The drastic reduction in American aid threatens years of advancements, but some see it as an opportunity for African leadership in the fight against HIV.

The world had been poised to discuss the imminent end of HIV as a public health threat, with many experts, like Prof Sharon Lewin, believing it was only five years away. However, recent drastic cuts in US funding for HIV programmes have cast a shadow over these optimistic projections. What was once a hopeful future is now uncertain, and fears of a resurgence in infections and deaths are growing.

The Trump administration’s decision to slash US foreign aid, including 83% of contracts tied to the President’s Emergency Plan for AIDS Relief (Pepfar), has disrupted essential services. Pepfar, which had invested over $110bn (£85bn) since 2003, had been credited with saving millions of lives and preventing further HIV infections, particularly in sub-Saharan Africa, where it had funded nearly all HIV-related spending in some nations.

Prof Lewin, director of Melbourne University’s Institute for Infection and Immunity, warns of a significant reversal in the progress made against HIV, with increased infections and deaths becoming a real risk. The immediate consequences of the cuts have included the suspension of various prevention programmes, leaving communities vulnerable, with only limited efforts to prevent mother-to-child transmission of HIV continuing.

In some cases, clinics have been forced to ration drugs, leading to growing fears among patients. UNAids reports widespread disruption, especially in programmes targeting transgender individuals, which have been dismantled due to the Trump administration’s stance on “gender ideology” and diversity.

However, the cuts have sparked new conversations about the future of HIV care. Experts believe Africa could emerge as a leader in responding to the crisis. For example, plans are underway for countries like Nigeria to produce their own HIV drugs and testing kits, which could reduce dependency on foreign aid.

At the same time, some scientists are sounding the alarm over the impact these cuts could have on vital HIV research. Prof Linda-Gail Bekker from South Africa’s Desmond Tutu Health Foundation highlighted how the interruption of key trials, such as one testing the potential HIV vaccine lenacapavir, threatens to derail the progress made in developing new treatments and prevention methods.

As funding becomes more scarce, many are forced to make difficult decisions about who receives treatment. With limited resources, experts fear the return to a situation where only a select few are treated, echoing the early days of HIV treatment when only a fraction of those in need could access life-saving drugs.

Beatriz Grinsztejn, president of the International AIDS Society, acknowledges the disruption but sees an opportunity for Africa to take the reins in the fight against HIV. She emphasises that despite the setbacks, the global HIV community is resilient, and countries are already working towards a more sustainable approach. Governments, particularly in Africa, are now looking at ways to take control of their own HIV programmes and reduce reliance on external funding.

Though the goal of ending AIDS by 2030 is still within reach, as UNAids’ Christine Stegling points out, it requires immediate action and a renewed sense of urgency from both national governments and the international community. The next few months will be crucial in determining whether the world can overcome this setback and continue to make strides in the fight against HIV.