US Aid Cuts Hit Global HIV Prevention: What Happens Next

Global HIV prevention is taking a major hit. The United States has sharply reduced foreign aid for HIV programmes. UNAIDS warns this could lead to millions of extra infections by 2030. The cuts affect testing, medication and prevention in dozens of countries.

What exactly changed?

In early 2025 the Trump administration froze large parts of US foreign aid. This includes PEPFAR, the President's Emergency Plan for AIDS Relief. PEPFAR has been the world's biggest HIV programme since 2003. It is credited with saving over 25 million lives, according to the US State Department.

After the freeze, many clinics in Africa and Asia closed their doors. Staff were sent home. Patients lost access to free testing and to PrEP, the pill that prevents HIV. Some emergency waivers followed, but the system is unstable. UNAIDS reported in May 2025 that drug shipments had been delayed in more than 50 countries.

Why this matters for HIV numbers

HIV prevention only works when it is continuous. People on PrEP need a steady supply. People with HIV need daily medication to stay healthy and to avoid passing the virus on. When supply stops, the virus spreads again.

UNAIDS modelling published in 2025 estimates that ongoing cuts could cause up to 6.3 million extra HIV infections worldwide by 2029. Up to 4.2 million extra AIDS-related deaths are possible in the same period. These figures assume the cuts are not reversed.

The World Health Organization (WHO) has echoed this warning. WHO Director-General Tedros Adhanom Ghebreyesus called the cuts a threat to decades of progress. He urged donor countries to fill the gap.

Who is most affected?

The biggest impact is in sub-Saharan Africa. Countries like South Africa, Mozambique and Uganda relied heavily on PEPFAR. In these countries, gay and bisexual men, sex workers and transgender people often depend on US-funded clinics. Local public health systems do not always serve them well.

In Asia, programmes in Thailand, Vietnam and the Philippines also took hits. These countries had been expanding PrEP access for gay and bisexual men. Several rollouts are now paused.

In wealthier countries, including the Netherlands, the direct impact is smaller. Dutch PrEP and HIV care are funded nationally. But experts warn that more global infections eventually affect everyone. Viruses do not respect borders.

What do experts say?

Aidsfonds, the Dutch HIV charity, called the cuts “a disaster for global health” in a statement in March 2025. Director Mark Vermeulen said years of work could unravel within months. He called on the European Union to increase its contribution.

The International AIDS Society (IAS) issued a similar warning. IAS president Beatriz Grinsztejn said the world was “closer than ever” to ending AIDS as a public health threat. She argued that withdrawing now wastes the investment already made.

The RIVM, the Dutch public health institute, monitors HIV trends in the Netherlands. It has not yet reported a direct effect from the US cuts. But RIVM does note that imported infections could rise if global prevention weakens.

What about new prevention tools?

The timing is painful because science is advancing fast. In 2024 the drug lenacapavir showed nearly 100% protection against HIV in a large trial in young women. It is given as an injection twice a year. Many experts called it a game-changer.

But a game-changer only works if people can get it. Without funded programmes, lenacapavir may stay out of reach in low-income countries. The manufacturer Gilead has signed licensing deals for generic versions, but distribution depends on national programmes — the same programmes now being cut.

For an overview of where HIV vaccine research stands, see our piece on HIV vaccine research in 2026.

What does this mean for you?

If you live in the Netherlands or another Western European country, your access to PrEP and HIV care has not changed. PrEP is available through GGD clinics and general practitioners. HIV treatment is fully covered by basic health insurance.

A few practical points:

• If you use PrEP, keep your appointments and tests. Continued use protects you and breaks transmission chains.
• If you have HIV, stay on your medication. Undetectable means untransmittable (U=U).
• If you travel to countries with weaker health systems, bring enough medication. Do not assume local supply.
• Test regularly for HIV and other STIs. Free testing is available through the GGD.

For broader STI prevention, also see our explainer on Doxy-PEP and bacterial STIs.

What happens next?

European countries are under pressure to step up. The Global Fund to Fight AIDS, Tuberculosis and Malaria is preparing a new funding round in 2026. The outcome will shape the next decade of HIV response.

In the US, some PEPFAR funding has been restored through congressional pressure. But the long-term direction remains unclear. NGOs warn that even short interruptions cause lasting damage. Patients lost to care often do not return.

UNAIDS continues to publish monthly updates on country-level impact. Aidsfonds and other organisations are running campaigns to raise emergency funding.

The bottom line

The world had a realistic path to ending AIDS as a public health threat by 2030. That path is now under serious strain. Whether the goal is still reachable depends on political choices in the coming year. Science has delivered the tools. The question is whether the funding will follow.

If you want to support continued HIV work, Aidsfonds and the Global Fund both accept donations. National policy advocacy — writing to your MEP or MP — is another route. For most readers, though, the most useful action is simple: stay tested, stay on treatment or PrEP if relevant, and keep the conversation going.