GFO Issue 464, Article Number: 2
ABSTRACT
The UNAIDS 2025 report highlights major progress in fighting HIV but warns of a critical funding crisis. The sudden PEPFAR withdrawal risks undoing decades of achievements. Urgent, equitable, and sustainable transformation of the global response is essential
The 2025 UNAIDS Global Report, titled “AIDS, crisis and the power of transformation,” highlights a stark paradox. On one hand, scientific breakthroughs and measurable progress in the fight against HIV fuel hope of ending AIDS as a public health threat by 2030. On the other, a sudden collapse in international funding threatens to dismantle decades of achievement. The abrupt withdrawal of key financial support, notably the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is crippling the global response architecture: clinics are shutting down, supply chains are breaking, prevention campaigns are suspended, and community networks are paralyzed. This alarming context calls for an in-depth analysis of the underlying dynamics, alongside a systemic rethink of urgent solutions.
Impressive progress, unevenly shared
Over the past two decades, the global HIV response has achieved substantial progress. By 2024, new infections dropped to 1.3 million – a 40% reduction since 2010 – and AIDS-related deaths decreased by 56%, down to 630,000 annually. These results are due to robust public health policies, medical advances, community mobilization, and strong international partnerships. Antiretroviral treatment coverage surpassed 77%, with 73% viral suppression rates among those treated. Sub-Saharan Africa, historically the most affected region, has shown exceptional progress, with countries like Lesotho, Malawi, Rwanda, Zimbabwe, and Nepal on track to cut new infections by 90% by 2030. Life expectancy in the region increased by nearly six years since 2010.
However, these global gains mask deep inequalities. Regions such as the Middle East and North Africa (MENA), Eastern Europe, and Central Asia have seen rising infection rates – a 94% increase in MENA alone since 2010. Children remain underserved: only 55% of children living with HIV received treatment in 2024, leaving over 620,000 without care. Men are less likely to access treatment than women (73% vs. 83%), and key populations – including sex workers, men who have sex with men, transgender people – remain marginalized. These gaps stem from not only structural health issues but political inertia, stigma, and discriminatory policies.
A systemic and destabilizing funding crisis
One of the most pressing issues raised in the 2025 report is the deepening funding crisis. PEPFAR, a pillar of the global response, had enabled access to HIV testing for 84.1 million people, treatment for 20.6 million individuals, and HIV prevention services for 2.3 million adolescent girls and young women in 2024. The abrupt suspension of this funding in early 2025 paralyzed national responses across sub-Saharan Africa, the Caribbean, and parts of Asia.
Consequences are immediate and widespread: drug shortages, healthcare center closures, staff layoffs, disruption of PrEP programs and prevention initiatives, and breakdowns in health information systems. UNAIDS projections show that if current funding gaps persist, up to 6 million new infections and 4 million AIDS-related deaths could occur by 2029. Many low- and middle-income countries rely on external donors for up to 80% of their prevention budgets. This over-reliance underscores the fragility of health systems when donor priorities shift or dissolve.
Prevention abandoned, key populations neglected
Prevention, despite being the most cost-effective strategy, is often the first casualty of funding cuts. In 2024, only 3.9 million people globally accessed PrEP, far below the 2025 goal of 21.2 million. Nigeria saw a dramatic 85% drop in PrEP users in just six months – from 43,000 to fewer than 6,000 – after U.S. funding was halted. Condom distribution programs, voluntary medical male circumcision, and youth-centered prevention campaigns were also scaled back or discontinued.
Key populations are most at risk. Though they account for 80% of new infections outside of sub-Saharan Africa, they remain underserved. Repressive laws, stigma, and social exclusion continue to limit access to HIV services. For the first time in years, the number of countries criminalizing key population behaviors rose in 2025. This regression threatens global HIV targets and undermines decades of rights-based advocacy. Inclusive and human rights-respecting prevention programs are urgently needed.
Communities on the frontline, yet underfunded
Community-led organizations have always played a critical role in the HIV response. They reach marginalized populations, provide culturally competent services, and deliver care where health systems fall short. Studies show these interventions significantly increase testing rates, treatment adherence, viral suppression, and reduce mother-to-child transmission. Despite their effectiveness, budget cuts in 2025 forced many community groups to shut down. This disrupts essential support networks and leaves millions without services.
Reintegrating community-led efforts into national HIV strategies is not just ideal – it's essential. Funding, institutional recognition, and inclusion in decision-making are required to sustain their contributions and strengthen resilience within public health systems.
Toward a new pact of solidarity and transformation
The UNAIDS report calls for a complete rethinking of HIV financing. Some countries are stepping up: 25 plan to increase HIV budgets by 2026, some by more than 10%. Still, these efforts are insufficient without global support. A new financial architecture is needed: incorporating HIV into health insurance schemes, leveraging mixed financing from public, private, and development sources, and reforming debt and taxation structures.
This requires a global compact for health equity, where international solidarity goes beyond aid to shared responsibility. Transformation must replace survival logic, with structural, sustainable, and inclusive solutions at the core of future health systems.
Conclusion: Urgency to act, courage to innovate
The global HIV response stands at a pivotal crossroads. Tools to end AIDS exist. The achievements to date prove that large-scale change is possible. Yet, the fragility of the current system, exacerbated by donor withdrawal, exposes the limits of an outdated model. Without renewed investment, political will, and strategic rethinking, the goal of ending AIDS by 2030 will slip away.
