The year 2025 was catastrophic for HIV control programs worldwide, UNAIDS has reported, with global development assistance falling by 23%, the sharpest single-year drop on record, and the consequences already visible in collapsed testing, decimated prevention programs, and dismantled community services.
A World Report published June 20 in The Lancet by John Zarocostas details the scope of the damage and UNAIDS’ urgent appeal for governments and donors to reverse course before the epidemic resurges.
“There’s no question that this is the most serious disruption in the HIV response since the world came together to fight this disease,” Winnie Byanyima, UNAIDS Executive Director, told the Lancet.
The data, drawn from UNAIDS’ June 2026 Global AIDS Brief, paint a stark picture of a public health infrastructure in collapse:
- HIV testing fell by 22% in high-burden settings between 2024 and 2025
- PrEP uptake dropped 38% across 62 reporting countries
- Condom funding was cut by more than 90% in some cases
- Prevention programs, already underfunded at just 11% of total HIV spending in 2024, are shrinking further
The collapse of community-based services has been even more dramatic. A survey of 79 organizations across 47 countries found that community support services for people living with HIV dropped 50%. Services for sex workers were reduced by 82%, and services for men who have sex with men by 85%. More than 60% of women-led organizations suspended essential programs.
The policy decisions behind the crisis
The report identifies the January 2025 U.S. executive order imposing a 90-day pause on all foreign assistance as the single most consequential trigger. PEPFAR, the President’s Emergency Plan for AIDS Relief, funds approximately 70% of the overall global AIDS response. Although an emergency humanitarian waiver was issued for life-saving HIV treatment within days, prevention programs, community outreach, and the workforce that delivers them remained frozen.
Thousands of HIV testing counsellors and clinic staff were laid off. Medicines sat in warehouses. In Ethiopia, 5,000 public health worker contracts were terminated along with 10,000 data clerks. In Zimbabwe, the Centre for Sexual Health and HIV Research reported that HIV testing “case finding” dropped by more than 50%.
The U.S. freeze was compounded by cuts from multiple other donor countries. Five nations providing more than 90% of international HIV funding announced reductions of between 8% and 70% for 2025-2026. The Organisation for Economic Co-operation and Development projected that external health assistance would drop 30-40% in 2025 compared to 2023.
The fragile progress at risk
The cuts are unraveling decades of hard-won progress. AIDS-related deaths had fallen 56% from a peak of 1.3 million in 2010 to approximately 570,000 in 2025. New infections had dropped 43% in the same period to 1.2 million. Some 78% of the 40.9 million people living with HIV globally were on treatment, 32.1 million people.
But nearly 9 million people remain untreated, and the gains are fragile. Modelling published in The Lancet HIV in March 2025 found that if PEPFAR support is permanently withdrawn, the result could be 6.6 million new HIV infections and 4.2 million AIDS-related deaths by 2029. A worst-case scenario could see new infections reaching 3.4 million per year by 2030, matching the peak of 1995.
“The funding cuts, combined with the reduction in civic space and the further criminalization of marginalized populations, have come together to create the biggest storm the HIV response has ever seen,” Byanyima said. “The question now is political: will we invest or will we retreat?”
Regional impact
Sub-Saharan Africa has been hit hardest. Western and Central Africa are approximately 90% dependent on external HIV funding. Countries including Malawi, Mozambique, Uganda, and Zimbabwe rely on PEPFAR for more than 60% of their total HIV budget. Meanwhile, new HIV infections have been rising since 2010 in Eastern Europe, Central Asia, Latin America, and the Middle East and North Africa, regions where the cuts have further crippled already-underfunded responses.
Source: The Lancet, “World Report] UNAIDS: HIV control hit hard by aid cuts” by John Zarocostas (June 20, 2026). Volume 407, Issue 10547. DOI: [10.1016/S0140-6736(26)01238-901238-9).