Low- and middle-income countries have increased domestic spending on HIV/AIDS in response to shrinking international aid, but the efforts remain insufficient to bridge widening funding gaps and sustain vital prevention services, the Joint United Nations Programme on HIV/AIDS (UNAIDS) warned in its 2025 annual report.
Unveiled in South Africa, the report underscores the devastating ripple effects of global donor cutbacks—particularly the abrupt halt of U.S. funding under the Trump administration’s decision to slash the President’s Emergency Plan for AIDS Relief (PEPFAR). If the funding is not restored, UNAIDS projects an additional six million infections and four million deaths could occur by 2029.
“Prevention was hit harder than treatment,” said Winnie Byanyima, Executive Director of UNAIDS. “Key populations—gay men, sex workers, adolescent girls—were disproportionately affected because they relied on community-led, targeted services, which were the first to disappear.”
Although many nations have maintained antiretroviral treatment supply chains, the closure of community clinics and layoffs of frontline health workers have crippled prevention initiatives.
Byanyima further noted that even before the U.S. funding cuts, development assistance from other major donors—especially in Europe—had begun to decline. Rising military expenditure and the war in Ukraine have been cited as factors diverting resources away from global health.
Internally, UNAIDS itself is scaling back, reducing staff from 661 to 294, reflecting the broader funding crunch affecting the global HIV/AIDS response.
The report acknowledges modest domestic progress: 25 out of 60 low- and middle-income countries increased their national HIV/AIDS budgets by an average of 8%, but this still falls short of replacing international funding in highly dependent regions.
Despite these challenges, the report highlights progress:
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New infections have declined by 40% since 2010,
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AIDS-related deaths have dropped by over 50%,
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Yet, 1.3 million new infections were recorded in 2024 alone, signalling that gains remain fragile without renewed global commitment.
UNAIDS is urging governments, donors, and stakeholders to redouble efforts toward prevention, particularly among high-risk groups, and ensure that the global HIV response does not lose momentum amid shifting international priorities.
“This is a critical moment,” Byanyima said. “We must act now to preserve progress and prevent millions of avoidable deaths.”
