President Donald Trump has accused European countries of not helping with the HIV/AIDS pandemic, as the United Nations warns sweeping US cuts to its HIV response programme will cost millions of lives.
Speaking to The Independent as part of a new documentary on the impact of the cuts, Mr Trump said the United States had spent “billions and billions of dollars” to combat the disease and was the “only country” assisting, adding that now it was Europe’s turn to step up.
“Nobody does anything but the United States… Other countries should be helping us with that,” he said onboard Air Force One during a trip back from Florida this month. “We’re the only country. Where are the others? Where is France? Where is Germany? We’ve spent billions and billions of dollars.”
Although the US has by far been the largest funder of HIV support worldwide – contributing over two-thirds of the financing according to United Nations AIDS agency – France, Germany, and the UK are also among the top five contributors globally.
PEPFAR – the President’s Emergency Plan for AIDS Relief – was first introduced by Republican President George W. Bush in 2003 and is widely regarded as one of the world’s most successful responses to a global disease crisis, having saved over 26 million lives.
The United Nations AIDS agency told The Independent it was integral to putting the world on track to ending the HIV/AIDS pandemic by 2030. But that progress is now in jeopardy.
In a shocking move during the first few hours of his presidency, Donald Trump signed an executive order freezing almost all foreign assistance for 90 days while programmes were reviewed to ensure they aligned with “American interests”.
That included a funding freeze for PEPFAR, disrupting supplies and treatment and impacting 20 million people worldwide.
Although a waiver was later issued by the State Department to allow the continuation of life-saving services, it remains unclear how or if that waiver is being implemented on the ground. The 90-day freeze period has now passed without a permanent decision made on the future of funding for programmes like PEPFAR.
A documentary investigation by The Independent, which includes reporting from remote areas in Uganda and Zimbabwe, shows that money is not getting through. Clinics are having to close and patients have lost access to their medication, causing illness, death, and medication-resistant HIV strains.
The Independent’s own calculations, based on UNAIDS data, show that if funding is not reinstated and nothing changes, the HIV/AIDS death toll will triple by 2030 — reaching the devastating levels seen in the 1990s and early 2000s. At the same time, there could be an additional six million new infections, including one million children, due to mother-to-child transmission.
PEPFAR’s Impact Tracker has predicted that, as a result of the freezes, an estimated 35,000 deaths have already occurred.
On the ground in Uganda, The Independent met women like Hadja, 27, a mother of three in Uganda, who is HIV positive and pregnant but unable to get hold of antiretrovirals — meaning she cannot prevent transmission of HIV to her unborn child. The documentary also features Hardlife, a 15-year-old Zimbabwean who lost both his HIV-positive parents earlier this year after they could not afford or find their medications.
The film also visits an HIV/AIDS clinic in southern Uganda that was 100 percent funded by USAID. Staff said they had to shut down for two months, then reopen with a skeleton crew working without pay. They now have only two months’ worth of drug supplies left and worry about the future of their patients.
Part of the problem is the “challenges” surrounding implementation of the waiver, Angeli Achrekar, deputy executive director of UNAIDS, told The Independent.
“The whole HIV service delivery system is an ecosystem. Any one kink in the system could cause a real ripple effect across the entire HIV ecosystem,” she said.
When asked about the apparent failure of the waiver, President Trump told The Independent “that shouldn’t be happening” and urged the countries involved “to act properly on the waiver.”
“But I do ask: why are we the only country doing it? I’m a big fan of getting this solved,” he added.
Although the US was carrying the lion share of the financial burden of funding the fight against HIV/AIDs – and is in the words UNAIDS “the most important donor” – it is not the only donor.
According to data shared by the Global Fund to Fight AIDS, tuberculosis and malaria, Germany and France are among the largest donors. The Global Fund is another major part of the global response to HIV/AIDs that pools resources from governments, civil society, and the private sector to fund programmes to end these diseases.
Their data shows France, a founding member of the Global Fund is the largest European donor and the second-largest public donor overall (behind the United States). They have contributed €6.9 billion since the fund was started 20 years ago. In the last replenishment conference in 2022 , France pledged €1.6 billion for the years 2023 to 2025 — nearly a quarter increase from its previous contribution.
Germany, meanwhile is the fourth-largest public donor overall, contributing over €5.3 billion since the fund was created 20 years ago. It pledged €1.3 billion for the 2023–2025 funding cycle, according to the Global Fund.
UNAIDS officials told The Independent that while the US has provided the most amount of funds, countries have also played a significant role relative to their economic size.
By measuring HIV contributions in 2023 per million US dollars GDP, the UK actually ranks first ($213.5 per $1 million GDP), followed by the US (US$ 208 per $1 million GDP), while France ranks fifth with $105.5 million GDP.
There has also been a move to increase domestic funding and resilience from countries hardest hit by the HIV/AIDs pandemic.
“We do recognise and want to celebrate that the US has been the largest donor and has done an amazing job during the last decades. Thanks to that we are where we are in the HIV response, So it has been an amazing leadership and contributions,” Jaime Atienza Azcona, a director at UNAID, told The Independent.
“Others have done their part, but to a lesser degree. Going forward, we need a more balance approach among the different donors. But we still need donor support and we still need the US leadership even if it is at a lower scale.”
The Independent reached out to the foreign ministries of both France and Germany for comment on President Trump’s accusations but has yet to receive a reply.
This story has been produced as part of The Independent’s Rethinking Global Aid series
