Abrupt funding cuts have resulted in “perilous risks” for the global HIV response that threaten the health and well-being of millions of people throughout the world, according to the 2025 UNAIDS report released on Tuesday.
“People living with HIV have died due to service disruptions, millions of people at high risk of acquiring HIV have lost access to the most effective prevention tools available,” notes the UNAIDS report.
“Over two million adolescent girls and young women have been deprived of essential health services, and community-led organisations have been devastated, with many being forced to close their doors.”
The UN agency has been forced to slash staff by more than half as it too has been defunded by the US government since the Trump administration took charge in January and froze all foreign aid, including the US President’s Emergency Plan for AIDS Relief (PEPFAR).
“It feels like the ground has been ripped out from under our feet,” a Mozambican woman with HIV told UNAIDS.
“Before, we had places to go, people to talk to, and we knew someone cared. I felt supported when there were peer groups and community counsellors.”
A South African sex worker and mother of three who lost access to antiretroviral (ARV) therapy for four months told the agency: “The only thing I could think of was my kids, and that I am going to die.”
Immaculate Bazare Owomugisha, of the International Community of Women Living with HIV based in Uganda, said that “community structures that supported people to remain engaged in care and come in for testing have been phased out” and her organisation had to retrench more than 30 people who did community-based monitoring.
PEPFAR supported 20 million people living with HIV in 55 countries, including 222,000 people on ARVs and 190,000 healthcare workers, according to the PEPFAR Program Impact Tracker. It estimates that the funding freeze has caused 132,933 adult deaths and 14,150 child deaths (by 25 November).
Long-lasting effects of disruptions
Although funding for some PEPFAR-supported HIV programmes has restarted, “service disruptions associated with these and other funding cuts are having long-lasting effects on almost all areas of the HIV response”, according to the report.
Access to treatment for many people with HIV in West and Central Africa was disrupted as donors cover 90% of the costs for antiretroviral (ARV) medicine.
In eastern and southern Africa, this figure is 38%. In Eswatini, which has the highest HIV prevalence in the world (23% of adults aged 15- 49 years), the HIV programme lost 20% of its funding.
In Ghana, 29% fewer pregnant women with HIV received ARVs to prevent HIV transmission to their babies during the first six months of 2025
Vital tests – CD4 counts and viral loads which gauge whether ARV treatment is working – have plummeted in several countries.
Some people didn’t get ARVs because funding cuts affected procurement and supply-chain management systems, resulting in stock-outs of HIV medicines in the Democratic Republic of the Congo, Ethiopia and Kenya.
But even quantifying the disruptions is difficult, as data capturers have lost their jobs and community-led monitoring has been disrupted.
However, the report identifies the most vulnerable areas as being HIV testing, prevention and care; data collection; community-led responses; services for “key populations” and human rights and gender equality.
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Collapse of services for key populations
“Key populations” refers to groups most vulnerable to HIV and where the virus is hardest to eliminate – often because these groups are heavily stigmatised.
These include adolescent girls and young women, men who have sex with men (MSM), sex workers, people who inject drugs, transgender people and prisoners.
“Donor funding accounts for most of the funding (100% in western and central Africa) for tailored HIV testing services in settings focusing on key populations,” according to the report.
In Zimbabwe, for example, many HIV services for sex workers and other key populations have “effectively collapsed” this year. Most key population clinics in Kenya and at least five in Nigeria have closed.
Over three-quarters (77%) of harm reduction programmes and other HIV services for people who inject drugs had been “severely disrupted by funding cuts”, according to a UNAIDS survey in April.
Prevention disrupted
Funding cuts have substantially affected access to pre-exposure prophylaxis (PrEP), antiretroviral therapy to prevent HIV infection, usually also targeted at groups at the highest risk of HIV.
When the US government resumed funding via bridging agreements in October, it made it confined several services, including PrEP, to pregnant and breastfeeding women only.
By mid-October, the AIDS Vaccine Advocacy Coalition estimates that 2.5 million people have lost access PrEP this year. This includes 64% of people in Burundi, 38% in Uganda and 21% in Viet Nam.
Meanwhile, male condom distribution fell by 55% in Nigeria between December 2024 and March 2025,
The number of HIV tests performed declined by 43% in Cameroon from January through July.
Community outreach ‘eliminated’
Community-led organisations play an important role in HIV prevention, testing, care and treatment services, including direct provision of these services – particularly for “key populations”.
“Community outreach services have been reduced or eliminated in Angola and Eswatini due to funding cuts’” the report notes.
“Over 60% of women-led HIV organisations have lost funding or been forced to suspend essential programmes, leaving entire communities without access to vital services”, while a survey of 45 youth organisations found that 60% had experienced a sudden and significant loss of resources.
Community-led organisations of men who have sex with men in Kenya, Mozambique and Viet Nam reduced staffing by at least one-third.
African solutions
Increasing domestic financing for HIV is essential, but tricky for many countries in western and central Africa, where public debt service is on average 5.5 times greater than public health allocations.
However, UNAIDS estimates that it is feasible for the domestic share of HIV financing to rise from 52% in 2024 to two-thirds by 2030.
This year, Nigeria approved a $200 million increase in its health budget. Uganda is taking steps to double its domestic spending on health, while Côte d’Ivoire and South Africa have increased their domestic investments to help mitigate the effects of reduced donor support.
Twenty-six of the 61 countries reporting to UNAIDS stated they expect to increase their domestic public HIV budgets.
African leaders adopted the Accra Reset earlier this year, calling for “a new era of health sovereignty rooted in national ownership, investment and leadership”.
Meanwhile, an extraordinary session of the African Union Assembly is being convened in next month to secure support for the implementation of the African Union’s roadmap on “sustaining the AIDS response, ensuring systems strengthening and health security for the development of Africa”.
African leaders have also committed to strengthening local manufacturing of medical products, and the vaccine alliance, Gavi, has committed $ 1.2 billion to the Africa Vaccine Manufacturing Accelerator initiative.
The report also introduces the new Global AIDS Strategy (2026–2031), to be adopted by the UNAIDS Programme Coordinating Board in December.
The new strategy is “person-centred and has fewer focused targets”. It focusses on integrating HIV services into national programmes, reducing stigma, and securing sustainable financing.
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UNAIDS estimates that $21.9 billion will be needed annually until 2030 to achieve global HIV targets in low- and middle-income countries.
“HIV programmes are at a time of great vulnerability and risk when people living with, at risk of or affected by HIV are losing access to lifesaving services and the organisations that support those communities are being decimated,” the report notes.
“There is hope, however, as seen through the political will and the resilience that both communities and countries have demonstrated in the past months. The world has come a very long way already on this journey and now is not the time to pause or step back. Now is the time to keep the promise and end AIDS by 2030.”
Image Credits: JB Russel/ The Global Fund/ Panos.
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