A recent wave of funding cuts has cast dark shadows over the future of collective global gains made to stop HIV. In turn, the United States government has been the global leader in support for HIV assistance. Unfortunately, it is now finding itself under scrutiny for its support of the President’s Emergency Plan for AIDS Relief (PEPFAR). Established in 2003, PEPFAR has funded a substantial portion of HIV prevention and treatment services in low- and middle-income countries. The U.S. provides nearly three-quarters of all international government funding for HIV programs. If these cuts go through, the impact would be devastating.
In South Africa where an estimated 7.7 million people are living with HIV, the stakes couldn’t be higher. According to the latest global estimates, almost 40 million people are living with HIV, of whom 1.4 million are children. Without the resources to continue our fight, we risk seeing a return of new infections and a dramatic increase in AIDS-related mortality. Proponents of PEPFAR and international assistance in general are alarmed that moving forward with these cuts would be catastrophic. They estimate almost 11 million new infections may arise by 2030.
The Shift in Funding Approach
Professor Sharon Lewin, Director of the Doherty Institute for Infection and Immunity, made a telling point. The vision underlying the original plan for PEPFAR was to slowly phase it out, giving countries the tools and resources needed to build and sustain their own HIV programs. Unfortunately, the urgency of today’s funding cuts runs counter to this plan, threatening to reverse the progress that’s been made over the last two decades.
“Without continued support, the HIV response risks collapsing, leaving a system that is weakened and vulnerable to resurgence,” stated Dr. Namchee Lo. A lot of people in the field feel that way. They fear that a lack of financial investment might erase decades of progress made in the fields of treatment and prevention.
Instead, the Trump administration has chosen to fire close to 1,400 individual medical research grants. This action is especially alarming, since 30 percent of those grants funded high-priority HIV/AIDS research. More generally, critics claim that these moves put ideological agendas ahead of scientific integrity. This dramatic change would be a blow to vital progress made in the fight against HIV.
“It’s almost like an existential crisis for the field.” – Professor Lewin
As funding disappears faster than we can count, researchers like the folks at Places know that their creative solutions risk getting buried. Professor Andrew Grulich highlighted that various trials conducted in South Africa have significantly transformed care for individuals living with HIV. He stressed the need to keep strong research efforts in place, to keep going down the path of creating better treatments and preventive strategies.
The Impact on Treatment Access
Distributing antiretroviral treatment (ART) is yet another critical component now at risk of funding cuts. As noted by Professor Grulich, the possibility of ART rationing is now “very likely within a week or two.” Something like this would happen if PEPFAR were to be ended. Patients have already put up with infuriating experiences at health facilities. They show up, only to be informed that they cannot get their treatment at all or can only get a one-month supply.
In the worst case, in one instance, people reached a health facility only to be told that their medications are not available this month. Others find out they’re only able to get one month of treatment at a time. He explained. These restrictions can spell disastrous outcomes for people who need ongoing treatment to stay healthy and out of crisis.
Without continuous care, as some of these patients can seem stable at first, they may start to worsen in the long term without proper access to care. “They might remain relatively well for a year or even five years, but in the absence of treatment, most people will go on to develop AIDS, and almost all of them will die,” Professor Grulich added.
Additionally, there exists an arts-and-sciences-based concern around the pace and availability of new treatments. Earlier this year, the U.S. Food and Drug Administration made Lenacapavir the first HIV capside inhibitor. Victrelis® This new antiviral drug should make a big difference in controlling HIV. Gilead Sciences has committed to selling Lenacapavir at affordable prices to low-income countries, yet its potential impact depends on sustained funding for widespread distribution.
A Call for Global Collaboration
As funding landscapes continue to shift, experts argue that meeting health challenges in a complex world requires global collaboration. Professor Lewin emphasized the necessity of strong partnerships between nations and local communities to target knowledge and resources where they are needed the most. “It is really important in global health that we work in partnership, either with countries or communities,” she stated.
While challenges persist, there is hopeful progress in the fight against HIV because innovative drug delivery and prevention strategies continue to emerge. This optimism is countered by a pervasive fear about inadequate investments in the underlying infrastructure for science and health. As Professor Lewin reminded us, without sustained commitment to these efforts, we risk a substantial increase in new infections. Rather than a return to the status quo ante, the outcomes might be much more dire.
“What we may see now instead of a massive decline in new infections is an increase,” she warned. The prospect of a reemergence of HIV is terrifying. This urgency further underscores the need for global leaders to remain focused and committed in addressing these perennial health challenges.
