Global donor funding to combat HIV in low- and middle-income countries fell by $2.1 billion in 2025, a 25% drop driven primarily by U.S. spending cuts. New reports from KFF and UNAIDS warn that the steep decline threatens prevention programs and decades of public health progress worldwide.
The Steepest Single-Year Decline in Global HIV Funding History
International financial support for the global HIV response fell by $2.1 billion in 2025, marking the largest single-year drop since donor funding scale-up began. Total disbursements dropped to $6.2 billion in 2025, down sharply from $8.3 billion in 2024, pushing funding back to levels last seen in 2007 according to findings released by KFF and the Joint United Nations Programme on HIV/AIDS (UNAIDS).
The contraction was driven entirely by a decrease in U.S. disbursements following substantial cuts in global health funding, programs, and personnel. U.S. spending fell to $4.6 billion in 2025, down from $6.7 billion in the previous year. While other major donor nations—including France, the United Kingdom, Japan, and Germany—kept their collective funding flat at $1.6 billion in 2025, their long-term commitments have steadily retreated, dropping nearly 50% since 2011.
Despite the cuts, the U.S. remains the world’s largest donor to HIV efforts, accounting for 74% of total donor government funding in 2025. France followed as the second-largest donor, contributing $280 million.
How U.S. Policy Shifts Reshaped PEPFAR and Community Programs
The sharp pullback stems from the U.S. administration’s America First Global Health Strategy, which scales back open-ended foreign assistance and implements an estimated $7.3 billion decline over five years. Agency for International Development, and stripped support from UNAIDS.
These policy changes immediately impacted service delivery on the ground. A study conducted across 166 PEPFAR-funded organizations in 46 countries by amfAR’s Public Policy Office, the Johns Hopkins Bloomberg School of Public Health, Funders Concerned About AIDS, and Data Etc. revealed that at least 1,714 HIV service sites—including mobile clinics, drop-in centers, and public health facilities—closed entirely after payments were delayed or terminated.
Prevention programs absorbed the heaviest blow, experiencing a 51% reduction in spending from fiscal year 2024 to fiscal year 2025. Nearly half of implementing partners permanently halted at least one prevention activity, such as distributing condoms or offering pre-exposure prophylaxis (PrEP). Services directed at key populations—including sex workers, gay men and other men who have sex with men, transgender individuals, people who use drugs, and incarcerated populations—suffered severe cutbacks, with 73% of partners stopping at least one key population service and 67% halting outreach.
Warnings of a Potential Resurgence as Prevention Services Collapse
Public health leaders meeting around the International AIDS Conference warned that the combination of funding cuts and the dismantling of community prevention networks threatens a wider resurgence of the epidemic. In high-prevalence countries, funding for condom programming plummeted by 93%, while resources dedicated to supportive laws, regulations, and policy environments dropped by 80%.
“Every day, around 3,400 people acquire HIV around the world. Every day, around 1,600 people die from AIDS-related illnesses. The HIV pandemic is not over. Without urgent action, it could resurge.”
Winnie Byanyima, executive director of UNAIDS
In Cameroon, Nigeria, and Zambia, the number of individuals receiving PrEP dropped by more than 50%. A separate study estimates that over 75,000 people will become infected with HIV within a year following the full withdrawal of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in settings lacking replacement funding. Zimbabwe similarly failed to reach an agreement with the U.S. on new funding arrangements.
Domestic Financing Pressures and the Search for Long-Term Solutions
With international aid retreating, approximately 60% of the global HIV response is now supported by domestic resources. South Africa’s Deputy Minister of Health, Dr. Joe Phaahla, noted that African nations are actively working to strengthen domestic investment, but cautioned that a 25% single-year cut forces governments to make very difficult prioritisation decisions at a very high speed affecting medicines, commodities, community workers, and data systems.
Other international actors are reassessing their strategies. France, through its Ambassador for Global Health Anne-Claire Amprou, emphasized priorities for the upcoming International AIDS Conference in Rio de Janeiro, including supporting civil society, ensuring equal access to long-acting treatments and local manufacturing, and reinforcing health sovereignty through sustained national financing.
“The era of relying on international aid is over. Countries cannot wait and they cannot go backwards. The world must urgently fix the broken financial system and accelerate debt restructuring so that governments can invest in what matters most—the health, education and futures of their people.”
Winnie Byanyima, executive director of UNAIDS
While global treatment numbers remain at an all-time high with 32.1 million people receiving antiretroviral therapy according to UNAIDS figures, analysts point out that Congressional appropriations for HIV have remained steady. This leaves unspent funding in the U.S. pipeline, though whether the administration will disburse those funds remains entirely unclear.
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