The US government’s decision to pause foreign assistance in January 2025 has triggered a global funding crisis for HIV/AIDS programs, potentially leading to an additional 6 million infections and 4 million deaths by 2029, a UNAIDS report warns.
The Global Fund to Fight AIDS, Tuberculosis and Malaria raised $11.34 billion during its November 2025 replenishment summit, falling short of its $18 billion target for 2027–2029. The United States, the largest contributor, reduced its pledge to $4.6 billion from a previously announced $6 billion, though it remains the primary donor. This partial funding response risks straining existing programs and delaying critical interventions.
HIV remains a major global health challenge, having claimed an estimated 44.1 million lives to date. An estimated 40.8 million people were living with HIV in 2024, with 65% concentrated in sub-Saharan Africa. Over 11 million individuals had unsuppressed viral loads last year, underscoring gaps in treatment coverage.
Global Fund Executive Director Anne Phelan stated that the “old model” of heavy reliance on international donors is unsustainable, urging nations to prioritize domestic financing. However, she cautioned against abrupt transitions that could destabilize health systems. Melanie Bisnauth, a public health expert, advocates for a multi-pronged approach, including integrating HIV services into primary care, leveraging domestic resources through taxation and insurance schemes, negotiating lower drug costs, and enhancing regional procurement networks to reduce costs.
The reduction in US funding has already caused immediate disruptions, including shortages of antiretroviral therapies and HIV prevention supplies, and potential job losses in the health sector that could create service inefficiencies. Programs in affected regions have scaled back services, while governments face pressure to reallocate limited domestic resources or seek alternative donors. Prolonged funding uncertainty threatens to reverse decades of progress, eroding public trust in health systems and increasing risks of drug resistance and poorer health outcomes.
These developments highlight the urgent need for African nations to diversify funding through domestic resources and innovative partnerships, while global donors must sustain commitments to prevent catastrophic setbacks in HIV/AIDS control.