A Stark Warning in a Time of Hope
Remember when headlines celebrated the “beginning of the end of AIDS”? Just last year, we saw historic milestones: AIDS-related deaths dropped to 630,000—the lowest since the 1990s. Seven countries, including Botswana and Zimbabwe, achieved the “95-95-95” targets, meaning nearly all people living with HIV knew their status, received treatment, and were virally suppressed. We had powerful new tools like long-acting injectable PrEP, which showed near-perfect efficacy in preventing HIV. The 2030 goal to end AIDS as a public health threat felt tangible.
Then, the floor fell out. In January 2025, the U.S. government paused all foreign HIV funding—including the $4.3 billion PEPFAR program that provided life-saving treatment to 20.6 million people and HIV testing for 84.1 million. Clinics across Africa and the Caribbean closed overnight. Health workers were laid off. Medicine stockouts began. A recent report delivered a chilling verdict: “A historic funding crisis is unravelling decades of progress”. If this collapse continues, we face 6 million new HIV infections and 4 million preventable deaths by 2029. This isn’t just a setback—it’s an AIDS progress reversal in real time.
The Funding Freefall: Crunching the Numbers
Let’s break down exactly what’s been lost—and why it’s catastrophic. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) funded 90% of global PrEP initiations and 80% of HIV prevention programs in sub-Saharan Africa. Its sudden suspension created a $4.3 billion void in 2025 alone. Countries like Nigeria, where PEPFAR supported 99.9% of HIV prevention drug budgets, had no contingency plan.
Only 25 of 60 affected countries increased domestic HIV funding for 2026—averaging just an 8% rise ($180 million total). This is hopelessly inadequate for nations like Mozambique, where PEPFAR funded 70% of HIV programs. South Africa—which funds 77% of its own HIV response—is a rare exception, but even its 5.9% annual health budget increase can’t replace lost support.
The Global Fund’s 7th Replenishment raised $14.25 billion—far short of its $18 billion target. Bilateral aid from the UK, Germany, and others has stagnated amid competing crises. As one HIV economist starkly noted: “Any responsible government would have given advance warning. Instead, patients were stranded”.
Documenting the “AIDS Progress Reversal”
The data isn’t theoretical—it’s visible in shuttered clinics and abandoned patients. In Nigeria, monthly PrEP initiations plummeted from 40,000 to 6,000 after PEPFAR’s exit. Programs for adolescent girls and young women—who acquire HIV at a rate of 570 per day—were decimated. PEPFAR alone reached 2.3 million with prevention services in 2024. Sixty percent of women-led HIV organizations lost funding or suspended services, crippling outreach to marginalized groups.
Nine point two million people still lacked life-saving antiretrovirals in 2024—including 620,000 children. Unsurprisingly, 75,000 children died of AIDS-related causes that year. South Africa’s ARV supply chains are faltering. Two hundred thirty thousand doses of long-acting PrEP sit unreleased due to funding paralysis.
After years of decline, models project 56,000–65,000 additional deaths in South Africa alone by 2028. Globally, 4 million could die by 2029 if services collapse. The 2025 report confirms the 95-95-95 targets are now unattainable by 2030 without urgent intervention.
The Human Cost: Beyond Statistics
Behind every data point are human beings. A peer educator for sex workers in Lusaka, Zambia, lost her job when PEPFAR-funded clinics closed. “We used to distribute 500 PrEP doses monthly. Now it’s zero. Women I’ve kept safe for years are testing positive.”
Mozambique’s HIV program shed 30,000 health workers—equivalent to firing every nurse in New York City. These were specialists in viral load testing, stigma reduction, and outreach to LGBTQ+ communities. Seventy-five percent of AIDS-related child deaths occurred in children not on treatment. With testing programs gutted, undiagnosed infants face near-certain mortality.
Uganda, Mali, and Trinidad tightened criminal laws against same-sex relationships and drug use in 2025, pushing key populations further from care. Infection rates among gay men and trans people are now spiking.
The Ripple Effect of Collapse
This funding crisis doesn’t exist in a vacuum. PEPFAR supported labs, supply chains, and health worker training used for all diseases. Its withdrawal means 580,000 fewer TB screenings and 35,000 fewer TB treatments in 2025.
The U.S. funded most HIV surveillance in Africa. With systems dark, outbreaks go undetected. “Without reliable data, stopping HIV’s spread becomes guesswork,” warns a leading public health expert.
Abandoning HIV signals that aid is transactional—not humanitarian. As one global health leader frames it: “This is a choice: solidarity or surrender”.
Halting the Reversal
Progress reversal isn’t inevitable. Here’s how we counter it. Donor action could reinstate PEPFAR via emergency legislation. Other G20 nations must fill gaps—e.g., Canada increasing Global Fund contributions. The International Conference on Financing for Development proposed canceling $100 billion in African debt, freeing domestic funds for health.
Though a new 6-month injectable drug is groundbreaking, its cost in the U.S. is prohibitive. Pressure is mounting to expand generic licenses beyond 120 countries to include Latin America. Rwanda (which achieved 95-95-95) now advises Malawi on viral load testing—proving peer knowledge-sharing works.
Redirect remaining funds to grassroots groups delivering ARVs via motorcycle or tele-PrEP consultations. As 80% of prevention programs relied on NGOs, their survival is non-negotiable.
Turning Awareness into Action
You didn’t cause this crisis—but you can help fix it. U.S. residents should call representatives to demand they co-sponsor emergency legislation to restore HIV funding. Non-U.S. citizens should push leaders to attend upcoming global pledging conferences.
Donate strategically to organizations where 93% of donations fund programs. Support groups helping women-led organizations in Zambia and Zimbabwe. Back South Africa’s last-standing clinic monitoring system.
Correct misinformation. Support LGBTQ+ shelters offering HIV self-tests. Share personal stories from affected communities using relevant hashtags to amplify the message.
A Crossroads for Compassion and Progress
We stand at a precipice. The funding collapse has already triggered an AIDS progress reversal—visible in abandoned clinics, interrupted treatments, and rising infections. But unlike the early pandemic, we now have tools to end AIDS: revolutionary PrEP, community expertise, and proven treatment models.
What’s missing is political courage. As a leading professor implores: “We need urgency, not silence. Millions of lives hang on choices made today”. This isn’t about charity—it’s about justice. Every dollar invested in HIV yields $7 in economic growth by preventing hospitalizations and orphan crises.
So let’s choose: Will we be remembered for surrendering to apathy—or for mustering the will to end AIDS? Your move. Your legacy.
