A staggering 10.8 million new HIV infections and nearly 3 million deaths could occur by 2030 if proposed cuts to international HIV funding are implemented, according to alarming new research published this week in The Lancet HIV journal.
The study, which used mathematical modeling across 26 countries, reveals that decades of progress in the global fight against HIV/AIDS could rapidly unravel as major donor nations—including the United States and United Kingdom—slash their foreign aid budgets.
“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 programmes have already disrupted access to essential HIV services including for antiretroviral therapy and HIV prevention and testing,” explained Dr. Debra ten Brink of the Burnet Institute in Australia, who co-led the study.
Since January 20, the situation has grown more precarious as the U.S. government—which provides nearly three-quarters of all international HIV support—paused virtually all foreign aid pending a 90-day review. This comes as five major donor countries that together provide over 90% of international HIV funding have announced plans to reduce their contributions by an average of 24% by 2026.
For people living with HIV in regions like sub-Saharan Africa, these cuts could have devastating consequences. The research shows that programs for vulnerable populations—including people who inject drugs, sex workers, men who have sex with men, and children—will likely be hit first and hardest.
“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,” warned co-lead author Dr. Rowan Martin-Hughes, also from the Burnet Institute.
The timing is particularly troubling as many recipient countries had been making remarkable progress. From 2010 to 2023, nations receiving PEPFAR support saw an average 8.3% yearly decrease in new infections and a 10.3% drop in HIV-related deaths. If this trend had continued, many countries would have been on track to eliminate HIV/AIDS as a public health threat by approximately 2036.
Instead, the researchers found that if funding cuts continue as planned, new infections and deaths could surge back to levels not seen since the early 2000s, effectively erasing two decades of progress.
Foreign aid programs like PEPFAR do more than just provide medication. They fund comprehensive services including HIV testing, laboratory services, healthcare worker training, and health systems strengthening. Many also integrate HIV services with other critical health programs addressing tuberculosis, maternal health, and child welfare.
Even a temporary funding disruption could have long-lasting effects. The study estimates that if support for HIV treatment is restored after 12 to 24 months, new infection rates could still stabilize at levels similar to those seen in 2020—representing a setback that might require an additional 20 to 30 years of investment to overcome.
“There is an urgent need for innovative, country-led financing strategies and an integration of HIV services into broader health systems; however, this can’t happen overnight,” noted study author Dr. Nick Scott of the Burnet Institute. “Long-term strategic planning is required for countries to transition from internationally supported to domestically financed programmes.”
The researchers acknowledge that their estimates may actually understate the true impact, as disruptions to supply chains, healthcare workforces, and health systems could create even broader health consequences beyond HIV.
For the millions of people whose lives depend on these programs, the stakes couldn’t be higher. As international attention shifts to new global challenges, this study serves as a stark reminder that abandoning long-standing health commitments risks undoing decades of hard-won progress—and could ultimately cost millions of lives.
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