December 1, World AIDS Day, finds experts reporting a marked deterioration compared with last year. They cite the suspension of international initiatives after decisions by the administration of Donald Trump, who took office in January 2025.
At that point, the United States stopped allocating new money to many foreign projects and effectively dismantled USAID, whose budget was $42.45 billion. Before that, Washington had provided about two-thirds of all international HIV prevention funding for low- and middle-income countries. The cuts also hit PEPFAR, which has received about $120 billion since its launch in 2003. It is credited with saving 25 million lives, including 5.5 million children, in at least 50 countries.
In 2024 alone, 20.6 million people received life-saving HIV medicines through PEPFAR, and more than 342,000 health workers were supported. In 2025, the program’s public reports became unavailable, and budget documents indicate that only $2.9 billion of the originally planned $6 billion was allocated.
The amfAR research foundation warned that the PEPFAR freeze could immediately deprive hundreds of thousands of people of access to effective, life-saving HIV treatment and other services.
The reductions also reached the US itself: CDC HIV prevention and surveillance divisions were eliminated, and the budgets of national testing, education and monitoring programs are set to be cut by $800 million. Estimates suggest this could result in 32,000 new infections each year in the country.
Some funding was later restored, including programs to prevent mother-to-child transmission. But other measures remain scaled back, and the drug lenacapavir is due to be supplied through PEPFAR in 2026 only to 8–12 countries with high incidence. By 2028, the plan is to procure 2 million doses.
Other major donors have also announced cuts: the United Kingdom, France, Germany and the Netherlands. Together with the US, these five countries provide more than 90% of international HIV funding and have reduced or plan to reduce aid by 8–70% in 2025–2026.
According to the WHO, since 1981 91.4 million people have contracted HIV and about 44.1 million have died from related causes. By the end of 2024, 40.8 million people were living with HIV worldwide, while annual deaths stood at 630,000. UNAIDS says that by the end of 2024 new infections had fallen by 40% and AIDS-related deaths by 56% compared with 2010. It now projects that by 2029, the funding collapse could cause another 6 million HIV infections and 4 million AIDS-related deaths.
Prevention services have been hit hardest, especially those serving adolescent girls, young women and marginalized communities. Doctors and researchers also warn of interruptions in antiretroviral treatment and the risk of drug-resistant strains emerging. Modeling by the Melbourne Research Institute suggests that if international aid drops by 24%, new infections could rise by 4.4–10.8 million by 2030, while deaths could increase by 770,000 to 2.9 million. Restoring PEPFAR support, the authors conclude, would sharply reduce those losses.