On 20 January 2025, the Trump administration called for a suspension of foreign aid, including global health initiatives such as the US President’s Emergency Plan for AIDS Relief (PEPFAR). This programme has facilitated human immunodeficiency virus (HIV) testing for 84.1 million individuals and provided treatment to 20.6 million people in nations with high HIV prevalence. Despite the issuance of a partial waiver a few weeks after the announcement, numerous programmes were unable to resume operations at full capacity, resulting in service disruptions across several countries. The Joint United Nations Programme on HIV/AIDS (UNAIDS) emphasised that the global HIV response is experiencing significant setbacks, ranging from increased mortality and a rise in new HIV infections to the development of resistance to treatment regimens, all due to these service interruptions. Additionally, UNAIDS highlighted that most HIV prevention funding is from external sources and is often not prioritised by local governments; for example, 80% of HIV prevention in sub-Saharan Africa and 66% in the Caribbean are externally funded. There has been a systemic shock to the HIV care ecosystem globally, with UN officials estimating that more than 4.2 million acquired immune deficiency syndrome (AIDS)-related deaths and 6.6 million more HIV infections will arise by 2029 due to these budget restraints. For example, in South Africa, the country鈥檚 National Health Laboratories Service indicated that HIV viral load testing dropped 21% in key groups in March to April 2025. This is predominantly due to a huge decrease in healthcare workers, as PEPFAR paid for the salaries of 15,000 South African workers, and the closures of nongovernmental organisation-run clinics.
In July 2025, US lawmakers passed a rescissions bill that exempted PEPFAR from proposed $400m cuts by the Trump Administration, out of the proposed $9bn of cuts. Despite this block, PEPFAR is operating at a lower calibre. For example, preexposure prophylaxis (PrEP) can now only be offered to pregnant and breastfeeding women, which excludes care to many high-risk groups such as sex workers, men who have sex with men, and drug users. Additionally, Trump has signed an executive order that eliminates federal programming for groups with elements of diversity, equity, and inclusion, which disproportionately impacts people impacted by HIV/AIDS.
Despite Trump鈥檚 America First reform, millions are now at risk of not only HIV exposure due to cuts in HIV prevention, but also an increase in AIDS-related deaths due to inaccessibility to life-saving medication. When looking at PEPFAR budget cuts globally, supply chains for HIV tests and medicines have been disrupted, and there is a decrease in healthcare workers and clinics due to lack of funding. UNAIDS has stated to call to prevent service disruptions, protect supply chains for medications and testing, and to restore HIV services. This is especially important as funding loss triggered by the US has exposed the fragility of many international HIV programmes. UNAIDS reports that 25 countries have already planned to increase domestic budgets for HIV/AIDS in 2026. Despite this, millions are still without care and lack preventative services, especially in marginalised communities globally, as organisations scramble to obtain funding to bridge the gap in care.
