8th April 2025

HIV/AIDS progress could reverse by 2030, warns study

A study in The Lancet finds that cuts to foreign aid proposed by major donor countries, such as the US and UK, could undo decades of progress made to end HIV/AIDS as a public health threat, with potentially 10.8m additional new infections by 2030.

HIV test at Pomerini in Tanzania, Africa. Credit: francovolpato

A new modelling study published in The Lancet HIV journal highlights the alarming potential impact of cuts to international funding for HIV prevention and treatment programmes.

The research estimates that, globally, between 4.4 and 10.8 million additional new HIV infections and 770,000 to 2.9 million HIV-related deaths in children and adults could occur between 2025 and 2030, if cuts proposed by the top five donor countries – including the USA and the UK – are not mitigated.

The most affected populations will likely be in sub-Saharan Africa, along with marginalised groups already at higher risk of acquiring HIV – such as people who inject drugs, sex workers, and men who have sex with men. Children are also considered a high-risk group.

The USA, UK, France, Germany and the Netherlands together account for over 90% of international funding for HIV in low- and middle-income countries (LMICs), making their support crucial to global efforts to treat and prevent the disease. However, all five have recently announced plans for major cuts to foreign aid.

Of particular note is the US government, by far the largest contributor to foreign aid – providing 73% of support – which paused all foreign aid funding (with only limited exceptions) on 20th January 2025 to allow for a 90-day review and evaluation.

A hospital in Kampala, Uganda. In this clinic for AIDS patients, a nurse comforts a young boy who is HIV positive. The boy sits on the lap of a woman who has taken over the care of the child from her sister, who recently died from the disease. In Africa, many children are orphaned by AIDS. Credit: Sjors737/Dreamstime

Foreign aid programmes, such as the US President's Emergency Plan for AIDS Relief (PEPFAR), provide HIV treatment and prevention services. This includes funding for health clinics that supply antiretroviral therapy (ART), HIV testing, and essential laboratory services. These programmes often extend beyond HIV to include health systems strengthening, healthcare worker training, and integration with broader health services such as maternal and child care.

"The United States has historically been the largest contributor to global efforts to treat and prevent HIV, but the current cuts to PEPFAR and USAID-supported programmes have already disrupted access to essential HIV services, including for antiretroviral therapy and HIV prevention and testing," said co-lead study author Dr Debra ten Brink of the Burnet Institute, Australia. "Looking ahead, if other donor countries reduce funding, decades of progress to treat and prevent HIV could be unravelled. It is imperative to secure sustainable financing and avoid a resurgence of the HIV epidemic which could have devastating consequences, not just in regions such as sub-Saharan Africa, but globally."

To understand the potential impact of these reductions, the authors used a 26-country mathematical model, simulating the immediate cessation of support from PEPFAR in all countries currently reliant on foreign aid for HIV services. When combined with other cuts, and extrapolated across all LMICs, the model estimates 4.4 to 10.8 million additional HIV infections by 2030, representing a 1.3 to 6-fold increase in new cases among higher-risk populations, compared to if funding remained stable. These cuts could also result in 770,000 to 2.9 million additional HIV-related deaths.

"There could be an even greater impact in sub-Saharan Africa, where broader prevention efforts – such as distributing condoms and offering pre-exposure prophylaxis [medication that reduces the risk of getting HIV] – are at first risk to be discontinued," said Dr Rowan Martin-Hughes, also of the Burnet Institute. "This is in addition to disruptions in testing and treatment programmes that could cause a surge in new HIV infections, especially in some of the areas where the greatest gains have been made, such as preventing mother-to-child transmission of HIV and paediatric HIV deaths."

From 2010 to 2023, many countries that received PEPFAR or other foreign aid support made substantial progress in treating and preventing HIV, with an average 8.3% yearly decrease in new infections and a 10.3% decrease in HIV-related deaths. If this trend continues, many countries would be on track to meet global targets to eliminate HIV/AIDS as a public health threat by around 2036.

However, if foreign aid is reduced as planned – or if PEPFAR ends entirely without a comparable alternative – new infections and deaths may quickly rise to levels not seen since 2010, potentially undoing all progress made since 2000. Even if support is restored within 12 to 24 months, the study suggests new infections could stabilise at 2020 levels – a setback that might require an additional 20 to 30 years of investment to recover from.

"There is an urgent need for innovative, country-led financing strategies and an integration of HIV services into broader health systems; however, this can't happen overnight," said co-author Dr Nick Scott, also of the Burnet Institute. "Long-term strategic planning is required for countries to transition from internationally supported to domestically financed programmes. Our study highlights how important international collaboration and investment have been in maintaining progress against HIV."

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