Call for urgent support as U.S. funding cuts threaten HIV/AIDS programs

Call for urgent support as U.S. funding cuts threaten HIV/AIDS programs

Amid ongoing funding disruptions for U.S. aid programs, a group of international experts is calling for urgent action to ensure continued life-saving interventions and support for children and families affected by HIV/AIDS in sub-Saharan Africa.

The new analysis of health policy, published inThe LancetIt is estimated that 1 million children could become infected with HIV, nearly half a million could die of AIDS by 2030, and 2.8 million children could become orphans in the region without consistent, stable funding for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).

The authors say their analysis presents strong evidence that funding PEPFAR programs for at least five years is critical to preventing unnecessary pediatric illness, death and orphanage, maintaining current progress in efforts to prevent new HIV infections worldwide, and maintaining the U.S. position as a leader in global health diplomacy.

PEPFAR, established by the United States government in 2003, has been a cornerstone in combating the global HIV/AIDS epidemic and provides over $120 billion in funding to treat and prevent HIV/AIDS. The program is estimated to have saved more than 26 million lives and ensured that 7.8 million babies were born HIV-free. It currently supports over 20 million people with HIV prevention and treatment services, primarily in sub-Saharan Africa.

However, continued funding for PEPFAR programs remains uncertain, raising concerns about the future of HIV/AIDS prevention and treatment efforts, particularly in light of U.S. President Trump's executive order halting all foreign assistance for 90 days, pending a review. Although PEPFAR received a limited waiver of some programs, many of PEPFAR's services have been interrupted or suspended as of January 20, 2025.

The future of Pepfar programs hangs in the balance. The loss of stable, long-term support for PEPFAR programs derails global progress to return HIV/AIDS to the dark age of the epidemic, particularly for children and adolescents. A sudden withdrawal of Pepfar programs, particularly in the absence of a long-term strategy to replace them, could lead to a resurgence of HIV infections and preventable deaths and a dramatic increase in the number of children orphaned by AIDS in the coming years - a setback that could erode two decades of progress. “

Lucie Cluver, co-lead author and professor at the University of Oxford

Cluver added: “Further investment in PEPFAR programs, combined with continued growth in African co-financing, can create a sustainable transition for country-led ownership of HIV programs and preserve Pepfar’s legacy of life-saving work.”

The authors conducted an original modeled analysis, using existing data, to identify the risks posed to children in sub-Saharan Africa in the absence of PEPFAR programs, including increased HIV infections, AIDS-related deaths, and orphanhood. The estimates suggest that by 2030 there could be 1 million new cases of pediatric HIV and 460,000 additional AIDS deaths among children. If there is a complete termination of PEPFAR, it could significantly reduce adult life expectancy and leave 2.8 million additional children orphaned.

“We are already seeing the devastating effects of recent foreign aid being frozen in the US,” said co-author Susan Hillis, Imperial College, London, UK. "By eliminating many programs, Pepfar supports children beyond HIV treatment and prevention, such as programs that prevent sexual violence and support children's overall health and well-being. Many of the children and adolescents who currently benefit from Pepfar programs will fall through the cracks that increase their chances of acquiring HIV or lead to further transmission, ultimately resulting in HIV infections and deaths increase."

The authors also highlight how PEPFAR programs have demonstrated long-term sustainability by reducing children's lifetime risk of acquiring HIV. Before the widespread availability of antiretrovirals in Africa, more than 20 million people died of AIDS-related causes in the region, leaving millions of orphaned children. PEPFAR's efforts have contributed significantly to reducing the number of AIDS orphans from its peak of over 14 million children in 2010 to 10.5 million by 2023.

In addition to modeling the immediate impact of Pepfar funding disruptions, the authors assessed PEPFAR's impact beyond HIV/AIDS, highlighting international diplomacy, economic benefits—including a four-fold increase in two-way trade between the U.S. and countries in Africa, educational improvements, and protection of health children and protection of swarms and protection of children.

"Renewing PEPFAR investments protects the health and well-being of millions of people and reinforces the U.S. position as a global leader in foreign aid and health diplomacy. Programs like Pepfar have successfully increased U.S. public opinion and enabled bilateral cooperation, not only with countries receiving PEPFAR support, but also globally. PEPFAR would be a Creating a gap that is likely to be occupied by other countries. Reports indicate that China and Iran are taking global health leadership roles, allowing them to increase their influence in the region," said co-lead author Gibstar Makangila, executive director of Circle of Hope (Zambia).

The authors also offer insights into building more sustainable PEPFAR programs in 2030 and beyond. He leads ongoing efforts to unite both international and local partners to close funding gaps, increase country and community-led initiatives, and support improvements to domestic health systems. PEPFAR-supported countries in Africa have already demonstrated commitments to ownership of HIV responses in 2030 with progressive increases in co-financing health systems from $13.1 billion per year in 2004 to $40 · $7 billion per year in 2021.

"Our analysis not only highlights the immediate impact of inadequate funding, but also highlights the broader socio-economic benefits of Pepfar investments and offers a glimpse into the future of Pepfar programs, where long-term strategies that build local capacity to improve health and well-being and improve well-being," said co-author Joel-Pascal Ntwali-N’konzi from the University of Oxford (UK).

Co-author Prof Chris Desmond from the University of KwaZulu-Natal (South Africa) added: "What is urgently needed now is a well-planned transition to expanded land ownership of Pepfar programs that will advance this life-saving work and provide stability and sustainability for countries currently on Pepvern to market. HIV."

The authors note some important limitations to this analysis, including that the international funding landscape is changing rapidly and the future of Pepfar programs is unknown. In addition, this analysis used the best available data on HIV infection and mortality rates to develop future estimates.

In related correspondence, also published inThe Lancet11 senior health officials from African countries wrote: “We are confident that we can achieve the goal of ending the HIV and AIDS pandemic as a global threat to our children and families as our African nations work with the United States and other international donors to move forward to strengthen and increase domestic investment in HIV and HIV health -HIV. World safer, stronger and wealthier. “

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