Four million more people could die of AIDS-related causes by 2029 if US aid gap isn’t filled

The temporary suspension of PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, and financial cuts impacting the fight against HIV will result in millions of unanticipated deaths and infections, warns UNAIDS in its report AIDS, Crisis, and the Power to Transform released this Thursday.

PEPFAR, which began in 2003 during George W. Bush’s presidency, had planned $4.3 billion for more than 50 countries in 2025, but this funding was abruptly halted in January of this year. If this financing is not replaced by some alternative, there is a risk that four million more people will die from AIDS-related deaths and six million additional HIV infections will occur between 2025 and 2029.

The report warns that instability in multilateral cooperation is not only due to cuts by the U.S. and other Global North countries but also increasing challenges such as wars, geopolitical shifts, and climate crises. The risk is not just that millions will die, but that years of progress in the fight against AIDS will be lost. “At the end of 2024, the declines in numbers were not sufficient to end AIDS as a public health threat by 2030 — but the means and the momentum for doing so existed. Examples of country successes were multiplying [...] New scientific breakthroughs continued to be made,” highlights the UNAIDS report.

Worldwide, nearly 40 million people are living with HIV: more than half are women and girls. In 2023, there were 630,000 deaths due to AIDS, and 61% of them lived in sub-Saharan Africa.

Over the last two decades, PEPFAR has provided prevention services, treatments, and community worker support in the regions hardest hit by HIV, such as the African continent. According to its own figures, it has helped save 26 million lives. The temporary freeze of the program ordered by U.S. President Donald Trump — along with other global health support programs — is already causing preventable harm among the most vulnerable populations.

UNAIDS Executive Director Winnie Byanyima explained in a recent interview with EL PAÍS that if the funding gap caused by the cuts is not closed, an additional 6.6 million new infections could be recorded by 2029. In 2024, there were 1.3 million new infections.

Byanyima also highlighted the impact of the cuts in Africa: “In the field of HIV, 73% of all external assistance came from a single country: the United States. So the impact of that withdrawal has been devastating, especially in countries with a high HIV burden. Most are in Africa and are also saddled with enormous debt. Many of them are spending four or five times more money on debt repayment than on health care, and they also have to deal with droughts, floods, and other consequences of climate change.”

UNAIDS fears that donor cuts will undermine the progress made in recent years in the fight against the HIV pandemic. Since 1996, the organization reports, 26.9 million deaths have been prevented thanks to treatment. In 2024 alone, 31.6 million people, or 77% of those living with the virus, were treated, according to Mary Mahy, director of Data for Impact at UNAIDS.

At a press briefing organized by the International AIDS Society (IAS) ahead of the XIII AIDS Conference to be held next week in Kigali, Mahy said the situation is especially dire in nine countries — Ethiopia, Haiti, Liberia, Malawi, Mozambique, Nigeria, South Sudan, Tanzania, and Zimbabwe — where over 90% of the HIV response depends on donor resources. “It will be essential to analyze the situation in these countries, determine how to support them, review their expenditures, and calculate their domestic contributions. This is not easy in a context of high debt burden,” she explained.

Peter Sands, executive director of the Global Fund, which fights AIDS, tuberculosis, and malaria, lamented the deep inequalities that persist in the fight against AIDS. “Globally, 45% of new infections in 2024 occurred among women and girls, a percentage that rises to 63% in sub-Saharan Africa,” he said.

“Every week, 4,000 adolescent girls and young women between the ages of 15 and 24 are infected with HIV, enough to fill nearly 80 classrooms, most of them in sub-Saharan Africa,” he added.

The UNAIDS report highlights critical cases such as Nigeria, where the number of people receiving pre-exposure prophylaxis (PrEP), a preventive HIV treatment, dropped significantly — from 43,141 people in November 2024 to just 6,000 patients in April 2025.

In Kenya, there was a sudden drop in HIV diagnostic testing for two-month-old infants in February 2025: 2,528 tests were administered in November, 1,333 in March, and the number rebounded to 2,750 in April.

The report also warns that community programs — which play a key role in encouraging vulnerable populations to access prevention and treatment services — are at risk. For example, 60% of women-led programs lost funding or suspended services in February 2025, and 45% of frontline community partners working against HIV have faced cuts, according to the report.

Of 60 countries analyzed by UNAIDS for this report, 25 plan to increase their national budgets to address the disease. While Mahy welcomed this news, she noted that in 35 other countries, domestic funding will either remain flat or, in some cases, decrease.