A catastrophe unfolds
Within a few years after the recognition of a new syndrome in 1981, later called AIDS, researchers began to realize that the virus would spread to many people. By 1994, projections were that 40 million people had become HIV positive. At that time, there was no effective treatment, and turning the tide against the spread of HIV as well as the illness and death caused by this virus seemed an impossible task.
However, in 1996 effective treatment was demonstrated in clinical trials and became available in high-income countries—and lives began to be saved. This progress was made possible by a vast research enterprise that was funded by the U.S. government through its National Institutes of Health (NIH).
In the early 2000s, President George W. Bush funded a program called the President’s Emergency Plan for AIDS Relief (PEPFAR). This funded HIV treatment for people in low- and middle-income countries. Later, funds from PEPFAR were used to help expand opportunities for HIV testing, referral for care and HIV treatment. Funds from the U.S. have helped to provide HIV treatment to more than 20 million people, and at least 84 million people have undergone HIV testing as a result of such funding. What’s more, it seemed as if the world was on track to significantly reduce the spread of HIV thanks to the rollout of testing, treatment and pre-exposure prophylaxis (PrEP).
However, the current government in the U.S. has largely ended progress on HIV by cutting many programs and giving chaotic directions about funding. Thousands of people in the U.S. who monitor international aid and HIV programs have lost their jobs. An estimated 270,000 people once employed by PEPFAR in low- and middle-income countries who played a crucial role in managing the HIV pandemic have also lost their jobs.
As a result of this abandonment of vulnerable populations at high risk for HIV, progress against HIV will be lost at the global level. The projections are stark. One study estimates that by 2040 there would be 15 million deaths from HIV-related complications that otherwise would not have happened. Many of those deaths will occur in sub-Saharan Africa. Another estimate is that by 2040 there will be 14 million children who will become orphans. The evisceration of PEPFAR will mean that 26 million people will become HIV positive.
It is likely that much damage to progress has already occurred and will occur in the short and medium term. For instance, one study projects that the cuts to funding could result in between four and 11 million new HIV infections between 2025 and 2030. In the same period, the study estimates that there could be three million excess deaths among people with HIV.
These numbers are huge and hard to comprehend, but they portend a catastrophe for individuals, communities and countries. Many countries can’t afford to spend the billions that the U.S. used to pour into international aid programs. People who were once taking HIV treatment and who no longer have access to it or who only have intermittent access can inadvertently develop strains of HIV that are resistant to treatment. As these strains spread in a city, country or region, it becomes difficult to help people stay healthy and stop the spread of HIV.
HIV is not the only sector that has been hit. There are important efforts underway to control tuberculosis (TB), malaria and other diseases, all of which will be affected. At best, these cuts are shortsighted. As the history of HIV, Mpox and COVID-19 shows, infectious diseases never stay in one place.
Science is at risk too
The administration has also enacted massive cuts to domestic and international research projects. Many of these projects are designed to help vulnerable populations at risk for HIV and other infections. These cuts will likely ultimately help the spread of infectious diseases in the U.S.
The cuts to scientific funding will likely affect ongoing and future research on efforts to cure HIV and treat many other infections, and likely other health conditions.
These cuts are accompanied by animus against the 2SLGBTQIA+ community, people of colour and their health and research needs. Accompanying the cuts is a fountain of irrationality about vaccines and other interventions proven to reduce the risk of disease and save lives. In a way, it seems that attitudes that were once consigned to medieval times have come roaring back to life. Public health measures are being ignored, seemingly fueled by disinformation campaigns on social media.
The architects of the funding cuts don’t seem to care that vulnerable communities are hurt. But, as we mentioned earlier, infectious diseases seldom stay in one place. It is likely that in the future old diseases will resurge and new diseases will appear in the U.S. and elsewhere. This will cause much suffering and could easily have been preventable. It is time for other high-income countries and regions such as Canada, China, Japan Australia, the UK and the EU to step up and revitalize international AIDS efforts.
The world is and will be going through a difficult time—there’s no doubt about that. Tensions between countries and ongoing wars will cause money to be diverted from the civilian economy to the military. As the U.S. devolves, it should be a lesson for people in Canada and other countries to realize that representative democracy is extremely fragile and needs nurturing. People should get in touch with their elected representatives at the local, provincial and national levels to let them know that they care about science-based policy, healthcare and our common humanity.
—Sean R. Hosein
REFERENCES:
- Bajaj SS. Trump blew up the global fight against AIDS. Can it recover? Nature. 2025 May;641(8061):22-25.
- Brink DT, Martin-Hughes R, Bowring AL, et al. Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries: a modelling study. Lancet HIV. 2025 May;12(5):e346-e354.
- Hill A, Fairhead C, Manalu S, et al. Could reduced dosing maintain more people on antiretrovirals after the sudden cuts in USAID funding? A crisis response. AIDS. 2025 Jun 1;39(7):F1-F4.
- Kozlov M. Judge rules against NIH grant cuts - and calls them discriminatory. Nature. 2025 Jun;642(8069):845-846.
- Kozlov M. NIH grant cuts will axe clinical trials abroad - and could leave thousands without care. Nature. 2025 Jun;642(8067):279-280.