In January 2025, the US government paused all foreign assistance, abruptly affecting the delivery of HIV medicines and prevention services to millions of people. According to UNAIDS, if global action is not taken, this disruption could result in an additional 6 million new HIV infections and 4 million AIDS-related deaths by 2029. The sudden funding halt has compounded existing challenges in HIV prevention and treatment, particularly in African countries where the majority of people living with HIV reside.
In November 2025, The Global Fund raised US$11.34 billion for HIV/AIDS, tuberculosis, and malaria. While significant, this fell short of the US$18 billion target needed for the 2027–2029 funding cycle. The US pledged US$4.6 billion, down from a previous pledge of US$6 billion, remaining the largest single donor contribution but highlighting the broader gap in global support. The shortfall threatens to strain existing programs, delay life-saving interventions, and reduce the effectiveness of HIV/AIDS responses in regions already struggling with high prevalence and limited resources.
HIV continues to be a major public health issue, with an estimated 44.1 million lives lost to date and around 40.8 million people living with the virus at the end of 2024, 65% of them in Africa. Reduced funding has led to service disruptions, including interruptions in antiretroviral therapy and shortages of prevention supplies. These challenges risk reversing progress, increasing infections, weakening health system trust, and creating conditions for drug resistance and poorer health outcomes.
Global health experts emphasize the need for countries to build self-reliant healthcare systems. Sudden transitions away from donor dependence can be dangerous, especially in regions where the COVID-19 pandemic has already strained healthcare infrastructure. Strengthening domestic financing, integrating HIV services into primary healthcare, and using data-driven approaches are crucial for sustaining effective HIV responses and maintaining community trust in health services.
African nations are encouraged to adopt multi-pronged strategies to sustain HIV programs. This includes allocating domestic resources through budget prioritization and social health insurance, leveraging public-private partnerships, negotiating regional pooled procurement to lower drug costs, and involving communities in program planning. Strengthening regional collaboration through bodies like the African Union can improve efficiency and reduce dependency on external donors while ensuring that services remain evidence-driven and community-centered.
The withdrawal of US funds has had immediate impacts on ongoing HIV prevention and treatment programs, causing disruptions in antiretroviral therapy supply and other essential services. This funding uncertainty threatens epidemic control, with potential increases in illness and mortality, and highlights the risks of reliance on a single donor. Diversifying funding portfolios, increasing domestic revenue, and integrating HIV programs into broader health systems are seen as essential steps for Africa to sustain progress, maintain treatment coverage, and protect the gains achieved in the fight against HIV/AIDS.
