email.
“In the worst case, if Pepfar’s funds completely ceased and no equivalent mechanism replaced it, the increase in the incidence of HIV could undo all the progress achieved since 2000.”
Ten Brink, et al. (2025)
However, despite the exemption, Pepfar services have not yet been resumed as normal, Given the exemption, he did not trigger immediate funds to eligible programs and many clinics had already been closed when it was broadcast. Even now, Pepfar’s future after the expiration of the exemption It is still uncertain.
After the US, the next four main donors for international HIV funds are the United Kingdom, France, Germany and the Netherlands. However, as of February 2025, each of these donors has also announced important cuts in foreign aid spending, “and could follow more,” the study authors wrote.
According to the projected cuts made by the five main donors, the researchers used a mathematical model to predict the rates of new cases and HIV deaths. They focused on their model in 26 LMIC, which together receive 49% of international aid against HIV, in general and 54% of Pepfar’s help. Then they used the data of these 26 countries to extrapolate all LMICs worldwide.
The cuts could “undo almost all the progress achieved since 2000”
The researchers considered several scenarios in their model. The first, the “status quo”, served as a baseline, projecting the cases of cases and deaths if the recent levels of HIV spending remained between 2025 and 2030, instead of cutting. In this scenario, more than 1.8 million new infections and more than 720,000 HIV -related deaths occurred in LMIC.
In the worst case that the team considered, all Pepfar funds stopped indefinitely on January 20, 2025, and alternative sources of financing did not emerge to fill that void. Simultaneously, other international financing sources that are not Pepfar were also reduced. That scenario led to an estimated 10.8 million cases more and 2.9 million more deaths than the status quo.
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This suggests that “the number of new infections in 2026 could return to 2010 levels, and by 2030 the number of new infections could exceed historical estimates,” the study authors wrote. “In the worst case, if Pepfar’s funds completely ceased and no equivalent mechanism replaced it, the increase in the incidence of HIV could undo all the progress achieved since 2000.”
This worst case would arrive in Sub -Saharan Africa (SSA) particularly difficult, from eight SSA countries included in the analysis, six receive more than 40% of their HIV funds through Pepfar. The authors predicted that children in the region could see an increase of almost three times in HIV infections.
And outside the SSA, other vulnerable populations, such as sex workers, would be much more affected by such cuts than the general population, which are shown to an increase of six times higher in cases than other demographic data, the data suggested.
The team also analyzed a less extreme scenario, modeling what would happen if new sources of financing filled the gap left by Pepfar. In this scenario, they assumed that the gap could be partially filled by 2026 and then fill completely by 2027. If that mitigation occurred, the number of additional cases decreases to 4.4 million and additional deaths to 770,000 in the course of five years.
Then, while filling the void left by Pepfar would help substantially, that sudden loss of financing would still have devastating impacts, the study suggests.
“Modeling reveals the potential for serious consequences after an abrupt stop, without prior notice, international support aimed at stopping AIDS as a worldwide threat to public health,” Dr. Catherine HankinsGlobal and public health professor at McGill University in Canada who did not participate in the study, said Live Science in an email.
You can feel cuts in the coming decades
According to the authors of the study, even if the Pepfar space could be filled within two years, the undulation effects would be felt in the coming decades. They estimated that they would take additional 20 to 30 years of levels of level 2024 to end aid as a threat to public health.
Ambitious objectives established by UNAIDS They aimed to finish the threat by 2030. And the historical trends of HIV suggested that many of the LMIC that appear in the new article could have achieved their objectives in approximately 2036, if the financing continued at the past levels, the authors wrote.
“This study indicates that an abrupt termination of programs has serious risks for human life,” Parkhurst said. “Even for those who believe that the US or other governments should reduce foreign aid expense in this area, you can plan how to do it without producing serious damage to millions of people around the world who have trusted treatment.”
The study suggests that, if that abrupt stop could be avoided, many lives could be saved.
The researchers observed what would happen if Pepfar were reinstated or “recovered equivalently” and estimated that there could be 70,000 to 1.73 million additional cases and 5,000 to 61,000 additional deaths, compared to the status quo. These estimates assume that other international funds will still be reduced, but that countries may compensate for some of the national funds nationwide.
The new study has some limitations, since “there is an uncertainty inherent in global modeling,” said the author of the study. Rowan Martin-HughesSenior Research Official of the Burnet Institute in Australia.
The “most important” limitation is that there is uncertainty in the HIV fiscal space, although the authors covered something of that unpredictability when observing a variety of possible results, said Martin-Hughes to Live Science in an email. There are also gaps in global financial data reports that could affect their model, and the 26 outstanding countries may not be completely representative of the general impacts of fund cuts, he added.
However, “in general, we believe that most uncertainty sources probably result in underestimating instead of overestimating the real effects of immediate and severe fund cuts to HIV programs worldwide, especially in the sub -Saharan Africa region,” he said.
In the light of imminent cuts, “it is now essential to track the mortality of the aid and the incidence of HIV while urgently reverts the cuts, mitigate the effects and creation of new financing strategies to avoid greater suffering,” said Hankins.
Martin-Hughes agreed.
“Governments, donors and interested parties must collaborate in feasible mitigation strategies to preserve HIV prevention, tests and treatment services to avoid resurgence in the HIV epidemic,” he said. “In doing so, the global community can ensure the long -term immediate stability of resilient health systems, so essential to save lives through the control of the HIV epidemic.”
The global investment, especially from the United States, has set goals for the elimination of HIV transmission within reach, he said. “But all that progress is vulnerable, and could be eliminated in a few years if there are dramatic and not administered to HIV services.”
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