When the UK government’s AIDS: Don’t Die of Ignorance campaign was launched in 1986, I was in primary school. But like so many other people, I can still recall the harrowing tombstone and iceberg adverts on television. The devastating human impact of the Aids epidemic is well-documented and made a long-lasting impression on me.
Decades later, as an NHS consultant working in the field, I have had the privilege of witnessing astonishing medical advances. Today, with medication, a person living with HIV can lead a long, healthy life and not pass on the virus to others.
However, cuts to HIV treatment and prevention threaten to roll back this progress and endanger the lives and human rights of millions of people around the world. The Independent reports that disruptions in consistent antiretroviral supply may result in emerging resistance to first-line drugs.
On 20 January 2025, the Trump-led US government implemented a 90-day freeze on international aid, to review whether the US was being prioritised in every programme. The United States Agency for International Development (USAID) was closed and 10,000 of its staff were fired overnight. To date, USAID has distributed more than $40bn a year of aid, including HIV programmes under Pepfar (President’s Emergency Plan for AIDS Relief). As of 2023, more than 25 million lives have been saved worldwide.
Although a temporary humanitarian waiver has been granted for life-saving interventions, including HIV antiretroviral therapy, the turmoil and uncertainty caused by the freeze has led to significant disruption. This has included the cancellation of grants and closure of essential HIV prevention, testing and treatment services, due to the impact on infrastructure and workforce. This has mainly affected people in countries in southern Africa and Asia, and marginalised key populations at highest risk of acquiring the virus. Thousands of research trials have also been halted suddenly, violating the safety and rights of the participants and breaching fundamental ethical principles. International collaborations have lost funding, which will limit scientific progress, as well as researchers’ careers.
UNAIDS, the joint United Nations programme on HIV and Aids, has predicted that if Pepfar is permanently closed, this could lead to an additional nine million new HIV infections and 6.3 million Aids-related deaths by 2029. Meanwhile amfAR, the Foundation for AIDS Research, estimates that 222,333 people will lose access to treatment for every day the freeze is in effect, of which 7,445 are children aged under 15 years. Over the 90 days, potentially 679,936 pregnant women will be denied HIV treatment which would prevent transmission to their babies, leading to 135,987 babies acquiring HIV.
Although the US is by far the largest donor, providing 72 per cent of funds to HIV services globally, cuts to aid by other leading donor countries is expected. A study published in the Lancet used a mathematical model with data from 26 countries to predict a 24 per cent cut in funding by 2026. In their worst-case scenario of Pepfar being permanently closed, the authors estimate between 770,000 and 2.9 million additional HIV-related deaths and between 4.4 million and 10.8 million new infections will occur by 2030. These kinds of figures have not been seen since the early 2000s.
The report raises concerns that disruptions to antiretroviral supply will lead to people developing resistance to Dolutegravir, a first-line drug in many low- and middle-income countries, potentially reducing its effectiveness. However, the more pressing concern is of people not receiving medication at all. Without antiretroviral medication to suppress the HIV virus to undetectable levels, people will quickly become unwell with preventable opportunistic infections taking advantage of their immunocompromised bodies. Hospitals will see a surge of people with Aids-related conditions that we should no longer see in this age of effective treatment. People being left untreated and with reduced access to testing and prevention tools will mean more transmissions, growing the epidemic.
What does this mean for us here in England? In 2023, 95 per cent of people living with HIV were diagnosed, 98 per cent of those diagnosed received antiretroviral treatment, and 98 per cent of those treated were virally suppressed. This demonstrates the success of HIV prevention and treatment efforts to date, and the unwavering advocacy of the HIV community and allies.
The government has committed to the UNAIDS targets of zero transmissions by 2030, and a new HIV action plan is due later this year. Funding has been pledged to raise awareness, increase testing, reduce stigma and address inequalities.
During National HIV Testing Week, Sir Kier Starmer publicly took a HIV self-test to normalise testing. However, simultaneously, the government has announced that it is almost halving overseas development aid from 0.5 per cent of the gross national income to 0.3 per cent (approximately £6bn) to pay for increased spending on defence. This led to international development minister Anneliese Dodds resigning.
HIV is a condition that does not discriminate or stay within borders. These cuts represent a shift in long-held principles of global health, which recognise that the health of all people is fundamental to global peace and security and is dependent upon international cooperation.
The UK government has an opportunity to lead on defending these principles by collaborating with other countries to provide emergency funding to fill the gaps left by USAID. Otherwise, we risk a resurgence of HIV infections and HIV-related ill health and deaths, reversing progress by decades.
The world’s poorest and most marginalised populations will bear the brunt of this – those whose voices are seldom heard. We cannot sit back and watch this humanitarian disaster unfold. We must act.
Dr Rageshri Dhairyawan is an NHS consultant working in the HIV/Aids field
This piece has been published as part of The Independent’s Rethinking Global Aid project
