International HIV Funding Cuts Threaten to Reverse Decades of Progress

• International HIV funding cuts are weakening prevention, testing, and community services.  

• The most immediate risk is not widespread treatment disruption, but declining prevention and case detection that could increase transmission and late diagnosis.  

• High-burden countries with limited fiscal capacity and heavy donor dependence face the greatest risk.

• Domestic funding increases remain insufficient to offset declining international support, leaving prevention and community-led services particularly vulnerable.  

• Continued service reductions are likely to disproportionately affect key populations, women, children, and other underserved groups.  

• Disruptions to laboratories, surveillance, supply chains, health information systems, and community health workforces could further undermine progress.   

In 2025, an estimated 41 million people were living with HIV, of whom 32.1 million were receiving antiretroviral therapy (ART). Approximately 1.2 million people acquired HIV, and 570,000 died from AIDS-related illness, representing declines of 42 percent and 57 percent, respectively, since 2010. Mother-to-child transmission has also fallen by 69 percent since 2010, with approximately 93,000 children acquiring HIV in 2025, the first time the annual total has fallen below 100,000 in several decades.  

Progress remains uneven and insufficient to meet the 2030 goal of ending AIDS as a public health threat. Approximately nine million people living with HIV were not receiving treatment in 2025, including more than 580,000 children. Global coverage also remains below the UNAIDS 95-95-95 targets, which aim for 95 percent of people living with HIV to know their status, 95 percent of those diagnosed to receive treatment, and 95 percent of those on treatment to achieve viral suppression. Global progress stood at approximately 88-89-95, with only 11 countries achieving all three targets.  

Sub-Saharan Africa continues to account for approximately half of new HIV infections, while infections are increasing in parts of eastern Europe and central Asia, Latin America, and the Middle East and North Africa.  

The sharp decline in international HIV financing in 2025 has exposed the extent to which epidemic control in many high-burden countries remains dependent on external support. Available resources for HIV programs in low- and middle-income countries fell to approximately USD 17.6 billion, about USD 4.3 billion below the estimated annual requirement to meet 2030 targets. International HIV funding declined by 18 percent, while donor government funding fell by roughly 25 percent, largely due to reductions in US foreign assistance.  

This concentration of funding creates systemic vulnerability. The US accounted for approximately 74 percent of donor government HIV financing in 2025. Domestic HIV financing increased by four percent and now accounts for roughly 59 percent of total spending in low- and middle-income countries. Still, most governments lack the fiscal capacity to replace lost external support rapidly.  

The impact of funding cuts extends beyond program budgets. A survey of 166 PEPFAR-supported organizations across 46 countries found that more than 77 percent experienced grant terminations or payment delays in 2025, contributing to the closure of at least 1,714 clinics, mobile units, drop-in centers, and other HIV service sites. Fewer than two percent of organizations secured alternative funding to replace these losses.  

Disruptions are also affecting wider health-system capacity. A WHO survey of 107 countries found that 47 reported HIV service disruptions in 2025, including interruptions to testing, pre-exposure prophylaxis (PrEP), and adult or pediatric ART. Eleven countries reported treatment disruptions, while nine had less than six months of stocks for major treatment regimens. Twenty-six countries reported disruptions to health data systems, and 29 reported losing staff, including laboratory technicians, data analysts, and community health workers. These less visible losses could have longer-term consequences by weakening surveillance, laboratory capacity, supply forecasting, and program management.   

Treatment continuity has generally been prioritized, but prevention, testing, and community-led services have absorbed deeper cuts. PEPFAR prevention spending fell by 51 percent between 2024 and 2025. In sub-Saharan Africa, more than 80 percent of HIV prevention funding came from international sources in 2024, leaving these programs particularly vulnerable to funding reductions.  

Community-based organizations are especially exposed because they provide essential services for populations facing stigma, discrimination, criminalization, or barriers to conventional healthcare. Their loss risks widening existing gaps among key populations, women, children, and other underserved groups.  

The effects of HIV funding reductions are likely to emerge gradually rather than through an immediate collapse of programs. ART coverage may remain comparatively stable as governments and implementing partners prioritize treatment continuity, potentially masking deterioration elsewhere in the response. Over time, reduced prevention and testing, weaker community outreach, workforce losses, and degraded data systems are likely to increase transmission risks, delay diagnosis, and undermine treatment retention and outcomes. The greatest risk is concentrated in high-burden countries with heavy donor dependence, limited fiscal space, and weak integration of HIV services into national health systems.  

Without predictable transition financing and sustained investment in prevention and community services, the global HIV response is likely to become increasingly fragmented. The principal risk is not an immediate collapse in treatment programs, but a progressive erosion of epidemic control that reverses gains made over more than two decades and jeopardizes the 2030 goal of ending AIDS as a public health threat. This represents the most complete data available as of Aug. 17.

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