An additional six million new HIV infections and four million AIDS-related deaths could occur between 2025 and 2029 if US-supported HIV treatment and prevention services collapse, according to UNAIDS.

“This is not just a funding gap. It’s a ticking time bomb,” said UNAIDS Executive Director Winnie Byanyima at the launch of the organisation’s 2025 global AIDS update on Thursday. 

“We have seen services vanish overnight. Health workers have been sent home. And people – especially children and key populations – are being pushed out of care.” 

“Key populations” refer to people most vulnerable to HIV infection, including sex workers, men to have sex with men, people who inject drugs and young women.

Some of the immediate effects of the US withdrawal of funds since Donald Trump assumed the presidency in January include the closure of health facilities, healthworker job losses, and disrupted treatment, testing and prevention services.

The US President’s Emergency Plan for AIDS Relief (PEPFAR) had committed $4.3 billion in bilateral support in 2025 and “those services were stopped overnight when the US government shifted its foreign assistance strategies,” notes the UNAIDS report. 

PEPFAR had supported HIV testing for 84.1 million people and HIV treatment for 20.6 million people.

“Disruptions are being felt across the HIV response and pose a huge risk of increased mortality, a surge of new HIV infections, and the development of resistance to the most commonly used treatment regimens.”

In Mozambique, for example, over 30,000 health personnel have lost their jobs.

UNAIDS itself faces huge job losses, and is reducing its Geneva head office staff from 127 to a mere 19 employees, according to a report this week by Geneva Solutions.

The UN agency’s restructuring plan will cut staff by 54% globally, leaving 280 staff worldwide. 

HIV prevention programmes hit hard

External funding financed almost 80% of HIV prevention in sub-Saharan Africa, 66% in the Caribbean and 60% in the Middle East and North Africa, according to UNAIDS.

PEPFAR alone reached 2.3 million adolescent girls and young women with comprehensive HIV prevention services in 2024 and enabled 2.5 million people to use pre-exposure prophylaxis (PrEP). Many of these programmes have now stopped completely, according to UNAIDS. 

PrEP involves taking medication to prevent HIV infection and is usually taken by people at high risk of infection, and PEPFAR funded over 90% of PrEP initiations globally in 2024.

“Countries are reporting limited availability of PrEP and reduced activities to prevent new HIV acquisitions, including among adolescent girls and young women,” said UNAIDS.

In Nigeria, budget cuts have reduced PrEP initiation from 40,000 to 6000 people per month.

At the end of 2024, just before a sudden collapse in funding, new HIV infections had been reduced by 40% and AIDS-related deaths by 56% since 2010, Byanyima notes in the report. Countries had also reduced the annual number of children acquiring HIV from their mothers by 62% to 120,000 since 2010.

However, prevention efforts were already flatlining before the withdrawal of US aid. In 2024, there were 1.3 million new infections, which was almost the same as the year before.

“Over 210,000 girls and young women aged 15 to 24 acquired HIV in 2024 – an average of 570 new infections every day,” according to the UNAIDS report.

In 2024, 630,000 people died from AIDS-related causes, 61% of them in sub-Saharan Africa. “Community-led services, which are vital to reaching marginalised populations, are being defunded at alarming rates,” said UNAIDS.

“In early 2025, over 60% of women-led HIV organisations surveyed had lost funding or were forced to suspend services.”

Domestic budgets inadequate

Only 25 of the 60 low- and middle-income countries included in the report have increased their domestic budgets for HIV in 2026. The average increase amounts to 8%, approximately $180 million in additional domestic resources. 

“This is promising, but not sufficient to replace the scale of international funding in countries that are heavily reliant,” UNAIDS notes.

“It is important for donors to recognize that the option of increasing domestic HIV funding is not immediately or equally available to all countries,” UNAIDS notes.

“Combinations of debt distress, slow economic growth and underperforming tax systems leave many countries, notably in sub-Saharan Africa, with limited fiscal space to increase their domestic funding for HIV. “

It cites the recent International Conference on Financing for Development in Seville in Spain, as offering a way forward with “calls for debt relief, international tax cooperation and reform of international financial institutions”.

These measure would provide “the first steps towards a new economic settlement that can give countries the fiscal space needed to invest in the global HIV response”, UNAIDS notes.

“Urgent action and revived solidarity are needed to sustain the progress made and prevent a resurgence of HIV.”

Image Credits: UNAIDS.