Global funding to fight HIV fell by 18% in 2025, its steepest single-year decline in nearly two decades, according to a new United Nations report that warns the drop could reverse years of progress and trigger a resurgence of the epidemic if the trend is not reversed.
What Happened
The report, titled “United to End AIDS,” was released by UNAIDS on the opening day of the 26th International AIDS Conference in Rio de Janeiro, which runs through July 31. It found that government funding for the global HIV response fell by more than $1.5 billion to $7.3 billion in 2025, the lowest level in nearly twenty years, driven substantially by reductions in US support.
A companion report from KFF and UNAIDS found that disbursements for the HIV response from the United States and other developed countries dropped by 25% between 2024 and 2025. Much of that decline followed the dissolution of USAID, which had implemented many of the programs previously funded through the President’s Emergency Plan for AIDS Relief, or PEPFAR. While PEPFAR itself received a waiver and was reoriented toward treatment services, the broader infrastructure supporting prevention and community outreach was significantly disrupted.
UNAIDS Executive Director Winnie Byanyima said the funding cuts, combined with rising inequality and growing restrictions on civic space in some countries, have created what she described as the most serious disruption to the global HIV response since the epidemic began.
Why It Matters
The report warns that continued underfunding of HIV prevention and community-led services could lead to a significant rise in new infections and deaths in the coming years, with earlier UNAIDS projections estimating up to 6 million additional infections and 4 million additional deaths by 2029 if funding gaps are not addressed.
Prevention programs have been especially hard hit. Uptake of pre-exposure prophylaxis, or PrEP, fell 38% between 2024 and 2025 across 62 countries reporting to UNAIDS, even as prevention already represented just 11% of total HIV spending before the cuts began. In some countries, funding for condom distribution has fallen by more than 90%.
Community-led organizations, which UNAIDS says reached up to 60% of marginalized populations most affected by HIV — including men who have sex with men, sex workers, and people who inject drugs — have been forced to close clinics and cut staff. A separate survey of 166 organizations across 46 countries that relied on PEPFAR funding found disruption was, in the words of one researcher involved, incredibly widespread.
Context and Background
The funding decline caps a period of significant scientific progress in HIV prevention, including new long-acting medications that offer protection comparable to a vaccine. UNAIDS estimates roughly 20 million people would need access to antiretroviral-based prevention to meaningfully reduce new infections worldwide, a goal now complicated both by funding shortfalls and by the high cost of newer medications still under patent protection.
Sub-Saharan Africa has been particularly affected, with roughly 80% of HIV prevention funding in the region historically coming from international aid. The report notes that many low-income countries have prioritized preserving core treatment services with available domestic resources, often at the direct expense of prevention and outreach programs that had been central to reducing new infections.
The Trump administration’s “America First Global Health Strategy,” issued in September 2025, has called for reduced US funding for global health programs going forward, characterizing prior spending levels as inefficient, even as it acknowledged the historical accomplishments of US-funded HIV programs.
Expert Analysis
Public health researchers attending the Rio conference describe the current moment as a fundamental tension between scientific capability and political will. Byanyima has said the primary obstacle to ending AIDS as a public health threat by 2030 is no longer scientific but political, pointing to the availability of highly effective prevention tools that remain out of reach for millions due to funding and access barriers rather than technical limitations.
Global health economists tracking the cuts note that while some funding remains in the US pipeline through prior congressional appropriations, the broader policy direction signaled by the America First Global Health Strategy suggests further reductions are likely, complicating long-term planning for countries that have relied heavily on US support.
Researchers also caution that the full impact of the 2025 funding disruptions may not be fully visible for several years, as programs that closed or scaled back this year continue to affect infection and treatment trends well into the future.
What Happens Next
The International AIDS Conference continues through July 31, with additional sessions expected to address how countries and international donors might close the emerging funding gap, including discussions on domestic resource mobilization and potential mechanisms to expand access to newer prevention medications.
UNAIDS has called for what Byanyima described as “radical change” in how the HIV response is funded and structured going forward. Whether governments respond with new funding commitments, or whether the current trajectory continues, is likely to determine whether the world moves closer to or further from its 2030 target of ending AIDS as a public health threat.
