The US President’s Emergency Plan for AIDS Relief, or PEPFAR, was launched in 2003 by US President George W. Bush, the biggest-ever commitment by any country focused on a single disease.
UNAIDS called the program a “lifeline” for countries with high HIV rates, and said that it supported testing for 84.1 million people, treatment for 20.6 million, among other initiatives. According to data from Nigeria, PEPFAR also funded 99.9% of the country’s budget for medicines taken to prevent HIV.
In 2024, there were about 630,000 AIDS-related deaths worldwide, per a UNAIDS estimate — the figure has remained about the same since 2022 after peaking at about 2 million deaths in 2004.
Even before the US funding cuts, progress against curbing HIV was uneven. UNAIDS said that half of all new infections are in sub-Saharan Africa.
Tom Ellman, of the charity Doctors Without Borders, said that while some poorer countries were now moving to fund more of their own HIV programs, it would be impossible to fill the gap left by the US.
“There’s nothing we can do that will protect these countries from the sudden, vicious withdrawal of support from the US,” said Ellman, director of Doctors Without Borders’ South Africa Medical Unit.
Experts also fear another loss: data. The US paid for most HIV surveillance in African countries, including hospital, patient and electronic records, all of which has now abruptly ceased, according to Dr. Chris Beyrer, director of the Global Health Institute at Duke University. “Without reliable data about how HIV is spreading, it will be incredibly hard to stop it,” he said.
The uncertainty comes as a twice-yearly injectable could end HIV, as studies published last year showed that the drug from pharmaceutical maker Gilead was 100% effective in preventing the virus.
At a launch event Thursday, South Africa’s health minister Aaron Motsoaledi said the country would “move mountains and rivers to make sure every adolescent girl who needs it will get it,” saying that the continent’s past dependence upon US aid was “scary.”
Last month, the US Food and Drug Administration approved the drug, called Yeztugo, a move that should have been a “threshold moment” for stopping the AIDS epidemic, said Peter Maybarduk of the advocacy group Public Citizen. But activists like Maybarduk said Gilead’s pricing will put it out of reach of many countries that need it.
Gilead has agreed to sell generic versions of the drug in 120 poor countries with high HIV rates but has excluded nearly all of Latin America, where rates are far lower but increasing.
“We could be ending AIDS,” Maybarduk said.
“Instead, the US is abandoning the fight.”
