The world has the knowledge and the science to fulfil the UN goal of eradicating Aids as a public health threat by the end of this decade, but will leaders act?
The world might face a resurgence of the HIV epidemic. This was the message from the International Aids Conference, the world’s largest scientific meeting of 6,000 scientists and activists taking place this week in Rio de Janeiro.
More than 3 million people worldwide could be infected with HIV by the end of the decade, according to the Joint United Nations Programme on HIV/Aids (UNAids). In 2025, 1.2 million people acquired HIV, and new HIV infections rose in three regions and 21 countries.
“The world is at a crossroads. We have the science to end Aids. The question is no longer whether we can end Aids. The question is whether we choose to end Aids,” said Winnie Byanyima, executive director of the Joint United Nations Programme on HIV/Aids (UNAids), which leads the global response.
Byanyima leads an agency that encapsulates the pressures piled on those people and groups tasked with fighting epidemics. Thirty years after its foundation, UNAids may be forced to shut down by the end of this year as the UN seeks to cope with massive cuts in funding.
The lowest level in nearly two decades
Before President Donald Trump took office, the US accounted for 75% of international spending on HIV. Last year, funding fell by 18% to $7.3 billion, the lowest level in nearly two decades, according to a UNAids report released in Rio.
However, some countries did increase their spending on HIV, so the overall fall in funding was only 6%. But many other countries do not have the capacity to spend, with sub-Saharan Africa accounting for about half of new HIV infections.
Scientists fear HIV infections will rise further. Protestors disrupted a US government event held in Rio de Janeiro just before the Aids conference opened to vent their anger over Trump’s overhaul of the US President’s Emergency Plan for Aids Relief (Pepfar).
Activists in Rio chanted, “You lie, people die. Restore Pepfar now”
The agency is credited with helping to cut HIV-related deaths from 2m two decades ago to 570,000 last year. But Trump wants to end Pepfar funding by early 2027.
Activists in Rio chanted, “You lie, people die. Restore Pepfar now.”
Washington has already announced it will cease Pepfar support for South Africa over the government’s alleged treatment of its white population. President Donald Trump has made widely-derided claims of a white “genocide” and created a refugee programme to welcome Afrikaners to the US.
“All people at risk” need services
Washington has also decided to exclude from its programmes groups of people considered key to controlling HIV, including sex workers, people who inject drugs, gay or transgender people.
But “all people at risk” need services, Rebecca Bunnell, deputy head of Pepfar implementation, admitted at the US event in Rio. “We can’t forget any group because if we do, we will fail,” said Bunnell, according to Health Policy Watch.
But her admission is unlikely to lead to any substantive change in US policy. Meanwhile, even the US emphasis on preventing HIV in mothers and babies is faltering.
Last year, around 9 million of the 41 million people living with HIV were not on treatment - UNAids
“There were some reports, for example, from 22 neonatal clinics, a network of hospitals in Africa where newborns come to. And they found that mothers had a 50% jump in HIV rates and [an] over 300% jump in those places finding women were not on treatment,” Atul Gawande, former USAID global health assistant administrator, told PBS.
“And that means more children are now at risk of being born with HIV. But we won’t know that for a while, especially when you have taken away the testing, taken away preventive measures,” he said.
Last year, around 9 million of the 41 million people living with HIV were not on treatment, and almost half of all children living with HIV did not have access to antiretroviral therapy, says UNAids.
“US foreign assistance is not charity”
More than 1,700 HIV service sites closed, including more than 1,000 public facilities, and more than 16,000 workers lost their jobs in the wake of Washington’s aid cuts, according to a survey across 46 countries conducted by Aids research groups.
Those organisations still in receipt of US funds are finding themselves having to deal with onerous and time-consuming administration to make sure they comply with a US crackdown on diversity, equity and inclusion (DEI) policies considered “woke”.
Aid groups face big cuts in funding from other donors, including France, Germany, the UK and Scandinavia
Aid groups also face big cuts in funding from other donors, including France, Germany, the UK and Scandinavia.
Recipient countries, meanwhile, are grappling with Trump’s America First Global Health Strategy. Some even want to turn down US cash because the bilateral deals include conditions, such as ensuring US access to health data and prioritising US pharmaceutical and medical firms to develop and deliver treatments.
“The Trump administration has made clear, US foreign assistance is not charity – rather it is strategic capital to be wisely invested to advance US interests – and we expect all of our allies and recipient nations to take seriously American strategic and commercial priorities,” a State Department spokesperson told the BBC.
Meanwhile, scientists are watching nervously for an uptick in HIV.
