Trump’s aid reset forces global fight against HIV into new era

The global fight against HIV/AIDS has entered a period of profound transition, with the United States’ retreat from its long-standing funding model forcing governments, aid organisations and researchers to rethink how the epidemic will be tackled in the coming years. As The Economist argues in a recent analysis, the upheaval has exposed the dangers of relying too heavily on a single donor while also accelerating efforts to build more sustainable national responses and invest in new prevention and treatment technologies.

The consequences of the policy shift initiated by US President Donald Trump have been severe. Since 2011, America’s share of international HIV funding had grown from 58% to 81%, making it the dominant financial backer of the global response. When Washington altered its approach, clinics closed, medicine supply chains were disrupted and community support networks were left scrambling for resources.

Despite the turmoil, the fight against HIV remains immense. According to UNAIDS, around 570,000 people died from AIDS last year, while approximately 1.2 million people were newly infected with HIV. Of an estimated 41 million people living with the virus worldwide, only about 32 million currently receive life-saving antiretroviral therapy.

The scale of the funding shortfall has become clearer in recent months. As cited by The Economist, the Kaiser Family Foundation estimates US HIV funding has fallen by $2.1 billion, equivalent to roughly a quarter of total global spending recorded in 2024. Meanwhile, a survey by the Foundation for AIDS Research found widespread shortages among organisations supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR), with many reporting difficulties obtaining condoms, antiretroviral medicines and preventive HIV drugs.

Rather than withdrawing completely, Washington has fundamentally changed how assistance is delivered. Instead of funding organisations directly, PEPFAR now signs government-to-government agreements that require recipient countries to contribute significant domestic financing. These agreements are designed to expire in 2030, reflecting the US ambition to transition from financial assistance toward technical support.

Supporters see the strategy as encouraging long-promised national ownership of HIV programmes, while critics argue it shifts responsibility onto countries that may struggle to finance healthcare systems already under pressure. Several African governments, including Kenya and Nigeria, have accepted the new model by committing billions of dollars in domestic spending alongside US contributions. Others, including Ghana, Zambia and Zimbabwe, have reportedly refused to sign agreements over concerns about data-sharing requirements and other conditions—allegations US officials deny.

Alongside funding reforms, scientific advances are providing cautious optimism. Long-acting preventive medicines are transforming HIV prevention, with Lenacapavir, administered just twice a year, emerging as one of the field’s most promising innovations. Another candidate, Alimatravir, a monthly pill currently undergoing clinical trials, could further expand access if approved.

Perhaps the most intriguing development lies in research aimed not merely at treating HIV but curing it. Scientists are increasingly focused on broadly neutralising antibodies (bNAbs), which target parts of the virus that rarely mutate. Early clinical studies suggest that, in a small number of patients, these antibodies may help suppress HIV for extended periods after treatment has ended, raising hopes they could train the immune system to control the virus independently.

As The Economist concludes, a cure remains a distant goal. Yet while the global HIV response is being reshaped by financial realities, breakthroughs in science offer a rare source of optimism that the next chapter in the fight against AIDS may ultimately be defined not only by adapting to reduced funding, but by transformative medical progress.

By Sabina Mammadli