Reacción a "International aid cuts could cause millions of HIV deaths in low- and middle-income countries"

The study, published in The Lancet HIV by Debra ten Brink et al on 26 March 2025, applies mathematical modelling (‘Optima HIV’) to 26 low- and middle-income countries to estimate how cuts in international funding (mainly PEPFAR and other donors) could impact on new HIV infections and deaths between 2025 and 2030.

The cuts in international funding described in the study directly threaten UNAIDS' 2030 targets, which aim for a 90% reduction in new HIV infections and deaths compared to 2010, and the achievement of 95-95-95 in diagnosis, treatment and viral suppression. Some of the key findings of this study include:

• Reversal in the sustained decline in new infections. Projections indicate a marked increase in cases if aid reductions - especially the cessation of PEPFAR - are not mitigated. This makes it more difficult to achieve the 90% reduction in infections, as much of the progress in prevention depends on donor funding, especially in key populations such as migrants, sex workers, men who have sex with men, people who inject drugs or transgender people.
• Increase in the number of new HIV infections and mortality. If the cuts are not offset, there would be an excess of between 4.43 million and 10.75 million new HIV infections and between 0.77 million and 2.93 million HIV-related deaths between 2025 and 2030. Treatment interruption and declines in community-based programmes would hinder retention in care and maintenance of viral suppression.
• Disproportionate impact. Withdrawal of aid impacts more on sub-Saharan Africa (especially children) and key populations in other regions. This uneven effect clashes with the UNAIDS approach of ‘leaving no one behind’ and delays the achievement of the 95-95-95 targets among the most vulnerable groups.
• Need for sustainable mechanisms. The study reinforces the urgency of mobilising domestic resources, optimising programmes and finding other sources to sustain universal coverage of prevention, diagnosis and antiretroviral therapy. Without this step, the UNAIDS global targets to eradicate HIV as a public health threat are unlikely to be met by 2030.