Hauwa Ali
As the world prepares to mark World AIDS Day on December 1, the global campaign against HIV/AIDS faces its most dangerous setback in decades. In a stark warning issued this week, UNAIDS described the global HIV response as having “entered crisis mode.”
Millions who once relied on international support for life-saving treatment and prevention care have been abruptly cut off. The consequences, the agency warns, could reverse decades of progress and cost countless lives.
At the heart of this reversal is a dramatic drop in international financing. In 2025 alone, external health assistance to low- and middle-income countries is projected by UNAIDS to fall by 30–40% compared with 2023.
The sharpest blow came in early 2025, when the world’s largest donor, the United States Agency for International Development (USAID), halted its HIV funding. That decision left a vacuum in programmes that had come to rely almost entirely on U.S. support.
Within weeks, dozens of implementing partners across multiple countries received termination notices, triggering closures of clinics and HIV-service programmes.
A March 2025 update from UNAIDS documented the human cost: thousands of health workers laid off, doctors, nurses, community-care providers, and HIV testing, prevention, and care services abruptly curtailed.
Perhaps most alarming: programs designed to reach the most vulnerable- young women, sex workers, people who inject drugs, and other key populations — have been decimated. Community-led organisations, previously the backbone of outreach and prevention, report widespread shutdowns.
The statistics in the latest UNAIDS report are chilling. As of 2024, around 40.8 million people worldwide were living with HIV. That year saw 1.3 million new infections, and critically, some 9.2 million people were still not receiving treatment.
Prevention efforts have taken the biggest hit. In several countries, access to pre-exposure prophylaxis (PrEP), a cornerstone of HIV prevention, plummeted. In Burundi, PrEP use dropped 64 percent; in Uganda, 38 percent; and in Vietnam, 21 percent.
Similarly, condom distribution in heavily affected countries has collapsed. In Nigeria — a country where millions rely on condoms and other prevention tools — distribution fell by 55 percent since late 2024.
At the same time, many clinics and community centres closed, and safe spaces for stigmatized or marginalized populations vanished. In many places, the result has been panic, confusion, and deep erosion of trust.
For pregnant women, the interruption of antenatal HIV testing and prevention services threatens to reverse nearly two decades of progress toward limiting mother-to-child transmission. UNAIDS estimates that as many as 350,000 children could become newly infected over the next four years if such services are not restored.
Behind every statistic are people. The children who missed their early HIV screening, the young women cut off from preventive care, the sex workers and people who inject drugs, once reached by trusted counsellors, are now left with empty clinics or closed doors.
Communities that relied on outreach, peer support, educational programs, and preventive services have been left scrambling — often at the point of maximum vulnerability. “We cannot abandon them,” said the UNAIDS Executive Director, urging governments and donors not to let decades of progress unravel.
In some countries, the psychological toll has already surfaced: fear, mistrust — even hoarding of ARV medications among people living with HIV who worry the supply may run out.
Despite the grim outlook, the UNAIDS report points to resilience in some corners. Several countries — including high-burden nations such as Nigeria, Uganda, Côte d’Ivoire, South Africa, and Tanzania — have committed to raising domestic investments in HIV services.
Furthermore, huge funding pledges have emerged from other global health actors. The Global Fund to Fight AIDS, Tuberculosis, and Malaria recently reported a replenishment of US$11.34 billion, part of urgent efforts to plug the gap.
Meanwhile, innovations — including extended-duration prevention options and long-acting treatments are being fast-tracked. UNAIDS argues that these technologies, paired with political will and renewed solidarity, could still prevent a catastrophic resurgence.
UNAIDS warns that if current funding shortfalls continue, the world could face a dramatic reversal in the HIV epidemic’s trajectory. Projections suggest an additional 3.3 million new HIV infections between 2025 and 2030.
Beyond the numbers, the damage would be felt most acutely by the world’s poorest and most marginalized: young women, key populations, children, remote communities, and those who have always depended on international solidarity to access care.
What’s more, a shrinking global commitment to human rights, including rising criminalization of same-sex relationships in some regions, complicates efforts to rebuild trust and outreach.
UNAIDS argues the crisis is both a warning and a crossroads. “This is our moment to choose,” its executive director said. “We can allow these shocks to undo decades of hard-won gains, or we can unite behind the shared vision of ending AIDS.”
As governments and global health funders convene on World AIDS Day, the call from UNAIDS is clear: treat the current funding collapse not as a temporary blip, but as a wake-up call.
Key steps, according to the agency:
Renew and sustain international funding — especially for low- and middle-income countries that remain heavily reliant on aid.
Accelerate domestic investment in HIV prevention and treatment, including long-term sustainability plans for countries themselves.
Expand access to innovative, affordable HIV prevention and treatment tools — including long-acting injections and generic formulations that reduce costs dramatically.
Protect human rights and ensure marginalized communities — women, young people, LGBTQ+ populations — have guaranteed access to care without stigma or criminalization.
For countries like Nigeria, where a significant population depends on international support for prevention services and medication access, the funding shock is profoundly worrying. Recent drops in condom distribution and PrEP access threaten to reverse hard-earned gains.
A few glimmers of hope remain: national budgets for HIV medicines have been increased; efforts to prevent mother-to-child transmission are ongoing; and domestic programmes are being positioned to step into the breach.
Still, experts caution that domestic funding alone is unlikely to match the scale of lost international support in the near term. The gap remains vast — and time is short.
As the world marks World AIDS Day, the message from UNAIDS is stark: decades of progress are in peril. The global HIV response, once seen as a public health success story, now teeters on the brink of collapse.
But this moment also offers a rare, urgent opportunity to reimagine how the world fights HIV: not as a series of donor-led initiatives, but as a global movement rooted in equity, solidarity, human rights, and community-led care.
The question is not whether the virus still kills — it does. The question is whether humanity will choose to abandon those who need help most or step up and fight back. The choice, the agency says, lies with the world — and the clock is ticking.