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The policy decisions made by Donald Trump to cut foreign aid are poised to have dire consequences for the fight against Aids. According to emerging data, the number of deaths attributed to Aids could escalate dramatically, reaching four million additional fatalities by 2030 if vital funding is not reinstated.
Recent projections from the UN Aids agency (UNAIDS) indicate that Aids-related deaths globally could rise from six million to ten million in the upcoming five years due to the funding gaps. The disruptions in global HIV initiatives caused by the US administration’s cuts are also expected to produce over three million additional Aids orphans by the decade’s end.
Notably, just last year, the UN had expressed optimism about the potential to end the Aids epidemic by 2030. This goal involved a 90% reduction in both new infections and fatalities related to the disease.
New data suggests that there will be an increase of 3.4 million orphaned children—those having lost at least one parent to Aids—and an estimated 600,000 more newborns may become HIV positive by 2030, effectively more than doubling initial forecasts and bringing the total number of infant infections to one million.
At an HIV/AIDS clinic in Jinja, Uganda, healthcare workers are providing services without any US funding and are anxious about running short on essential medications.
In response to the alarming data, Professor Francois Venter from the University of Witwatersrand in Johannesburg notes, “Many advancements we’ve made over the past two decades are at risk of being undone.” He recalls a time when hospitals were overwhelmed with dying patients, warning that current facilities will soon find themselves similarly unprepared for the increasing number of cases.
Testing and preventive programs aimed at high-risk groups in South Africa are collapsing due to interrupted funding.
Overview of HIV and Aid Funding Cuts Under Trump
January 20: Trump announces a freeze on foreign aid, implementing a 90-day review.
January 24: US aid-funded programs are halted.
February 1: Limited exceptions are established for “urgent life-saving HIV treatments,” yet clarity issues and staff shortages disrupt services.
February: Legal challenges arise against funding decisions, while the Trump administration resists mandates to pay aid partners.
By March 10: A majority of international aid grants and contracts are canceled.
March 25: Approval for the largest global HIV program funded by the US expires.
By March 28: USAID confirms a shutdown, resulting in significant staff layoffs.
April 19: The review period concludes without a clear plan for reinstating funding.
“Key population programs have been completely halted,” emphasizes Venter. “Community HIV testing has nearly stopped altogether.”
On Trump’s first day as president, he imposed a 90-day freeze on nearly all US foreign assistance funds pending a review to ensure alignment with “American interests.” Although the review period is coming to an end, many contracts were terminated beforehand.
This disruption has led to significant fallout, including lost records and patients missing out on critical medications.
Current estimates link approximately 35,000 deaths to these significant HIV funding freezes, as indicated by research from scholars studying the US-funded HIV initiative.
Data from UNAIDS outlines a troubling scenario in which, absent renewed funding for the President’s Emergency Plan for Aids Relief (PEPFAR), the leading global HIV response initiative, Aids-related deaths could surge to over three times higher than prior expectations by 2029, potentially rising from 490,000 to 1.6 million.
PEPFAR, initiated in 2003 during George W. Bush’s presidency to address a fast-growing HIV crisis, provides essential resources for medication, prevention, and research efforts across more than 50 nations.
Individuals receiving effective HIV treatment can lead near-normal lives and are less likely to spread the virus. However, lacking such treatments increases morbidity and transmission risks.
PEPFAR also supports testing, condom distribution, and PrEP (pre-exposure prophylaxis) that significantly reduce the rate of new infections. If PEPFAR services cease entirely, by the end of this year, annual new infections could double to 1.6 million, far exceeding the previously projected figure of 830,000 for 2025.
UNAIDS’ projections anticipate a worst-case scenario in which US funding for HIV programs remains absent and no alternative support from other donors or governmental entities emerges.
The Independent sought comment from the US State Department, which declined to provide definitive information regarding the full restoration of PEPFAR. Secretary of State Marco Rubio has indicated his desire for PEPFAR to continue but suggests a gradual reduction. Although some services for pregnant women and new mothers have been allowed to persist, on-ground implementation remains hindered by ambiguity and resource scarcity.
In recent years, there has been a decline in HIV infections among newborns. However, cuts to PEPFAR funding threaten to reverse this trend sharply. Without timely interventions, more than half of infants born with HIV, either in utero or through breastfeeding, may not reach their second birthdays.
Amidst these financial setbacks, The Independent met Hadja in southern Uganda. This mother-of-three contracted HIV before her fourth pregnancy and is now deprived of essential medications that help control her viral load. She fears her inability to access treatment will endanger her unborn child.
“Once medication stops, the virus can rebound swiftly,” warns Professor Lucie Culver from the University of Oxford. “Children are particularly vulnerable due to their weaker immune systems.”
“Just recently, I received a heartbreaking image of a young girl in a hospital in Liberia with no antiretrovirals available. She was born HIV positive and likely has only two years to live,” she adds.
Significant progress has been achieved in controlling the HIV epidemic over the past two decades, and there had been hope for an eventual end to the crisis, notes Angeli Achrekar, deputy director of UNAIDS.
Yet, she cautions, “With 2,300 new infections occurring every day, the targets for ending Aids are becoming increasingly unattainable. The flow of new infections cannot be halted under these conditions.”
Some nations are crucially dependent on US PEPFAR support more than others. For instance, Tanzania relies on PEPFAR for 94% of its HIV services.
Reports from the field indicate that in Zimbabwe, where PEPFAR funds accounted for 60% of HIV services, supplies are dwindling, causing government hospitals to turn away patients.
“We lack facilities to manage or mitigate the number of infections, yet there is simply no medication available,” says Promise Masawi, a volunteer health worker.
The effects of these funding cuts can be gauged not only in terms of health and mortality but also in the increased difficulty of treating HIV effectively.
Without their antiretroviral treatments, individuals who resume therapy face a higher risk of developing drug-resistant infections, making treatments less effective.
With limited options for alternative medications, healthcare providers are left with costlier options once initial treatments fail—a year’s supply of the standard HIV drugs costs $64, while the second-line therapies run about $300. If patients must move on to a third-line treatment, the expense jumps to $405—an increase of six times the original treatment cost.
This scenario presents a significant threat to the progress made over decades toward ending the Aids pandemic.
“This situation is profoundly tragic,” Achrekar concludes, highlighting the human cost of such policies. “In the end, these aren’t just numbers; they are lives at stake.”
This article is part of The Independent’s Rethinking Global Aid project
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