But 25 low- and middle-income countries have responded with plans for increased allocation of HIV funds, says the UNAIDS executive director. "...countries, governments and civil society are not lying down and waiting to die..."

If U.S. cuts in funding that support HIV prevention programs become permanent, there could be an additional 6 million HIV infections and 4 million AIDS-related deaths by 2030, mostly in Africa, according to the annual report of the Joint United Nations Programme on HIV/AIDS (UNAIDS) issued today.

Winnie Byanyima

In addition to funding cuts, UNAIDS Executive Director Winnie Byanyima said at a livestreamed meeting in Johannesburg, South Africa, that for the first time since UNAIDS started issuing reports, the number of countries that are criminalizing same-sex relations or gender expression has increased.

“We see that people who should come forward for services are also not coming forward because of this backlash on rights,” said Byanyima.

Byanyima also spoke about resilience and a response to the Trump administration’s cuts to the U.S. President’ Plan for AIDS Relief (PEPFAR), which, according to the 2025 UNAIDS report, supported HIV testing of 84 million people in 2024 in countries with high HIV burdens and HIV treatment for 20.6 million people.

“We also see that countries, governments and civil society are not lying down and waiting to die, that there is action, that there is transformation,” said Byanyima. In a sample of 60 low- and middle-income countries, 25 indicated that they were talking about or planning reallocation of funds for HIV-related efforts, and some are HIV services, she said, and some have created new sources of funding.

In her remarks and in the foreword to the 120-page report, Byanyima heralded the achievements of the response to the HIV epidemic. Compared with 2010, the number of new HIV infections in 2024 had decreased by 40% worldwide, and the number of AIDS-related deaths had decreased by 56% over the same period.

“The story is one of the most successful public health responses in history, saving more than 26 million lives, showing what is possible when the world comes together to fight a disease,” Byanyima said at the live event in Johannesburg, while noting that gaps remain and that 1.3 million people were newly infected in 2024.

UNAIDS issued the annual report three days before the International AIDS Society meeting in Kigali, Rwanda, is scheduled to start on July 13. The five-day meeting focuses on science and research, but the implications of U.S. funding cuts are expected to be a major theme of the meeting.

UNAIDS’ 95-95-95 targets call for 95% of all people living with HIV knowing their status, 95% of those who have been diagnosed with HIV to be receiving treatment and 95%. Figures in the forward of today’s show shortfalls in all three categories in 2024: 87% of people living with HIV knew their status, 89% who were diagnosed were receiving aantiretroviral therapy,and 94% who were treated had a suppressed viral load.

The 95-95-95 targets are seen as milestones toward achieving the goal of ending AIDS as a public health threat by 2030, which the UNAIDS has defined as reducing the number of new infections and AIDS-related deaths by 90% from the number that occurred in 2010. The UNAIDS report says between 2010 and 2024, new HIV infections decreased by 56% in sub-Saharan Africa, 21% in the Caribbean, and 17% in Asia and the Pacific but increased by 94% in the Middle East and North Africa, 13% in Latin America, and 7% in Eastern Europe and Central Asia. The report says new infections have increased in 32 countries and that the world is “off track” from reaching the goal of 370,000 fewer infections by a wide margin.

The pulling back of $7.1 billion in PEPFAR funds was part of the Trump administration’s broad cancellation of foreign aid programs and the shuttering of the United States Agency for International Development, which implemented a large percentage of PEPFAR programs. The administration issued waivers to the foreign aid freeze for some PEPFAR projects, particularly those for pregnant and breastfeeding women.

Even before the PEPFAR cuts, prevention efforts were lagging behind the stated goal. According to the UNAIDS report, highly effective prevention options such as preexposure prophylaxis (PrEP) reached 3.9 million people last year, far below a 2025 target of 21.2 million people. The report says PEPFAR funded 90% of the PrEP starts in 2024, making the future of PrEP programs especially shaky. The report highlights what has happened with PrEP in Nigeria. The reported number of people receiving PrEP fell from 43,000 in November 2024 to below 6,000 in April 2025. According to the latest available data about Nigeria’s AIDS spending, almost all of the country’s PrEP program was funded by PEPFAR.

The forward of the report mentions Gilead’s lenacapavir PrEP, which is administered as a twice-a-year injection, and a “suite of long-acting medicines.”

“Within the next few years, annual injections and monthly tablets to prevent HIV could be a reality,” the report says. “We could be on the verge of an HIV prevention revolution that reduces new infections towards epidemic control — if the world comes together again to overcome monopolies, drive down prices and ensure everyone who could benefit has access to these new, highly effective prevention tools.”

Byanyima stressed that HIV is a global disease. “We need the global solidarity to keep fighting together, and developing countries are putting their foot forward. Rich countries must also maintain support to end a global disease,” she said.