HIV funding cuts risk 'unravelling decades of progress', global health experts warn

Without renewed commitment and action, the world risks a resurgence of the HIV epidemic as funding cuts threaten progress. The recent cuts in the global HIV response threaten to unravel decades of progress, highlighting the need for moving beyond donor dependence, global health experts warn. These cuts are severely impacting HIV prevention, testing and key components of treatment programmes, such as the range of community-led services that reach the people most affected by HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS) said in a new report. Prevention programmes have historically relied heavily on donor assistance in most regions. But in 2025, external financing for the global HIV response in low- and middle-income countries fell by 18% compared with 2024, the largest decline in international HIV resources in almost 20 years. “The donor funding allowed us to get to where we are now,” Mwelwa Phiri, expert in HIV/AIDS at the Antwerp Institute of Tropical Medicine and Zambart in Zambia, told Euronews Health. If the underfunding continues, Phiri added, the situation will “definitely go backwards.” While the full effects of the funding cuts will become evident over the next few years, the effects are already being seen on the ground. “We're not going to reach [those in need], because we've stopped doing what we were doing, which was working,” said Phiri. She added that, from one day to the next, the money was gone, causing people to lose their jobs, services to be abruptly cut, and health systems left unable to respond. “People don't deserve to suffer because decisions are made abruptly. People need dignity wherever they are, no matter how poor they are, and we can offer some social dignity by planning this properly and ensuring that this is done right,” she said, adding it is important to give time to the health systems to respond to cuts. One of the biggest donors to withdraw its support was the United States through the dismantling of the United States Agency for International Development (USAID). “USAID funding actually supported some staff in the health facilities and what we've seen is that the staff that are there are stretched and the health system is overburdened at this point, and it's harder for people to access services,” Phiri said. She explained that not everyone who needs HIV testing feels unwell, which deters them from attending crowded, overstretched health facilities, leading to fewer people knowing their HIV status. “We do not have volunteers going out into the communities to offer testing to people who are not able to come to the facility,” Phiri added. As with every other condition, the sooner a patient knows they are infected, the sooner they can start treatment. For HIV, early detection is essential; starting treatment early prevents the condition from progressing and allows patients to reach an undetectable viral load, meaning the virus cannot be transmitted to others. National data submitted to UNAIDS show major declines between 2024 and 2025 in pre-exposure prophylaxis (PrEP) uptake in Cameroon, Nigeria and Zambia, with each country recording a decline of more than 50% in the number of people receiving PrEP at least once during the year. Decades of progress now at risk Decades of hard work and global solidarity have reduced the annual numbers of people acquiring HIV and people dying from AIDS-related causes to their lowest levels in more than 30 years, the UNAIDS report noted. Worldwide, the number of AIDS-related deaths in 2025 was 57% lower than in 2010, decreasing from 1.3 million in 2010 to 570,000. At the same time, in December 2025, 32.1 million people living with HIV were receiving treatment — an annual increase of 3% from 2024. However, experts warn that these gains could be reversed by the abrupt defunding. Globally, countries are not on track to reach the HIV elimination targets set for 2030, the UNAIDS report warns. In 2024, there were one million more new infections and 400,000 more AIDS-related deaths than there would have been had the world been on track to reach the global targets. According to the UN agency, “mortality remains unacceptably high for a treatable condition.” Moving towards ending reliance The current financial landscape requires a shift away from donor dependence towards country ownership and domestic financing, with continued global solidarity, according to the UN report. Phiri agreed: “We have to continue, plan it and do it in a phased manner for this to be beneficial for everybody, for the people on the ground, for the funders, and for the health systems and countries "There are a lot of fundamental structural issues that need to be addressed to get there, not just within the health system, but across different sectors, including social welfare," she said, stressing the need for sufficient time to fill the gaps through a gradual withdrawal of funding.