Johannesburg, South Africa

Saturday, July 12, 2025

The end of American aid is “a time bomb” that risks wiping out more than twenty years of progress in the fight against the AIDS pandemic, warned UNAIDS in a report presented in South Africa on Thursday.

Some 31.6 million people were receiving antiretroviral treatment in 2024, and deaths linked to the virus have more than halved since 2010, to 630,000 a year, says the UN agency in charge of the fight against AIDS.

But the number of infections is likely to rise again as a result of budget cuts to prevention and treatment programs.

Historically the largest humanitarian donor, the United States abruptly reduced its international aid in February after Donald Trump took office in the White House.

“We are proud of our results but concerned about this sudden interruption, which is erasing the progress made,” Onusida Executive Director Winnie Byanyima of Uganda told  ahead of the report’s presentation in Johannesburg.

South Africa is one of the countries that has paid the heaviest price for AIDS, with life expectancy having fallen to 52 years in 2006, before rising again, and more than one in ten people living with the virus (12.7%), or 8 million people, according to government figures for 2024.

“We’ve gone from a situation where people were dying every day to a point where (AIDS) is really akin to a chronic disease,” Byanyima stresses, however.

So “the question of whether the investment (in prevention and treatment, ed. note) was worth it doesn’t arise, and it continues to be worth it. It saves lives”, she says.

However, with the end of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Onusida has made its calculations: this would cause over six million new infections and 4.2 million more deaths in four years.

This would bring the pandemic back to the levels the world experienced in the early 2000s.

– Time bomb” –

“It’s not just a lack of money, it’s a time bomb”, stresses Mrs Byanyima in a press release, whose country has more AIDS orphans than South Africa (890,000 versus 630,000 in 2024, UNAIDS figures).

Over 60% of the women’s AIDS associations contacted have already lost funds or suspended services, according to the report. In Nigeria, for example, the number of people on prophylactic preventive treatment to prevent transmission of the virus fell by 85% in the first months of 2025.

“The way the world has managed to unite (against AIDS) is one of the most important pages of progress in global public health,” Byanyima stresses.

“But this fantastic story is being severely undermined” by US government’s decision, she says. “Priorities may change, but you don’t just withdraw vital support from populations like that.”

Crucial medical research into prevention and treatment has already been halted, including in South Africa, a country with one of the highest AIDS prevalence rates in the world and at the forefront of research.

The global fight against AIDS, supported by grassroots activism, remains “resilient by nature”, the leader hopes.

And in 25 of the 60 low- and middle-income countries surveyed by UNAIDS, governments have been able to make up some of the shortfall through local funding.

“We need to move towards nationally-financed responses that are specific to each country”, argues Ms. Byanyima, calling for debt relief and reform of international financial institutions to “free up budgetary room for maneuver so that developing countries can finance their own response”.

Humaniterre with AFP