In Mozambique, a teenage rape victim sought care at a health clinic but found it closed. In Zimbabwe, AIDS-related deaths have increased for the first time in five years. In Ethiopia and the Democratic Republic of Congo (DRC), patients with suspected HIV remained undiagnosed due to test-kit stocks running out.
Stories of the devastating impact of US, British and wider European aid cuts on the fight against HIV – particularly in sub-Saharan Africa – are looming by the end of 2025, and have emerged in a series of reports released last week.
The Trump administration abruptly cut all foreign aid spending in January, with funding restored only piecemeal since then. Other countries including Britain have announced their own cuts. It is estimated that external health assistance in 2025 will be 30% to 40% less than in 2023.
Winnie Byanyima, USAID’s executive director, said: “The complex ecosystem that sustains HIV services in dozens of low- and middle-income countries was fundamentally shaken.”
Without rapid action to get services back on track, UNAIDS estimates that there will be 3.3 million more new HIV infections than expected by 2030. And although some countries are showing signs of improvement, including new domestic funding, access is still not universal.
The UN agency’s report found that services working to prevent HIV infections were particularly likely to be donor-funded and to be among the hardest hit – with limited resources, priority has been given to treating existing patients. For example, in Burundi, the number of people receiving preventive HIV drugs has declined by 64%.
A separate series of country-level reports from the British charity Frontline AIDS, covering Angola, Kenya, Malawi, Mozambique, Nigeria, Tanzania, Uganda and Zimbabwe, highlights similar issues.
It will take time to collect complete data, but in some places there are already signs that new HIV cases, or AIDS-related deaths, are increasing after years of decline.
Many gains in the fight against HIV in recent years have come through the recognition that certain groups of people are at greater risk of infection – known as “key populations”. These include men who have sex with men, people who inject drugs, sex workers, transgender people, and prison inmates.
In each case, offering services specifically designed to suit the needs of those groups has paid off – for example, LGBTQ+ friendly walk-in clinics can mean access to care for people who avoid public clinics because of the stigma associated with HIV.
Many of those clinics and other outreach services have closed, as have many community-led organizations that previously relied on donor funding. A member of the LGBTQ+ community in Uganda, quoted in the Frontline AIDS country report, said that the loss of safe spaces has left them “isolated and exposed (…) the mental stress is very high”.
In sub-Saharan Africa, adolescent girls and young women are disproportionately affected by HIV, but programs designed specifically for them are another common casualty of the cut.
In Kenya, activists report that those who can do so are hiding the fact that they are from a dominant population in order to safely receive care at public clinics. They fear it will mean information about where and how the virus is spreading will be lost.
John Plaistow, executive director of Frontline AIDS, said: “We are already seeing progress being rolled back.”
But Plaistow also saw the potential for reimagining health policies. “In many countries,” he said, “we are seeing the first signs of governments and communities working together to build more sustainable, domestic HIV responses.”
UNAIDS also gave signs of hope, with countries including Nigeria, Uganda, Côte d’Ivoire, South Africa and Tanzania all pledging to increase domestic investment.
And, he said, innovations such as new long-acting injectable drugs to prevent infections were “gaining momentum.”
“We know what works – we have the science, the tools and proven strategies,” Byanyima said. “We need political courage now: investing in communities, in prevention, in innovation, and in protecting human rights as a path to ending AIDS.”
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