Abrupt cuts to HIV funding, sparked by Donald Trump’s “America First” policy, could result in 6 million new HIV infections and up to 4 million HIV-related deaths by 2030. Archibong Bassey finds the cuts are devastating the global goal to end AIDS as a public health threat in the next four years.
When Angela Jambo was diagnosed with HIV in 2000, antiretroviral medicines were not widely available in Zimbabwe. “Back then, it was a death sentence,” she recalled.
But over the years, things changed, treatments became increasingly accessible and Angela became an advocate for people living with HIV, volunteering to support children to access local support groups.
Last year, Angela received a WhatsApp message, sent to a group of volunteers, to stop all activities including support groups for children. Donald Trump’s executive order brought an abrupt halt to food, therapy and educational programmes.
“Support groups were everything,” Angela told Doctors Without Borders. “It’s stressful and disturbing. These children had found a family in our groups. Now all of that is gone.”
Photo of Angela by Conrad Gweru/MSF
THE EXPECTED IMPACT OF HIV FUNDING CUTS IS ALARMING
The US government, one of the largest HIV donors, abruptly halted funding in January 2025 as part of its “America First” policy. This triggered a freeze in foreign aid, causing concern and uncertainty, and sending shockwaves across programmes that had become the backbone of HIV prevention, treatment, and support in many countries.
The data is alarming. UNAIDS warns that with the abrupt stop to previously supported HIV programmes, the world could see an estimated 6 million additional new HIV infections, with an additional 4 million AIDS-related deaths by the year 2030.
Another study found that the withdrawal of this funding support could result in anywhere between 770,000 and nearly 3 million HIV-related deaths between the years 2025 and 2030. These cuts devastate the global goal to end AIDS as a public health threat by 2030.
For people who want to access HIV prevention medicines like Pre-Exposure Prophylaxis or “PrEP” (a prescription medicine that can reduce the risk of getting HIV by about 99%), accessibility is becoming increasingly difficult.
An October 2025 UNAIDS report stated that “the AIDS Vaccine Advocacy Coalition estimates that 2.5 million people who used PrEP in 2024 lost access to their medicines in 2025 due to donor cuts”.
More recently, Winnie Byanyima, head of UNAIDS, said: “It’s the biggest disruption since the global HIV response was put together and it poses a major threat to the progress we have had.”
HIV care consists of more than access to essential medicines, it is also the human infrastructure that helps people get tested, stay in care and return for follow-up. These include the health workers and communities who support HIV programmes on the ground. In Malawi, UNAIDS has found there is reduced capacity across government facilities, and community-led monitoring activities have come to a halt.
People most vulnerable to HIV, often referred to as “key populations”, include marginalised groups such as gay men, transgender people, sex workers, and people who inject drugs. In contexts where they were already heavily stigmatized, the sudden loss in aid has consequences beyond the closure of health services.
Since many donor-funded programmes had provided rights-based services, including safe spaces, legal assistance and some protection against discrimination to these key populations in contexts where they would otherwise be criminalised, these services were seen as politically controversial (even though they benefited other populations such as women, children and adolescents).
Now, the loss of these services has exposed key populations to increased scrutiny, stigma and violence, and in some cases, reinforced perceptions that these populations were underserving of support and tagged as possible suspects for the funding freeze.
These funding cuts risk exposing people and communities to stigma, discrimination and violence. In the case of people like Angela and those she works with, these programmes offered vital access to antiretroviral therapy, emotional support, tuition and dignity.
These ripples show how a funding decision has become a human rights crisis.
And it is important to highlight that governments across Africa are not simply standing still. Malawi has allocated more funding to its health ministry and plans to absorb thousands of workers onto the public payroll. Nigeria, Uganda, Kenya, Côte d’Ivoire, South Africa, Tanzania and other countries have announced increases in domestic HIV spending.
These moves really matter because political will is essential to address these complex issues. But political will can only do so much. Governments may be able to increase funding for providing anti-retroviral treatment in clinics, but prevention and community-led services depend on trained peer/community workers, safe spaces, trusted relationships, and outreach networks that often take many years to build.
In Nigeria, community volunteers went door-to-door to reconnect thousands of people to HIV treatment after funding cuts disrupted services, while access to PrEP, condoms and HIV testing remained heavily affected.
COMMUNITY-LED PEOPLE-POWERED SOLUTIONS
Radical and meaningful change is possible when communities themselves are at the heart of decision making, priority setting, and monitoring of the HIV response. People living with HIV, key populations and health workers are best placed to check how and where resources are being used and to identify what is not working, such as treatment shortages, unsafe services, or long travel times to facilities. They can then present the data they’ve collected to local governments, making their priorities clear.
Local governments can then invite these grassroots communities to priority setting meetings to determine how to deliver the agreed priorities in practice.
Working in this way means communities are heard and can hold local governments, NGOs and pharmaceutical companies to account. Ritshidze, a community-led data-collection and monitoring system in South Africa, is a real-life example of this.
Ritshidze empowers people living with HIV to monitor services provided by PEPFAR, the second largest funder of the HIV response in South Africa. Ritshidze’s 2020 report stated that much of PEPFAR’s $523 million funding was spent at public sector clinics, but before the launch of Rishidze’s community-led clinic monitoring, there was limited accountability of how the money was spent. In the wake of the funding freeze in South Africa, Ritshidze continues to monitor the situation at the grassroots, pushing for government support to meet the country’s HIV treatment targets.
This is just one example of people living with HIV collecting evidence, identifying challenges and proposing solutions, improving service delivery.
CIVIL SOCIETY, COURTS, AND LAW
Courts, civil society actors, and affected communities can also play an important role in holding governments accountable as they respond to HIV funding cuts.
In the wake of the abrupt disruption of US foreign assistance in January 2025, the government in Kenya negotiated a new health cooperation framework with the United States of America. However, the proposed solution in the framework raised human rights concerns.
Human rights activist, Okiya Omtatah and other civil society actors challenged the Kenya-US framework, arguing that it had not been subjected to adequate public participation and parliamentary oversight and raised concerns about public finance, devolution and the protection of sensitive health data.
In December 2025, the High Court temporarily suspended implementation of the framework because there were serious constitutional questions about how it had been negotiated and would operate.
THE FIGHT GOES ON
Services can re-open but operations don’t bounce back to normal as soon as a shutdown is lifted or a support group restarted.
For Angela, and for millions whose lives depend on similar services, HIV funding cuts are not just a story of numbers or statistics. They are directly impacting people’s lives and human rights in the global HIV response.
A July 2026 report in Frontiers in Public Health quoted a health worker who said: “We had it [HIV] under control. My fear is we’ll have more infections, premature deaths, mother-to-child transmission so that will be a crisis for us.”
At this critical moment in global health and human rights history, we stand at a defining crossroads in the HIV/AIDS response. The cuts are significant and the road ahead will not be easy. But we can take inspiration from the resilience and tenacity of people living with HIV, activists, organizations, and professionals, who have been fighting for decades, and continue to build on their legacy.
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