Experts warn of rising HIV deaths with planned aid cuts

Global deaths from HIV/AIDS and new infections could soar to levels unseen since the start of the century if planned funding cuts to foreign aid are sustained, undermining years of progress, experts warn.

A study published today (Thursday) in the journal The Lancet HIV estimates there could be 4.4 million to 10.8 million additional new HIV infections by 2030 in low- and-middle income countries and 770,000 to 2.9 million HIV-related deaths in children and adults.

The administration of UN President Donald Trump has severed support for humanitarian work worldwide—including withdrawing the US from the World Health Organization and freezing funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Agency for International Development (USAID).

Other major international donors, such as the United Kingdom, France, Germany, and the Netherlands, which together with the US, account for over 90 per cent of international aid, have also announced plans to implement significant cuts to foreign aid.

Collectively, it could lead to a 24 per cent reduction in global international HIV funding by 2026, according to the researchers.

Progress unraveled

Historically, the US has been the largest contributor to the global HIV response, investing more than US$100 billion through the PEPFAR since it was established in 2003.

However, cuts to PEPFAR and USAID-supported programmes have already severely disrupted access to essential HIV services, including for antiretroviral therapy and HIV prevention and testing, says Debra ten Brink of the Burnet Institute, Australia, co-lead author of the study.

“Looking ahead, if other donor countries reduce funding, decades of progress to treat and prevent HIV could be unravelled,” she said.

“It is imperative to secure sustainable financing and avoid a resurgence of the HIV epidemic which could have devastating consequences, not just in regions such as Sub-Saharan Africa, but globally.”

‘Ten-fold increase’

Separately, the head of the UN agency coordinating the fight against HIV-AIDS warned that an additional 6.3 million people will die in the next four years, unless support is reinstated. This represents a “tenfold increase” from the 600,000 AIDS-related deaths recorded globally in 2023, she said.

“We will see a … real surge in this disease,” UNAIDS executive director Winnie Byanyima told journalists in Geneva on Monday (24 March).

“[We] will see it come back and we [will] see people dying the way we saw them in the 90s and in 2000s.”

She also predicted an additional 8.7 million new infections—up from 1.3 million new infections globally in 2023.

Mathematical model

The authors of The Lancet HIV study used a mathematical model to estimate the effects of anticipated international aid reductions in 26 countries, including the immediate end to support from PEPFAR in all countries currently dependent on foreign aid to support programmes to diagnose and prevent HIV.

They found there could be between a 1.3- to six-fold increase in new infections for people at higher risk of acquiring HIV, compared to if funding levels remained as they were.

The greatest impact would likely be in Sub-Saharan Africa and among vulnerable populations, including people who inject drugs, sex workers, men who have sex with men, and children, according to the researchers.

They called for a multipronged approach to help offset the effects of sudden funding cuts and build long-term sustainability.

HIV integration

“Integrating HIV care with other primary healthcare services may improve efficiency and leverage shared resources,” said Rowan Martin-Hughes, a senior researcher at Burnet Institute and co-author of the study.

He noted that in Vietnam, this integration along with health insurance to cover HIV services, centralising antiretroviral therapy procurement and mobilisation of domestic resources, has resulted in an increase in domestic financing of the HIV response from 32 per cent in 2013 to 52 per cent in 2022.

“Introducing a modest HIV-specific tax levy or incorporating HIV services into a broader health insurance mechanism may provide additional domestic funding streams,” he told SciDev.Net.

“Such measures, although challenging, have been successfully tried in some Sub-Saharan African countries.”

In many countries, HIV services have existed separately from the rest of the government-funded health system, because of the international focus on the disease, Martin-Hughes explains, adding that healthcare workers, infrastructure, and other basic pillars of health systems in many resource-poor countries have been supported by HIV funding.

“These are the countries that are being most acutely affected by the immediate pausing of that aid,” he said.

Angela Muvumba Sellström, senior researcher at the Nordic Africa Institute, believes the findings are credible.

She says the short-term result of the withdrawal of this much aid will be an increased disease burden on weak health infrastructure, especially in Africa.

“And of course, we expect large levels of deaths as people living with HIV and without access to medicine become more vulnerable to HIV-related illnesses,” she told SciDev.Net.

She challenged international large-scale financing actors like the African Development Bank, World Bank and the IMF to commit more to financing for health and ease the debt burden by rescheduling payment for some African governments.