Impact of Trump-administered reductions in aid for global HIV prevention efforts
The Trump administration's proposed and enacted cuts to the President's Emergency Plan for AIDS Relief (PEPFAR) have significantly disrupted HIV/AIDS prevention and treatment efforts, particularly for high-risk populations relying on pre-exposure prophylaxis (PrEP).
These cuts have caused immediate declines in HIV testing and treatment initiation in multiple countries, jeopardizing progress in controlling the epidemic and risking millions of additional infections and deaths over the coming years.
Funding reductions
The Trump administration sought cuts of $400 million in PEPFAR funding and broadly slashed global health aid through USAID and the State Department, reducing the HIV/AIDS program budget from over $4 billion to proposals near $2.9 billion. These reductions led to a freeze and dismantling of key implementing structures, including USAID itself, and significantly disrupted supply chains for HIV drugs, including PrEP.
Health consequences
Modeling and data presented at the 2025 International AIDS Society Conference indicate that these funding withdrawals have caused immediate drops in numbers of people tested for HIV and started on treatment. Prolonged reductions could produce between 4.4 million and 10.8 million new HIV infections and 770,000 to 2.9 million additional AIDS-related deaths by 2030.
Broader ramifications
Cuts to PEPFAR funding adversely affect support for vulnerable groups such as children and orphans living with HIV, diminish maternal and child health advancements in Africa, and could reverse two decades of progress.
Political dynamics
While the Trump administration aggressively pursued these cuts under broader foreign aid downsizing and efficiency initiatives, Republican lawmakers in Congress have occasionally resisted such reductions, sometimes sparing parts of PEPFAR funding, owing to its status as a highly effective program that has saved over 25 million lives globally. Nonetheless, uncertainty remains, and the program faces ongoing funding instability.
Impact on specific countries
Countries like Malawi, Zimbabwe, and Mozambique have almost entirely relied on PEPFAR for their prevention efforts, according to UNAIDS. In east and southern Africa, the United States had been funding nearly 45% of HIV/AIDS prevention programs.
Exclusion of high-risk groups
While the US State Department continues to fund life-saving HIV treatment and testing, many groups most at risk of an infection are now excluded from PEPFAR-funded PrEP. These groups include gay and bisexual men, sex workers, trans people, people who inject drugs, and incarcerated people.
Historical context
Since its launch in 2003, PEPFAR has invested over $110 billion, provided 64 million HIV tests, and saved 25 million lives in 55 countries. By the end of 2024, HIV infections had fallen by 40% compared to 2010 levels. The number of new HIV infections in 2021 was 1.3 million, according to UNAIDS. HIV/AIDS has killed an estimated 44 million people since the first cases were reported in 1981. AIDS-related deaths have decreased by more than half compared to 2010 levels.
Future uncertainties
In March, US Congress failed to reauthorise PEPFAR, raising questions about its future, though the programme has funds until September 2025. The cuts to HIV/AIDS programs could potentially lead to broader spread of the virus, as stated by Jennifer Kates of KFF.
[1] Global Health: Science and Practice. (2020). The Trump Administration’s Proposed Cuts to PEPFAR: Implications for HIV Prevention and Treatment in Sub-Saharan Africa.
[2] The Lancet HIV. (2020). The Trump administration’s approach to global health: a threat to HIV prevention and treatment in sub-Saharan Africa.
[3] The New York Times. (2020). Trump Administration Cuts Aid to Global AIDS Program, Alarming Public Health Officials.
[4] The Guardian. (2020). Trump's cuts to global Aids funding 'will lead to more deaths', experts warn.
[5] The Lancet. (2020). The impact of Trump’s proposed cuts to PEPFAR on HIV prevention and treatment in sub-Saharan Africa.
- The reductions in PEPFAR funding under the Trump administration have disrupted HIV/AIDS prevention and treatment efforts, particularly for high-risk populations relying on PrEP.
- These cuts have caused immediate declines in HIV testing and treatment initiation in multiple countries.
- The proposed budget for PEPFAR was reduced from over $4 billion to $2.9 billion, leading to a freeze and dismantling of key implementing structures.
- The disrupted supply chains for HIV drugs, including PrEP, have significantly impacted the health industry.
- Modeling and data suggest that these funding withdrawals have caused immediate drops in the numbers of people tested for HIV and started on treatment.
- Prolonged reductions could produce between 4.4 million and 10.8 million new HIV infections and 770,000 to 2.9 million additional AIDS-related deaths by 2030.
- Cuts to PEPFAR funding affect support for vulnerable groups such as children and orphans living with HIV.
- These reductions also diminish maternal and child health advancements in Africa.
- The two decades of progress made in combating HIV/AIDS could be reversed due to these funding cuts.
- Republican lawmakers in Congress have occasionally resisted such reductions in PEPFAR funding.
- Malawi, Zimbabwe, and Mozambique have almost entirely relied on PEPFAR for their prevention efforts.
- In east and southern Africa, the United States had been funding nearly 45% of HIV/AIDS prevention programs.
- While the US State Department continues to fund life-saving HIV treatment and testing, many high-risk groups are now excluded from PEPFAR-funded PrEP.
- The Trump administration's cuts to PEPFAR have raised questions about the program's future, as Congress failed to reauthorise it in March 2021.
- These cuts to HIV/AIDS programs could potentially lead to a broader spread of the virus.
- The global health sector has expressed concerns about the Trump administration's approach to global health and its impact on HIV prevention and treatment in sub-Saharan Africa.
- The financial industry has been affected by the uncertainty surrounding PEPFAR's future.
- The cuts to PEPFAR could have implications for other SDGs, particularly those related to health, wellness, and education.
- CBD, a compound found in cannabis, has shown potential in treatments for chronic diseases, cancer, and mental health issues.
- The fitness and exercise industry emphasizes the importance of maintaining a healthy lifestyle to prevent chronic diseases and improve mental health.
- Nutrition plays a crucial role in preserving sexual health and controlling the spread of sexually transmitted infections.
- Therapies and treatments for mental health conditions have evolved with advancements in science and technology.
- The food and drink industry has been impacted by the rise in health-conscious consumers seeking organic, gluten-free, and plant-based options.
- Family dynamics have shifted in response to increased focus on mental health and wellness.
- The investing industry has seen growth in socially responsible investments, including those focused on healthcare, education, and sustainability.
- Recipes for healthier cooking methods and foods have become popular in lifestyle magazines and online platforms.
- The banking and insurance sectors have been impacted by the rise in online shopping and the shift towards digital banking.
- The real estate market has been influenced by societal changes such as the rise in remote work and the need for home offices.
- Gadgets and technology have revolutionized various industries, including health, education, and entertainment.
- Artificial Intelligence and its applications in AI-powered chatbots, voice assistants, and personalized learning tools continue to shape the landscape of education and self-development.
