What is the future of HIV programs?

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which has provided treatment to people in 55 countries over the past 20 years and saved an estimated 25 million lives, is now at risk of being shut down. According to Science.org, one of the most successful global health initiatives is being undermined by administrative obstacles and funding cuts.

According to an analysis by the Council on Foreign Relations, ending PEPFAR funding could lead to more than 4 million AIDS deaths and 6 million new HIV infections by 2029.

Last year, the Donald Trump administration dismantled the U.S. Agency for International Development (USAID), which had served as the program’s primary implementing agency. The Centers for Disease Control and Prevention (CDC) were named the new lead implementer, but the agency has faced a severe funding shortfall. The State Department has transferred only half of the budget approved by Congress to CDC accounts. Analysts warn that without full funding restored, the program could grind to a halt as early as June.

Funding in Exchange for Resources

Under the new “America First” strategy, the terms of aid have changed dramatically. In the past, budgets were developed jointly with international NGOs and local governments. Now the State Department has required participating countries to sign new memorandums of understanding that include a strict five-year plan to fully wean themselves off U.S. support.

The approval process has become even more complicated because of political and economic demands. Zimbabwe and Zambia have already refused to sign the documents. The reason is that, in exchange for funding HIV treatment, the United States has requested access to mineral resources and internal information about disease outbreaks. Public health experts say that using medical aid as a tool of direct pressure undermines epidemic control.

According to KFF, the expiration of PEPFAR’s latest reauthorization in March 2025 has raised questions about the program’s future and its ability to continue its mission.

Loss of Oversight and Corruption Risks

The shift in the funding mechanism, under which money is supposed to go directly to foreign governments, has sharply reduced transparency. Experts fear this approach will make corruption harder to detect and strip the program of proper accountability.

The system has already been hit by a mass exodus of staff and the halt of regular effectiveness reports. As Science reports, internal assessments from earlier this year show a sharp decline in HIV testing and weaker viral suppression among patients on treatment. Regular interagency meetings have stopped, and decisions are now being made in the absence of adequate information.

Congress has not formally terminated PEPFAR, but the current administrative overhaul has effectively paralyzed the initiative. The medical community says that in its previous, effective form, the program no longer exists.