Proposed cuts to global foreign aid, including slashing programs in the United States, could lead to millions of HIV deaths and soaring rates of infections around the world in the coming years, according to a new study.
Published Wednesday in The Lancet HIV journal, the modeling study estimates that by 2030, there could be between 4.4 million to 10.8 million additional new HIV infections in low- and middle-income countries and 770,000 to 2.9 million HIV-related deaths in children and adults. To estimate the impacts, the authors examined 26 countries that used foreign aid for HIV resources, including Albania, Cambodia, Colombia, Côte d’Ivoire, South Africa and Sri Lanka.
They noted that international funding has been crucial in reducing HIV transmissions and deaths, and that five countries — the U.S., U.K., France, Germany and the Netherlands — provide over 90% of international HIV funding, with the U.S. being by far the largest contributor. The U.S. committed $5.71 billion in 2023, or about 73% of total donor government funding, according to analysis by KFF, a nonpartisan health policy organization.
But as of February, they report, donor nations have announced reductions in aid of between 8% and 70% between 2025 and 2026.
The Trump administration froze foreign aid spending, including funding for HIV/AIDS programs, soon after taking office, and the Department of Government Efficiency, or DOGE, is spearheading major cutbacks.
“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 study author Debra ten Brink of the Burnet Institute in Australia said in a news release.
The study’s authors said ongoing disruptions could undo decades of progress to end HIV/AIDS as a public health threat.
“Looking ahead, if other donor countries reduce funding, decades of progress to treat and prevent HIV could be unravelled. 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,” said ten Brink.
PEPFAR, or the President’s Emergency Plan for AIDS Relief, was launched under then-President George W. Bush in 2003 and has invested over $100 billion in the global HIV/AIDS response over the years. According to the State Department, the program has saved the lives of 26 million people since it began — but its funding stopped after Secretary of State Marco Rubio ordered a pause on foreign aid earlier this year.
“PEPFAR is the largest commitment by any nation to address a single disease in history, enabled by strong bipartisan support across ten U.S. congresses and four presidential administrations, and through the American people’s generosity,” the government website HIV.gov reads. “PEPFAR shows the power of what is possible through compassionate, cost-effective, accountable, and transparent American foreign assistance.
Others have already warned about the devastation these cuts could bring to those who rely on it. Earlier this week, the UNAIDS chief warned that without funding, millions will die and the global AIDS pandemic will resurge.
“It is reasonable for the United States to want to reduce its funding over time, but the sudden withdrawal of lifesaving support is having a devastating impact,” UNAIDS executive director Winnie Byanyima told reporters in Geneva. “We urge for a reconsideration and an urgent restoration of services — lifesaving services.”
contributed to this report.
