The United Nations has issued a dire warning that millions could die by 2029 if US funding for HIV programs isn’t replaced. According to The Hindu, this comes after the abrupt withdrawal of $4 billion in funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR). According to UN officials, this sudden shortfall poses a systemic threat to global HIV prevention and treatment efforts, especially in vulnerable regions where the epidemic is still widespread.
Since the cuts began in early 2025, HIV-related healthcare systems in several developing countries have started to crumble. Clinics have closed their doors, antiretroviral supply chains have broken down, and large-scale testing and outreach programs have stalled. Community-led prevention services—especially those targeting key populations like sex workers, men who have sex with men, transgender people, and young girls—are now severely disrupted.
UNAIDS Executive Director Winnie Byanyima called the decision reckless and dangerous, warning that without urgent replacement of funds, the world could witness up to six million new HIV infections and an additional four million deaths by the end of this decade. She stressed that the impact will be most devastating in low-income countries, where PEPFAR has historically played a vital role in saving lives and controlling the spread of the virus.
Sub-Saharan Africa is expected to bear the brunt of this crisis. In countries such as Nigeria, PEPFAR accounts for nearly all HIV prevention medications and support services. In the Democratic Republic of Congo, critical post-exposure prophylaxis kits have become unavailable, leaving sexual assault survivors unprotected and driving new infections upward. Local health workers have reported that HIV rates are rising above national averages in many underserved areas.
Adding to the crisis is the collapse of HIV surveillance systems. For years, US funding supported the backbone of global HIV data infrastructure—everything from electronic medical records to early warning systems for drug resistance. With these systems now paralyzed, experts fear health authorities will be flying blind, unable to detect or respond quickly to new outbreaks. Global health expert Dr. Chris Beyrer emphasized that without timely data, prevention efforts will lose direction and effectiveness, making it much harder to stop the virus from spreading.
Despite the grim outlook, there is a glimmer of hope in the form of a breakthrough injectable HIV prevention drug, Yeztugo (lenacapavir). Approved recently in the United States, this drug has shown 100 percent effectiveness in clinical trials and only needs to be administered twice a year. However, affordability and accessibility remain major concerns. Without expanded licensing and reduced prices, low- and middle-income countries may not be able to offer this life-saving treatment to those most in need. Pharmaceutical companies, in collaboration with international health agencies, are planning to make it available to two million people in Africa by the end of the year, but much more will be required to bridge the growing gap.
The funding crisis has emerged at a time when many donor nations are also slashing international aid budgets. Several European countries have redirected funds toward defense and internal priorities, further shrinking the pool of available support. UNAIDS and partner organizations have already announced deep cuts to their field operations, including a 50 percent reduction in staffing, which will severely affect HIV prevention, treatment, and community mobilization efforts in high-burden areas.
As the world stands at a crossroads, the call for action has never been louder. Global leaders, philanthropic organizations, and the private sector must step up to fill the void left by the US funding cuts. Equitable access to new prevention tools like lenacapavir must be fast-tracked. HIV surveillance systems must be restored to ensure a data-driven response. And most importantly, the global community must reaffirm its commitment to ending AIDS—not just through words, but with sustained funding and coordinated action.
The UN’s warning serves as a wake-up call. Without swift and strategic intervention, the world risks undoing decades of progress in the fight against HIV/AIDS. Time is running out, but with renewed focus, innovation, and global solidarity, the worst-case scenario can still be prevented.
Photo Credit: The Hindu
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