The chances of the world ending Aids as a public health threat by 2030 are looking increasingly remote, according to concerned global health experts at the 26th International Aids Conference in Brazil this week, who cited steep cuts in US funding as a major setback, reports News24.
International HIV funding plunged in 2025, almost entirely due to the drastic reductions in US support, with Desmond Tutu HIV Foundation CEO Professor Linda-Gail Bekker saying it is “very unlikely” HIV would be eradicated as a pandemic by 2030 because new infections were not falling fast enough and alternative funding had yet to materialise.
The funding cuts threaten to reverse decades of progress, according to the new data released at the Rio de Janeiro event, which is being convened by the International Aids Society (IAS), and attended by around 7 000 scientists, policymakers, healthcare workers, funders and people with HIV to chart the future of the global response amid growing financial uncertainty.
IAS president and Aids 2026 International co-chair Beatriz Grinsztejn said the scale and speed of the funding cuts were unprecedented.
“Never has donor funding fallen so far, so fast, and those most vulnerable are already paying the price.”
Bekker said current trends showed the reduced odds of the 2030 target being achieved, “judging by the trajectories of mortality reduction and incidence reduction – that is, new infections”.
The most critical aspect is the reduction in new infections, and that is off by quite a long shot. Although various international commitments had renewed hope, she said the funding cuts had significantly undermined those ambitions.
“Clearly, alternative resources are going to have to be found, and it isn’t yet clear where and in what volume that new funding is going to be.”
Treatment Action Campaign general secretary Anele Yawa agreed that the 2030 target was looking unreachable, and that the withdrawal of US funding had fundamentally disrupted the global HIV response.
However, he said responsibility could not rest solely with the US.
“Some of the countries need to take responsibility. With the withdrawal of that funding, as well as a shrinking funding space, the response is under threat.”
Governments would increasingly have to rely on domestic resources to sustain HIV programmes, he added, noting that in South Africa, between 70% and 75% of the national HIV response was already funded domestically, with international donors contributing roughly a quarter to a third of overall funding.
He said that domestic investment had helped cushion the impact after US-funded NGOs were forced to scale back services., and that despite the challenges, the country had recorded significant achievements, including the successful rollout of the 1.1m Close the Gap campaign, wider implementation of multi-month dispensing of ARVs, and the introduction of long-acting HIV-prevention technologies.
Addressing delegates, Deputy Health Minister Joe Phaahla acknowledged that the HIV response had entered a “new era”, and that countries would have to become less dependent on international donors and take greater ownership of their own HIV programmes.
He said the new Global Aids Strategy marked a shift away from donor-led programmes towards country-owned responses, and that sustainability was no longer simply about replacing lost donor funding.
“Sustainability is about ensuring that countries have the institutions, systems, financing mechanisms, workforce capacity, governance structures and community partnerships required to maintain HIV gains for generations to come.”
Phaahla warned that prevention programmes, services for vulnerable populations and community-led initiatives remained particularly exposed as the international funding landscape continued to change.
The warnings from Rio come as UNAIDS continues to caution that without urgent investment and renewed political commitment, gains made over the past two decades could be reversed, placing millions of lives at risk.
Africa, Asia take the brunt
Recent research from the Clinton Health Access Initiative (CHAI) has corroborated the concerning declines in HIV testing and in people accessing oral prevention services, reports Devex.
The data show huge drops in HIV services across Africa and Asia after the fundings cuts from the US government and the Global Fund to Fight Aids, TB and Malaria that began in early 2025: across 10 countries, CHAI recorded a 42% drop in people starting oral HIV prevention services, or PrEP, in 2025, compared with 2024.
The number of HIV tests conducted in eight countries declined by 12% in the same period. And the percentage of children who were enrolled in HIV treatment dropped by 15% across eight countries.
“What I keep coming back to is just that we’re not seeing a rebound,” Carolyn Amole, CHAI’s VP of HIV, hepatitis and TB, told Devex. “Across the board, key indicators haven’t recovered since the funding cuts began.”
The new CHAI data offer a more comprehensive picture of the state of HIV services than the numbers released by the President’s Emergency Plan for Aids Relief, or Pepfar, in April. Those were the first data Pepfar had released since the end of the 2024 fiscal year, but without the first three quarters from 2025, it is “difficult to assess current trends”, according to the CHAI report.
The CHAI data also look beyond Pepfar-supported services.
Nevertheless, there are similarities. The Pepfar figures showed the flagship US HIV programme had maintained about the same number of people on HIV treatment – 20.6m – during the last quarter of 2024 as it did during the same period in 2025.
In one of the few improvements, CHAI’s data do show a 0.6% increase in the total number of adults on antiretroviral services in eight countries in 2025 compared with 2024.
“That number actually should have been increasing at a faster clip if we’d held steady-state from before the aid disruptions, so the fact that we only saw a 0.6% increase is not necessarily a ‘positive’, but it is also not as bad as some predicted,” Amole said.
The Pepfar data tell a similar story to the CHAI numbers, with marked declines in people getting tested for and diagnosed with HIV and in people starting oral PrEP.
The drop off in oral PrEP initiation could have consequences for countries as efforts to roll out the new six-month injectable form of prevention, lenacapavir, begin to speed up. South Africa recently became the latest country – and the ninth in Africa – to introduce LEN.
“At the exact moment we have a tool that could genuinely change the trajectory of the epidemic, the delivery foundation we’d built it on has been badly weakened,” Amole said.
The figures are even more concerning, she said, given the ongoing reduction in Global Fund awards and the rapid push for countries to take financial ownership for their HIV responses under the new US bilateral health agreements.
“My hope had been that before we start shifting more of the financing burden on to governments, we could at least get the core indicators back to where they were before the disruptions began in early 2025,” Amole said. “We’re still not there, and that worries me.”
The report raises further concerns about the speed of that transition, including the push for countries to take over in-country supply chains. This includes what Amole described as the “unglamorous” work of planning, customs clearance, warehousing and then distributing products.
The wind-down in US support for these efforts has put 11 of 14 countries that CHAI examined at medium-to-critical risk.
“The direction is right: countries should own their own supply chains. But this is moving too fast, and that’s where it gets dangerous,” Amole said.
Devex article – ‘We’re not seeing a rebound’: New data show HIV services not recovering
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US aid cuts could mean millions of TB deaths – global analysis
USAID cuts force HIV/TB services into business rescue
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