A new modeling study demonstrates the disastrous future effects we can expect from predicted cuts to international HIV funding. Such reductions would hit low- and middle-income countries (LMICs) particularly hard. The report examines the effects of funding reductions by large bilateral donors, including the United States, United Kingdom, France, Germany and the Netherlands, on global HIV programs. These cuts wreak havoc on the impact of these critical programs. Since 2015, LMICs have depended on international sources for an average of 40% of their HIV program funding. The study considers three scenarios: maintaining current levels of funding, reinstating or recovering funding equivalent to PEPFAR levels, and the worst-case scenario of indefinite cessation of PEPFAR funding. These study results determine that the worst-case scenario may lead to 2.9 million more HIV-related deaths by 2030.
Recent disruption of PEPFAR services has further exacerbated this distressing trend. This pause came after the administration of then-President Donald Trump released an executive order. Although the state has made efforts to restore services, more than half of clinics are still closed and funding hasn’t been quickly returned. Researchers urged that if Congress does not fully reinstate or otherwise replace PEPFAR funding by 2025, the impacts would be dire. They project up to 1.73 million more new HIV infections and 61,000 more deaths if we don’t sustain current levels of support.
Global Impact of Funding Cuts
The study highlights the important role of international funding in sustaining HIV program efforts in LMICs. With five out of the top six donor countries announcing severe foreign aid cuts, the life of these programs hangs in the balance. Dr. Catherine Hankins, a professor at McGill University, described the seriousness of the crisis.
"Modelling reveals the potential for severe consequences following abrupt stopping, with no notice, of international support aimed at stopping AIDS as a global public health threat," said Dr. Catherine Hankins.
Dr. Crump and colleagues write that without immediate action, the increase in infections will reverse almost all progress made since 2000. People in vulnerable populations—including sex workers—would be hit hardest by the funding cuts.
Potential Scenarios and Outcomes
Each scenario represents an opportunity for future funding, and the analysis in the study details their possibility. The first scenario holds HIV spending at recent levels from 2025 to 2030. The second scenario imagines a return of PEPFAR funding or similar support, while the third and most alarming scenario anticipates an end to all PEPFAR funding.
Even in this worst-case scenario, researchers expect the HIV epidemic to increase dramatically. They project an additional 10.8 million cases and 2.9 million deaths at current funding levels are not sustained. Additionally, Dr. Hankins emphasized that time is of the essence to monitor trends in HIV incidence and mortality rates.
"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," added Dr. Hankins.
There’s one major point that the study’s authors want to make clear. They caution that despite finding replacement funding in two years, the damage from these cuts will be felt for decades.
The Call for Sustainable Solutions
Fighting HIV is a battle of sustained political will and sustained investment, the study makes clear. Co-author Dr. Ali Zumla warned that the expected surge in infections and deaths was a result of policy choices being made today.
"The projected surge in new infections and deaths is not an inevitability; it is a consequence of choices being made today," remarked Dr. Ali Zumla.
He further warned against complacency in the fight against HIV.
"These findings are a sobering reminder that progress in the fight against HIV is not guaranteed — it is the result of sustained political will and investment," said Dr. Ali Zumla.
To address this research gap, the researchers are calling on national governments and international organizations to fundamentally rethink how they spend foreign aid in this space. Strategic planning now will save excessive damage to millions that rely on these essential programs.
