In January 2025, the US government abruptly paused all foreign assistance, disrupting the delivery of life-saving HIV medicines and prevention services to millions of people. A UNAIDS report warns that without urgent action, there could be an additional six million new HIV infections and four million AIDS-related deaths by 2029. In response, The Global Fund raised $11.34 billion in November 2025 for HIV/AIDS, tuberculosis, and malaria, falling short of its $18 billion target for 2027–2029. Public health experts highlight the need for African nations to address the shortfall and sustain HIV/AIDS control efforts.
The US pledged $4.6 billion to the Global Fund during the 2025 summit in South Africa, down from a previous $6 billion commitment. While this demonstrates that the US remains engaged in multilateral global health efforts, the reduction signals potential constraints on prevention, treatment, care, and related services for the three diseases. The shortfall threatens to strain existing programs, delay expansion of interventions, and potentially result in job losses and reduced service delivery. Prior to the 2025 funding cuts, over 11 million people in Africa had unsuppressed viral loads, highlighting the urgency of sustaining HIV programs.
Reduced funding and disrupted services carry serious long-term consequences. Interruptions in treatment can lead to increased infections, drug resistance, and poorer health outcomes, while eroding trust in healthcare systems. The Global Fund’s executive director emphasized that the previous model of heavy reliance on international funding is no longer sufficient and warned that abrupt transitions to self-reliance could be dangerous. Countries must gradually strengthen domestic financing to avoid gaps in care, especially in systems already strained by the COVID-19 pandemic.
African governments are urged to prioritize locally funded healthcare, strengthen health system financing, and collaborate with civil society to ensure community-centered, evidence-driven HIV responses. Innovations such as integrating HIV services into primary care, using data-driven targeting, negotiating lower drug costs, and leveraging public-private partnerships can enhance program sustainability. Regional cooperation, pooled procurement, and support from organizations like the African Union can improve bargaining power and reduce dependency on external aid while maintaining effective HIV interventions.
