Consequence of U.S. HIV Funding Cuts Are Showing, Threatening Years of Gains, Say Researchers | IAS 2025
“Millions of lives and decades of progress hang in the balance,” says the president of the International AIDS Society (IAS) during a premeeting press conference.
Cuts in U.S. funding for HIV prevention programs are already having a notable effect that could result in an increasing number of HIV infections and deaths, unraveling decades of progress, according to research findings presented at a press conference today in advance of the International AIDS Society (IAS) meeting next week in Kigali, Rwanda.
In Johannesburg, South Africa, after termination in February 2025 of a grant funded through the President’s Emergency Plan for AIDS Relief (PEPFAR), HIV testing decreased by 8.5% during the first quarter of 2025 compared with the first quarter of 2024, according to findings presented by Khensani Chauke of the Gauteng Provincial Department of Health in Pretoria. Over the same time period, HIV diagnoses declined by 31% and initiation of antiretroviral therapy (ART) by 30%.
In Mozambique, February 2024 to February 2025 comparisons showed a 25% reduction in ART initiation, from approximately 22,000 to 17,000, according to a news release summarizing research that is scheduled to be presented at the IAS meeting, known formally as the 13th IAS Conference on HIV Science. The same research showed that those being treated for AIDS, there was a 38% in reduction in tests of viral loads and similar decrease in test results received, according to the news release. The 2024-to-2025 decreases were larger among children: a 44% reduction in viral load testing and a 71% decrease in test results received.
Anna Grimsrud, Ph.D., M.D., a technical adviser to IAS who spoke on behalf of the Mozambique study team at the press conference, said that modeling shows that if the current trends continue, new HIV infections will increase 15% in Mozambique by 2030 and deaths related to AIDS will climb by 10%.
“These findings underscore that stability in funding is essential for maintaining HIV delivery gains,” Grimsrud said at the press conference. “Even short-term interruptions create measurable effects on service access and, ultimately, health outcomes.”
Jack Stone, Ph.D., an associate professor at the University of Bristol, said that the foreign aid freeze and subsequent waiver have meant a pause in U.S. funding for preexposure prophylaxis (PrEP) for everybody in sub-Saharan Africa except pregnant and breastfeeding women. Stone said that PEPFAR funding had supported 90% of PrEP initiations. His research focused on what he termed “key groups” that are marginalized and are at heightened risk of acquiring HIV: men who have sex with men, female sex workers, transgender women, and people who inject drugs. According to Stone, at the end of last year, PEPFAR was providing PrEP to approximately 720,000 individuals who were not pregnant or breastfeeding in 28 countries in sub-Saharan Africa. Of that number, 200,000 were from the key population groups he mentioned. Stone said his mathematical model shows that the removal of PEPFAR’s provision of PrEP over one year would result in 6,700 new HIV infections among those who would have been on PrEP were it not for the PEPFAR cuts. Factoring in secondary transmission, Stone said the model shows that a one-year pause of PEPFAR-based prep would result in 10,000 additional HIV infections over the next five years.
Not just Africa
Although the cutback in PEPFAR funding has mainly affected African countries and programs, the Trump administration’s shuttering of the United States Agency for International Development (USAID) has affected HIV treatment and prevention programs elsewhere. Meg Stevenson, M.S.P.H., a senior research data analyst at the Johns Hopkins Bloomberg School of Public Health, presented findings of a survey of HIV organizations in Latin America and the Caribbean that showed 21 of the 24 organizations that received U.S. funding, directly and indirectly, had had their funding suspended. On average, the U.S. funding had accounted for about half of the organizations’ funding. Stevenson said the loss of USAID funding to these organizations translated into a loss of HIV treatment and prevention services for 150,000 people.
Beatriz Grinsztejn
Beatriz Grinsztejn, the IAS president and a leading HIV/AIDS researcher in Brazil, began the press conference with observations about the paradoxical times in which the IAS meeting is taking place. “We are witnessing scientific breakthroughs that could transform prevention and treatment and even bring us closer to a cure,” she said. “On the other hand, these very advances are under threat from massive funding cuts that risk stalling clinical trials, slowing our progressand jeopardizing the progress we have fought so hard to achieve.”
Funding cuts threaten to undermine the HIV infrastructure that has brought the world to a promising point in the HIV response, Grinsztejn said. “Millions of lives and decades of progress hang in the balance.”
Zackie Achmat, a South African AIDS activist and a member of the Global HIV Treatment Coalition, spoke about the HIV epidemic being “so close, so close to being ended.”
Achmat added, “And yet, today we sit with 20 million people in Africa on death row, placed there by an authoritarian regime, that of Donald Trump, the criminally convicted president of the United States.”
Achmat said the debt service of African countries is more than double the amount that the U.S. gives in foreign aid, exclusive of the money it sends to Israel and Ukraine. He called on China, Brazil, India and Thailand to do more to support HIV prevention and treatment efforts on the continent.
Today, the clade 2b outbreak has reached alarming proportions, with over 94,000 confirmed cases reported across 117 countries, including significant numbers in the U.S. and Brazil, and up to 103 deaths. The virus has been found to affect younger men who have sex with men, who are linked to high rates of HIV co-infection.
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