A generation after the peak of the AIDS epidemic, the global fight against HIV is facing a dire setback. The Trump administration’s freeze on foreign aid has thrown critical HIV treatment programs into chaos, jeopardizing the lives of millions who rely on the U.S.-funded President’s Emergency Plan for AIDS Relief (PEPFAR).
PEPFAR, widely regarded as one of the most successful foreign aid programs in history, has provided lifesaving antiretroviral treatment to millions of people worldwide. However, confusion surrounding a temporary waiver for PEPFAR—combined with widespread disruptions to U.S.-funded contractors, healthcare workers, and financial systems—has led to significant gaps in access to essential medications. Health experts warn that without immediate intervention, the world could see a devastating resurgence of AIDS-related deaths.
A Looming Health Crisis
The United Nations AIDS agency has projected that up to 6.3 million people could die from AIDS-related illnesses within the next five years if treatment disruptions continue. This grim warning comes amid rising global complacency about HIV, declining condom use among young people, and reliance on pre-exposure prophylaxis (PrEP), a medication that some believe could help end the epidemic.
To track the impact of the aid freeze, the U.N. has begun monitoring new HIV infections worldwide. Experts warn that if treatment interruptions persist, the virus could mutate, becoming more resistant to existing drugs and increasing transmission rates.
The Consequences of Stopping HIV Treatment
HIV, which is transmitted through bodily fluids such as blood, semen, and breast milk, weakens the immune system and leaves individuals vulnerable to life-threatening infections. The AIDS epidemic of the 1980s shocked the world with the sudden emergence of rare diseases among young, otherwise healthy people. Intense advocacy efforts led to the creation of PEPFAR in 2003, providing treatment to millions who would have otherwise died.
Antiretroviral drugs prevent HIV from replicating in the body, keeping viral levels undetectable and significantly reducing the risk of transmission. However, when patients stop taking these medications, the virus rapidly multiplies, leading to immune system failure and the onset of AIDS. Within weeks, HIV can rebound to detectable levels in the bloodstream, endangering both patients and their sexual partners. Pregnant women with untreated HIV also face a higher risk of transmitting the virus to their newborns.
Without treatment, the Centers for Disease Control and Prevention (CDC) estimates that people with AIDS typically survive only about three years. Opportunistic infections such as pneumonia, tuberculosis, and fungal diseases become increasingly difficult to fight. The situation is particularly dire in countries like South Africa, which has both the highest number of HIV cases and one of the largest tuberculosis burdens in the world.
Urgency to Restore PEPFAR’s Operations
For years, HIV-positive individuals have been urged to take their medications daily, at the same time each day, to prevent viral resistance. Now, with the future of U.S. funding uncertain, that crucial consistency has been shattered.
Thousands of healthcare workers and outreach staff funded by PEPFAR have already lost their jobs in countries like Kenya and Ethiopia, leading to a collapse in HIV testing, treatment, and support services. Some clinics in Africa have been forced to turn patients away, leaving them without access to the drugs they need to survive.
Reversing the damage caused by the Trump administration’s aid freeze will take time—time that many people with HIV simply do not have. While a 90-day review period is underway to determine the fate of PEPFAR funding, health officials warn that delays could be catastrophic.
Meanwhile, Winnie Byanyima, head of the U.N. AIDS agency, has raised concerns that prolonged treatment interruptions could lead to the emergence of more resistant strains of HIV, further complicating efforts to control the epidemic.
If the crisis is not resolved swiftly, experts warn that an additional 3.4 million children could be orphaned, echoing the devastating early years of the AIDS epidemic when millions died with few treatment options available. As the world waits for a resolution, the lives of millions hang in the balance.