Report: The world risks facing a new wave of the HIV epidemic

Recent cuts to funding for the global HIV response are putting decades of progress at risk and, according to global health experts, demonstrate that the world needs to move away from its dependence on donor funding.

The funding reductions are already affecting HIV prevention, testing and key components of treatment programs, including community-led services aimed at people most affected by HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS) said, according to Euronews.

Historically, HIV prevention programs in many regions have relied heavily on donor assistance. However, in 2025, external funding for the global HIV response in low- and middle-income countries fell by 18% compared with 2024 — the largest decline in international HIV funding in almost two decades.

“Donor funding enabled us to get to where we are today,” said Mwelwa Phiri, an HIV/AIDS expert at the Institute of Tropical Medicine in Antwerp and Zambart in Zambia. If underfunding continues, she warned, the situation “will definitely start to deteriorate.”

The full impact of the funding cuts will become clearer in the coming years, but their first consequences are already being seen on the ground.

“We will no longer be able to reach the people who need help because we have stopped doing the things we used to do, and those things worked,” Phiri said.

She added that funding disappeared almost overnight: people lost their jobs, services were abruptly shut down, and health systems were left struggling to respond.

“People should not suffer because decisions are made suddenly. People need a dignified life wherever they live and no matter how poor they are. We can ensure social dignity if we plan properly and make sure things are done correctly,” she said, stressing that health systems need sufficient time to adapt to funding reductions.

US funding cuts raise concerns

One of the largest donors to withdraw support was the United States, following the effective dismantling of the US Agency for International Development (USAID).

“USAID funding essentially covered the costs of some health facility staff, and now we are seeing the remaining workers become overwhelmed while the health system is operating at its limits, making it harder for people to access services,” Phiri said.

She explained that not everyone who needs an HIV test feels unwell, which can discourage people from visiting overcrowded and overstretched health facilities. As a result, fewer people may learn their HIV status.

“We no longer have volunteers going into communities and offering testing to people who cannot reach health facilities,” Phiri added.

As with other diseases, the earlier an infection is detected, the sooner treatment can begin. For HIV, early diagnosis is particularly important. Starting antiretroviral therapy in time prevents the disease from progressing and can reduce the viral load to an undetectable level, at which point the virus cannot be sexually transmitted to other people.

HIV prevention is already being affected

National data submitted to UNAIDS show that between 2024 and 2025, coverage of pre-exposure prophylaxis (PrEP) fell sharply in Cameroon, Nigeria and Zambia. In each of these countries, the number of people who received PrEP at least once during the year declined by more than 50%.

According to the UNAIDS report, decades of sustained work and global solidarity have helped reduce annual new HIV infections and AIDS-related deaths to their lowest levels in more than 30 years.

Worldwide, the number of AIDS-related deaths in 2025 was 57% lower than in 2010, falling from 1.3 million to 570,000. Meanwhile, by December 2025, 32.1 million people living with HIV were receiving treatment, 3% more than in 2024.

However, experts warn that this progress could be reversed if funding is abruptly withdrawn.

The 2030 targets are at risk

According to UNAIDS, the world is already behind schedule in meeting the goal of ending the HIV epidemic by 2030.

In 2024, there were 1 million more new HIV infections and 400,000 more AIDS-related deaths than there would have been if the world had remained on a trajectory toward meeting global targets.

The UN agency estimates that “the death rate remains unacceptably high for a disease that can be treated.”

The current financial situation, according to the UN report, requires a transition away from dependence on donors toward greater national responsibility and domestic financing, while maintaining global solidarity.

Phiri agrees that such a transition is necessary but says it must be carefully managed.

“We need to keep going, plan carefully and implement changes gradually so that the outcome benefits everyone: people on the ground, donors, health systems and countries,” she said.

She added that achieving this will require addressing fundamental structural problems not only within health systems but also in other areas, including social protection.

The transition away from donor funding, she emphasized, must be gradual and allow enough time to close emerging gaps in HIV prevention, testing and treatment.

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