Proposed reductions in global foreign aid, particularly cuts to programs within the United States, could result in millions of HIV-related deaths and a significant rise in infection rates worldwide in the years ahead, according to a recent study.
Published on Wednesday in The Lancet HIV journal, the modeling study predicts that by 2030, there could be an increase of 4.4 million to 10.8 million new HIV infections in low- and middle-income countries, along with an estimated 770,000 to 2.9 million HIV-related deaths among both children and adults. To analyze these effects, the researchers focused on 26 countries that have utilized foreign aid for HIV resources, including Albania, Cambodia, Colombia, Côte d’Ivoire, South Africa, and Sri Lanka.
The study emphasizes that international funding has been vital in lowering HIV transmission rates and deaths. According to the findings, five nations—the U.S., U.K., France, Germany, and the Netherlands—account for over 90% of the international funding for HIV, with the United States being the largest contributor. In 2023, the U.S. pledged $5.71 billion, representing approximately 73% of the total donor government funding, as noted in a KFF analysis, a nonpartisan health policy organization.
However, as of February, donor nations have indicated plans to cut aid by between 8% and 70% between 2025 and 2026.
The Trump administration had previously frozen foreign aid spending, which included funding for HIV/AIDS programs, shortly after taking office, and the Department of Government Efficiency, or DOGE, is leading significant cutbacks.
“Historically, the United States has been the largest donor to global HIV treatment and prevention efforts, but the current reductions to PEPFAR and USAID-funded programs have already obstructed access to crucial HIV services, such as antiretroviral therapy and HIV testing and prevention,” stated Debra ten Brink, co-lead author of the study from the Burnet Institute in Australia, in a press release.
The authors of the study expressed concern that ongoing disruptions could reverse decades of advancement in curbing HIV/AIDS as a public health threat.
“If other donor countries also cut back on funding, years of progress in treating and preventing HIV could be undone. It is essential to secure sustainable financing to avert a resurgence of the HIV epidemic, which could have dire consequences, not only in areas like sub-Saharan Africa but across the globe,” ten Brink added.
Established in 2003 under then-President George W. Bush, PEPFAR, or the President’s Emergency Plan for AIDS Relief, has allocated more than $100 billion to the global HIV/AIDS response over the years. The State Department reports that the program has saved the lives of 26 million individuals since its inception — though funding was halted after Secretary of State Marco Rubio ordered a pause on foreign aid earlier this year.
“PEPFAR represents the most substantial commitment by any nation to tackle a single disease in history, supported by strong bipartisan consensus across ten U.S. congresses and four presidential administrations, along with the American people’s generosity,” states the HIV.gov website. “PEPFAR demonstrates the remarkable outcomes achievable through compassionate, cost-effective, accountable, and transparent American foreign assistance.”
Others have issued warnings about the severe consequences these cutbacks may cause for those who depend on this support. Earlier this week, the UNAIDS chief cautioned that without financial support, millions could die and the global AIDS pandemic may resurge.
“While it’s understandable for the United States to gradually lessen its funding, the abrupt withdrawal of lifesaving support is proving to be devastating,” said UNAIDS executive director Winnie Byanyima during a press briefing in Geneva. “We implore a reevaluation and an immediate restoration of these lifesaving services.”
