What's the impact of Trump's aid cuts on global HIV prevention?

BERLIN - U.S. President Donald Trump's foreign aid cuts have had a severe impact on HIV prevention efforts worldwide, said health experts who feared new infections might already be surging and millions more could die of AIDS as a result.

A July report by UNAIDS said that if the Trump administration's HIV cuts remain permanent, there could be six million extra infections and four million more deaths by 2029.

Here's what you need to know:

What global HIV/AIDS funds did Trump cut?

The Trump administration has cancelled more than 80% of programmes led by the U.S. Agency for International Development (USAID) and this month shut down the organisation.

As a result, many HIV/AIDS programmes have been cancelled, including funding for surveillance systems that helped track the spread of the virus, education campaigns and clinics offering tests and treatment.

A limited waiver in February permitted "life-saving" treatment services funded by the flagship President's Emergency Plan for AIDS Relief (PEPFAR) to resume. But pre-exposure prophylaxis (PrEP) medicine that helps the prevention of HIV remains curtailed for most people.

PEPFAR has invested more than $110 billion since it was launched in 2003, provided 64 million HIV tests and saved 25 million lives in 55 countries, the State Department says.

In March, U.S. Congress failed to reauthorise PEPFAR, raising questions about its future, though the programme has funds until September 2025.

How have U.S. aid cuts impacted HIV prevention?

In east and southern Africa, the United States had been funding nearly 45% of HIV/AIDS prevention programmes.

Countries like Malawi, Zimbabwe and Mozambique have almost entirely relied on PEPFAR for their prevention efforts, according to UNAIDS. 

While the U.S. State Department continues to fund life-saving HIV treatment and testing, as well as mother-to-child transmission prevention, 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.

At least 3.5 million such people have lost access to PEPFAR-funded HIV prevention in the past six months, according to data last updated this month by PrEPWatch, a global tracker set up by the HIV non-profit AVAC.

Many sites catering to these vulnerable groups have also closed due to the cuts.

Health officials and activists say some of those who have lost access to the preventative medication because of the foreign aid cuts are already testing positive.

But measuring the increase in HIV infections is impossible as the organisations tracking the spread have also been defunded.

How could these cuts impact the fight against HIV/AIDS?

By the end of 2024, infections had fallen by 40% and AIDS-related deaths by more than half compared to 2010 levels. But there were still 1.3 million new infections last year, UNAIDS said.

Experts say cutting prevention efforts could undermine decades of progress in the fight against the virus, which has killed an estimated 44 million people since the first cases were reported in 1981.

"In HIV, it's really important from an epidemiological perspective to stop infections and to stop spread among those most at risk," said Jennifer Kates of KFF, a non-profit organisation working in health policy.

"By not providing PrEP and cutting back on prevention services for those populations, it really risks continuing broader spread. That's just how infectious diseases work."

(Reporting by Enrique Anarte; Editing by Jon Hemming.)