4 million could die by 2029 if US HIV funding isn’t restored, warns UN

London: The sudden withdrawal of $4 billion in US foreign aid for HIV programmes in January 2025 came after President Donald Trump ordered a suspension of all foreign aid and later initiated the closure of the US AID agency. This decision has had wide-ranging global repercussions, particularly for nations in sub-Saharan Africa, where US funds have long supported life-saving HIV prevention and treatment programmes.

Andrew Hill, an HIV expert at the University of Liverpool, said, "Any responsible government would have given advance warning so countries could plan," criticising the overnight shutdowns of clinics that left patients stranded.

What was the scale of the US support before the cuts?

The US President's Emergency Plan for AIDS Relief (PEPFAR), launched in 2003 by President George W. Bush, was the largest commitment ever made by a single country to address one disease. UNAIDS described it as a "lifeline" for many countries grappling with high HIV rates.

PEPFAR had supported testing for 84.1 million people and provided treatment for 20.6 million. In Nigeria, PEPFAR reportedly funded 99.9 percent of the country's HIV-prevention medicine budget.

What has been the impact of the funding withdrawal?

A new report released by UNAIDS on Thursday detailed the devastating effects already being seen. According to the report, the loss of funding has "already destabilised supply chains, led to the closure of health facilities, left thousands of health clinics without staff, set back prevention programmes, disrupted HIV testing efforts and forced many community organisations to reduce or halt their HIV activities."

UN Assistant Secretary-General Angeli Achrekar, a deputy executive director at UNAIDS, who served as PEPFAR’s principal deputy coordinator until January 2023, confirmed that the programme is currently under review by the Trump administration.

She noted that US Secretary of State Marco Rubio had issued a waiver to allow continued treatment, but added, "The extent to which it will continue in the future, we don’t know. We are cautiously hopeful that PEPFAR will continue to support both prevention and treatment services."

What are the potential consequences if the funding isn't restored?

UNAIDS has warned that failure to replace the lost funding could result in more than 4 million AIDS-related deaths and 6 million new HIV infections by 2029. Experts also fear the loss of crucial data, as U.S. funding covered most HIV surveillance in African countries, including hospital records and patient databases.

Dr. Chris Beyrer, director of the Global Health Institute at Duke University, said, "Without reliable data about how HIV is spreading, it will be incredibly hard to stop it."

Is there any hope from new treatments?

The cuts come at a time when hope was building around a twice-yearly injectable drug for HIV prevention. Approved last month by the US Food and Drug Administration, Gilead's drug, Yeztugo, was found to be 100% effective in trials.

At a launch event, South Africa's Health Minister Aaron Motsoaledi declared, "We will move mountains and rivers to make sure every adolescent girl who needs it will get it," adding that Africa's historical dependence on US aid was "scary."

However, advocates have expressed concern over the accessibility of the drug. Peter Maybarduk of Public Citizen said, "We could be ending AIDS. Instead, the US is abandoning the fight."

He added that Gilead’s pricing makes the drug unaffordable for many, despite the company agreeing to sell generics in 120 poorer countries. Nearly all of Latin America has been excluded, even though HIV rates there are rising.

The global response to HIV now faces a critical turning point. While some poorer countries are beginning to invest more in their own programmes, Tom Ellman of Doctors Without Borders cautioned, "There's nothing we can do that will protect these countries from the sudden, vicious withdrawal of support from the US."

(AP inputs)