A recent highly controversial modeling study has sounded the alarm about anticipated cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR). This important effort is managed by the Agency for International Development (USAID). This study highlights the potentially devastating impact on new HIV cases and related deaths in low- and middle-income countries (LMICs), where PEPFAR funding plays a pivotal role in sustaining HIV programs.
PEPFAR counteracts these actions as the largest source of international funding devoted exclusively to combatting HIV and AIDS. More than 54% of this financial assistance flows to low- and middle-income countries (LMICs). The United States has a key role if not the most critical in the fight against the HIV epidemic. Its total contribution is more than 72% of the overall global funding for HIV programs. However, proposed funding cuts put these important efforts in jeopardy. If they do, infection rates and mortality among the people who would be most affected might increase exponentially.
The ramifications of such severe funding cuts would be devastating. Even if PEPFAR ends cold turkey by January 20, 2025, we are still looking at the precipice of a deep cliff with grave consequences. Without these fresh funding sources, projections indicate that HIV infections and deaths may double, reversing the tremendous progress we’ve made since 2000. The report cautions that without this crucial funding, we risk an extra 10.8 million new HIV infections. It further forecasts 2.9 million additional deaths than on our current trajectory.
Impact of Funding Cuts on HIV Programs
The most direct impact of these funding cuts is apparent. PEPFAR’s critical services were forced to shut down temporarily because of funding shortfalls, until a provision in the law granted a waiver that let some programs keep running. Sadly, this waiver wasn’t enough to get timely funding into qualifying programs. Consequently, numerous clinics were forced to shut their doors long before the waiver was granted.
The ripple effects of these draconian cuts would be felt for decades. The reality is that the research shows it can be done in two years or less. The fight against AIDS as a public health threat would require an additional 20 to 30 years of sustained funding at 2024 levels.
“It is paramount now to track AIDS mortality and HIV incidence while urgently reversing the cuts, mitigating the effects, and creating new funding strategies to prevent further suffering.”
PEPFAR’s funding cuts would guarantee a disastrous increase in new infections and deaths. That’s not a small number—that number represents a very real danger posed to millions of American lives. Dr. Ali Zumla pointed out that the consequences of these choices are dire:
Overall, the study paints a hopeful yet cautionary tale that advances in fighting HIV won’t happen by default. It crucially depends on ongoing political commitment and investment. Dr. Zumla further warned about the repercussions if current funding trends continue:
“Overall, we think most sources of uncertainty are likely to result in underestimating rather than overestimating the real effects of immediate and severe funding cuts to HIV programmes globally, especially in the sub-Saharan African region.”
Long-term Consequences for Global Health
This sentiment is echoed by Justin Parkhurst, who highlights the severe risks associated with abrupt program terminations:
“The projected surge in new infections and deaths is not an inevitability; it is a consequence of choices being made today.”
National experts are encouraging immediate action to protect existing programs as policymakers look to reallocate money while looking to identify new methods of funding. At the same time, the urgency increases because we’ve come so far in our battle against HIV over the last 20 years. These hard-won victories are still fragile.
“If these funding cuts move forward, we risk unraveling decades of hard-won progress, leaving millions vulnerable and pushing global HIV goals further out of reach.”
The international community must recognize that cutting HIV funding not only threatens current progress but could result in a regression that takes generations to overcome.
“This study indicates that an abrupt termination of programmes has serious risks to human life.”
The Need for Urgent Action
As policymakers consider budget allocations, experts urge immediate action to safeguard existing programs and explore new funding strategies. The urgency is compounded by the knowledge that the fight against HIV has achieved notable victories over the past two decades, but these gains are fragile.
Dr. Hankins cautioned against complacency:
“But all of that progress is vulnerable and could be wiped out within a few years if there are dramatic and unmanaged cuts to HIV services.”
The international community must recognize that cutting HIV funding not only threatens current progress but could also result in a regression that takes generations to overcome.
