Rise in HIV/AIDS cases feared after US aid cuts

New data from Africa and Latin America shows rising infections, stalled treatment, and strained health systems

Kampala, Uganda | RONALD MUSOKE | Scientists, researchers, policy makers and HIV/AIDS advocates at a meeting in Kigali, Rwanda, from July 13-17 for the 13th International AIDS Conference on HIV Science (IAS 2025), have raised an alarm over what they say is a “devastating impact of sudden international funding cuts on the global HIV/AIDS response.” They warn that years of hard-won progress in prevention and treatment could be undone if urgent action is not taken.

The conference which is held every two years brings together scientists, policymakers, and community leaders to advance evidence-based responses to HIV. This year’s meeting will detail how the recent funding cuts by the U.S government under President Donald Trump are rolling back decades of concerted efforts to push back the HIV/AIDS global pandemic. It will also highlight new scientific breakthroughs, including innovations in long-acting HIV/AIDS treatments and potential vaccine candidates.

Speaking ahead of the conference, scientists presented on July 8 new data from sub-Saharan Africa and Latin America showing stalled treatment programmes, rising HIV infections, and strained health systems, particularly in low- and middle-income countries.

“This year’s conference takes place at a paradoxical moment for all of us who have dedicated our careers to ending the HIV pandemic,” said Dr Beatriz Grinsztejn, the president of the International AIDS Society.

“On one hand, we’re witnessing extraordinary breakthroughs that could transform prevention and treatment, and even bring us closer to a cure. On the other hand, these advances are under threat from massive funding cuts that risk stalling trials, slowing our progress, and jeopardizing the progress we’ve fought so hard to achieve.”

The most immediate disruption has come from a freeze in US government funding, especially of the President’s Emergency Plan for AIDS Relief (PEPFAR)—an American-funded programme that has, for over two decades, been the backbone of HIV prevention and treatment efforts in many African countries including Uganda.

According to the in-coming IAS President, Prof. Kenneth Ngure, the sudden cuts to U.S. funding have been deeply felt across the African continent by the millions of people who rely on HIV prevention, testing and treatment services, and by the researchers and health workers striving to end the pandemic.

“The studies discussed at IAS 2025 offer real-world insights into how these actions are impacting vulnerable populations and the impact they could cause in the future,” Prof. Ngure said.

Africa on the brink

In a modelling study led by Dr Jack Stone, an Associate Professor in Infectious Disease Mathematical Modelling at the University of Bristol, HIV incidence and related deaths look set to significantly increase in sub-Saharan Africa as a result of funding for HIV pre-exposure prophylaxis (PrEP) being halted under PEPFAR.

Before the President Donald Trump administration made changes in its international funding model, PrEP funded by PEPFAR was received by nearly 700,000 people living across 28 sub-Saharan African countries by late 2024.

The researchers say the halt in PEPFAR-funded PrEP at the beginning of this year could result into thousands of new HIV infections in just one year across 28 African countries. The researchers’ mathematical model also predicts thousands of further acquisitions over the next five years. According to the researchers, close to 3000 of the additional acquisitions are projected to be among gay and bisexual men who have sex with men, while more than 2,000 are shown to be among female sex workers.

The findings of the study also estimated increases in HIV acquisition levels will exceed 5% in eight of the 27 countries for men who have sex with men, two countries for people who inject drugs, five countries for trans women and six countries for female sex workers.

“Ceasing PEPFAR’s funding for PrEP in sub-Saharan Africa will remove approximately 700,000 individuals from using oral PrEP. If this continued for one year, then 10,000 additional infections could occur over the next five years, with many of these infections being among gay and bisexual men who have sex with men and female sex workers,” Dr Stone said. “It is crucial that funding is found to continue and expand PrEP services in sub-Saharan Africa.”

Mozambique’s HIV/AIDS situation

According to a real-time study from Mozambique presented by Anna Grimsrud, the Senior Technical Advisor at the International AIDS Society, the U.S. funding freeze has had an immediate impact on the country.

Mozambique has the third highest number of people living with HIV globally, and health facilities serve approximately 2 million of the 2.4 million people living with HIV. To evaluate the impact of the U.S. executive order on HIV services, the authors compared select indicators from the country’s district health information system in February 2024 and February 2025.

They found that there was a 25% reduction in ART initiation among adults, from over 22,000 to just over 17,000, in February 2025 compared to February 2024. Among those on treatment, there was a 38% reduction in viral load tests performed. There was also a 37% reduction in test results received and a 33% reduction in the number of results showing viral suppression.

Among children, there was a 44% reduction in viral load tests, a 71% reduction in test results received and a 43% reduction in virally suppressed results, indicating a disproportionate impact on the paediatric population.

The study projected that, if the funding interruption persists, Mozambique could see an estimated increase of 83,000 new HIV acquisitions (a 15% rise) and 14,000 additional HIV-related deaths (a 10% increase) by the year 2030.

In South Africa, an on-the-ground report also shows how funding cuts have stalled progress toward ending the HIV pandemic. In Johannesburg, funding cuts have hindered progress made toward ending the HIV epidemic, according to an abstract presented by Khensani Chauke of the Gauteng Provincial Department of Health, Pretoria, South Africa.

Johannesburg was the recipient of the Accelerating Programme Achievements to Control HIV Epidemic (APACE) award, funded through PEPFAR, to support achievement of the 95-95-95 goals. However, the award was withdrawn in February 2025. This impacted key healthcare workers, including counsellors providing community-based HIV testing to vulnerable populations.

The study team assessed the impact of the award termination by comparing HIV tests, HIV diagnoses and ART initiations from 2023 to 2025. They found that testing decreased by 8.5% from early 2024 to early 2025. There was also a 31% decline in HIV diagnoses and a 30% decline in ART initiations.

Humanitarian catastrophe

The impact of the funding crisis extends beyond Africa. In Latin America and the Caribbean, 87% of HIV-focused community organisations surveyed reported complete or partial suspension of U.S. funding—some losing their entire annual budgets.

According to data presented by Meg Stevenson from Johns Hopkins Bloomberg School of Public Health, Latin American and Caribbean organisations focused on HIV have been impacted by the suspension of U.S. foreign aid.

Researchers distributed an online survey to 40 community-based HIV service organisations in Latin America and the Caribbean between 18 February and 14 March 2025. Funding cuts began in late January.

The survey found that 21 of 24 (87%) of participating organisations that reported receipt of U.S. funding in the last year had their funds suspended. These cuts represent an average of nearly 50% of the organisations’ annual budgets. In some cases, it was 100% of their budgets. Funding cuts affected programmes that were providing HIV prevention and treatment, as well as ancillary services, to adults and children.

Global call to action

Going forward, The Independent understands HIV/AIDS advocates at the conference will among other responses to the funding cuts push for global debt restructuring.

Zackie Achmat, the founder of the Treatment Action Campaign and a member of the Global HIV Treatment Coalition, noted during the press conference that there is an urgent need for debt refinancing to protect the HIV response in low- and middle-income countries.

“You can’t end the AIDS pandemic while African nations must choose between paying creditors and saving lives,” Achmat said. “As someone who has lived with HIV for more than half my life, I have seen the cost of political inaction.”

“We fought for treatment when the world said it was impossible. Now, the convergence of crushing debt and funding cuts threatens everything we’ve built. We need urgent debt restructuring so African countries can invest in saving lives instead of servicing debt.”