This crisis is also an opportunity to reassess priorities, rebuild commitments, and design a more just, inclusive, and resilient global health system. Failure to act would abandon millions to suffering. Acting now affirms that global solidarity and health justice are not negotiable ideals – they are imperatives.
The 2025 UNAIDS Global Report, titled “AIDS, crisis and the power of transformation,” highlights a stark paradox. On one hand, scientific breakthroughs and measurable progress in the fight against HIV fuel hope of ending AIDS as a public health threat by 2030. On the other, a sudden collapse in international funding threatens to dismantle decades of achievement. The abrupt withdrawal of key financial support, notably the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is crippling the global response architecture: clinics are shutting down, supply chains are breaking, prevention campaigns are suspended, and community networks are paralyzed. This alarming context calls for an in-depth analysis of the underlying dynamics, alongside a systemic rethink of urgent solutions.
Impressive progress, unevenly shared
Over the past two decades, the global HIV response has achieved substantial progress. By 2024, new infections dropped to 1.3 million – a 40% reduction since 2010 – and AIDS-related deaths decreased by 56%, down to 630,000 annually. These results are due to robust public health policies, medical advances, community mobilization, and strong international partnerships. Antiretroviral treatment coverage surpassed 77%, with 73% viral suppression rates among those treated. Sub-Saharan Africa, historically the most affected region, has shown exceptional progress, with countries like Lesotho, Malawi, Rwanda, Zimbabwe, and Nepal on track to cut new infections by 90% by 2030. Life expectancy in the region increased by nearly six years since 2010.
However, these global gains mask deep inequalities. Regions such as the Middle East and North Africa (MENA), Eastern Europe, and Central Asia have seen rising infection rates – a 94% increase in MENA alone since 2010. Children remain underserved: only 55% of children living with HIV received treatment in 2024, leaving over 620,000 without care. Men are less likely to access treatment than women (73% vs. 83%), and key populations – including sex workers, men who have sex with men, transgender people – remain marginalized. These gaps stem from not only structural health issues but political inertia, stigma, and discriminatory policies.
A systemic and destabilizing funding crisis
One of the most pressing issues raised in the 2025 report is the deepening funding crisis. PEPFAR, a pillar of the global response, had enabled access to HIV testing for 84.1 million people, treatment for 20.6 million individuals, and HIV prevention services for 2.3 million adolescent girls and young women in 2024. The abrupt suspension of this funding in early 2025 paralyzed national responses across sub-Saharan Africa, the Caribbean, and parts of Asia.
Consequences are immediate and widespread: drug shortages, healthcare center closures, staff layoffs, disruption of PrEP programs and prevention initiatives, and breakdowns in health information systems. UNAIDS projections show that if current funding gaps persist, up to 6 million new infections and 4 million AIDS-related deaths could occur by 2029. Many low- and middle-income countries rely on external donors for up to 80% of their prevention budgets. This over-reliance underscores the fragility of health systems when donor priorities shift or dissolve.
Prevention abandoned, key populations neglected
Prevention, despite being the most cost-effective strategy, is often the first casualty of funding cuts. In 2024, only 3.9 million people globally accessed PrEP, far below the 2025 goal of 21.2 million. Nigeria saw a dramatic 85% drop in PrEP users in just six months – from 43,000 to fewer than 6,000 – after U.S. funding was halted. Condom distribution programs, voluntary medical male circumcision, and youth-centered prevention campaigns were also scaled back or discontinued.
Key populations are most at risk. Though they account for 80% of new infections outside of sub-Saharan Africa, they remain underserved. Repressive laws, stigma, and social exclusion continue to limit access to HIV services. For the first time in years, the number of countries criminalizing key population behaviors rose in 2025. This regression threatens global HIV targets and undermines decades of rights-based advocacy. Inclusive and human rights-respecting prevention programs are urgently needed.
Communities on the frontline, yet underfunded
Community-led organizations have always played a critical role in the HIV response. They reach marginalized populations, provide culturally competent services, and deliver care where health systems fall short. Studies show these interventions significantly increase testing rates, treatment adherence, viral suppression, and reduce mother-to-child transmission. Despite their effectiveness, budget cuts in 2025 forced many community groups to shut down. This disrupts essential support networks and leaves millions without services.
Reintegrating community-led efforts into national HIV strategies is not just ideal – it's essential. Funding, institutional recognition, and inclusion in decision-making are required to sustain their contributions and strengthen resilience within public health systems.
Toward a new pact of solidarity and transformation
The UNAIDS report calls for a complete rethinking of HIV financing. Some countries are stepping up: 25 plan to increase HIV budgets by 2026, some by more than 10%. Still, these efforts are insufficient without global support. A new financial architecture is needed: incorporating HIV into health insurance schemes, leveraging mixed financing from public, private, and development sources, and reforming debt and taxation structures.
This requires a global compact for health equity, where international solidarity goes beyond aid to shared responsibility. Transformation must replace survival logic, with structural, sustainable, and inclusive solutions at the core of future health systems.
Conclusion: Urgency to act, courage to innovate
The global HIV response stands at a pivotal crossroads. Tools to end AIDS exist. The achievements to date prove that large-scale change is possible. Yet, the fragility of the current system, exacerbated by donor withdrawal, exposes the limits of an outdated model. Without renewed investment, political will, and strategic rethinking, the goal of ending AIDS by 2030 will slip away.
This crisis is also an opportunity to reassess priorities, rebuild commitments, and design a more just, inclusive, and resilient global health system. Failure to act would abandon millions to suffering. Acting now affirms that global solidarity and health justice are not negotiable ideals – they are imperatives.
