Four million more people will die from HIV in the next four years if the US spending cuts gap is not covered.

The temporary suspension of PEPFAR , the US President's Emergency Plan for AIDS Relief, and the financial cuts affecting the fight against HIV will result in unforeseen deaths and infections in the millions, UNAIDS warns Thursday in its report, "AIDS, Crisis and the Power to Transform ."

The PEPFAR program, which began in 2003 during the George W. Bush presidency, had planned $4.3 billion (€3.672 billion) for more than 50 countries by 2025, but that support was abruptly cut off in January of this year. If that funding is not replaced with an alternative, there is a risk that four million more people will die from HIV-related causes and that another six million additional infections will be recorded between 2025 and 2029.

The report warns that instability in multilateral cooperation is not only due to cuts by the US and other countries in the Global North, but also to growing problems such as wars, geopolitical shifts, and the climate crisis. The risk is not only that millions of people will die, but that years of progress in the fight against AIDS will be lost. “By the end of 2024, the decline in numbers was not sufficient to end AIDS as a public health threat by 2030, but the means and momentum to do so existed. Success stories in countries were multiplying [...] and new scientific advances continued to be achieved,” UNAIDS emphasizes.

Worldwide, nearly 40 million people are living with HIV : more than half are women and girls. In 2023, there were 630,000 deaths due to AIDS, and 61% of them were in sub-Saharan Africa.

Over the past two decades, PEPFAR has provided prevention, treatment, and support services to community workers in the world's hardest hit by HIV, such as Africa. According to its own figures, it has helped save 26 million lives. President Donald Trump's temporary freeze of the plan— along with other global health support programs —is already causing preventable harm among the most vulnerable populations.

UNAIDS Director Winnie Byanyima explained in a recent interview with EL PAÍS that if the funding gap caused by the cuts is not closed, an additional 6.6 million new infections could be recorded by 2029. In 2024, 1.3 million were recorded.

Byanyima also highlighted the consequences of the cuts on the African continent: “In the field of HIV, 73% of all external assistance came from a single country: the United States. So the impact of that withdrawal has been devastating, especially in countries with a high HIV burden. Most of them are in Africa and are also saddled with enormous debt . Many of them are spending four or five times more money on debt repayment than on health care, and they also have to deal with droughts, floods, and other consequences of climate change.”

UNAIDS fears that donor cuts will undermine the progress made in recent years in the fight against the HIV pandemic. Since 1996, the organization reports, 26.9 million deaths have been prevented thanks to treatment. In 2024 alone, 31.6 million people, or 77% of those living with the virus, were treated, according to Mary Mahy, director of Data for Impact at UNAIDS.

In a meeting with journalists organized by the International AIDS Society (IAS) ahead of the 13th HIV Conference to be held in Kigali next week, Mahy noted that the situation is particularly dire in nine countries—Ethiopia, Haiti, Liberia, Malawi, Mozambique, Nigeria, South Sudan, Tanzania, and Zimbabwe—where the HIV response depends on donor resources for more than 90%. “It will be essential to analyze the situation in these countries and determine how to support them, review their expenditures, and calculate their domestic contribution. This is not easy in a situation where there is a high debt burden,” she explained.

Peter Sands, executive director of the Global Fund, which fights AIDS, tuberculosis, and malaria, lamented the deep inequalities that persist in the fight against AIDS. “Globally, 45% of new infections in 2024 occurred among women and girls, a percentage that rises to 63% in sub-Saharan Africa,” he said.

“Every week, 4,000 adolescent girls and young women between the ages of 15 and 24 are newly infected with HIV, enough to fill nearly 80 classrooms, most of them in sub-Saharan Africa,” she added.

The UNAIDS report, for example, warns of critical cases , such as that of Nigeria, where the number of people receiving pre-exposure prophylaxis (PrEP) , a preventive treatment for HIV, dropped significantly. The country went from providing PrEP to 43,141 people in November 2024 to just 6,000 patients in April 2025. In Kenya, on the other hand, a sudden drop was detected in February 2025 in diagnostic tests for two-month-old babies: 2,528 were administered in November; 1,333 in March; and 2,750 in April.

It also warns that community-based programs, which play a key role in enabling vulnerable populations to access prevention and treatment services, are on the line. For example, 60% of women-led programs lost funding or suspended their services by February 2025, and 45% of community partners working on the front lines against HIV have suffered cutbacks, according to this report.

60% of women-led programs lost funding or suspended services by February 2025, and 45% of community partners working on the front lines against HIV have suffered cuts.

Of the 60 countries analyzed by UNAIDS for this report, 25 will increase their national budget to combat the disease. While Mahy welcomes this good news, he points out that in another 35 countries, domestic funding will remain at the same level or, in some cases, decrease.