Global AIDS Fight at Risk as US Funding Cuts Deepen
RIO DE JANEIRO — The 26th International AIDS Conference opened this week in Rio de Janeiro under a theme of “Rethink. Rebuild. Rise.” — but for the thousands of researchers, activists and public health officials gathered here, the most urgent question is whether the global campaign to end AIDS can survive the steepest funding cuts in a generation.
As 6,000 attendees convened at the conference organized by the International AIDS Society (IAS), they faced a stark reality: the United States, the single-largest funder of global HIV/AIDS programming, has slashed its contributions from $6.7 billion to $4.6 billion in the past year, according to KFF data cited by NPR. International HIV financing dropped by more than $1.5 billion between 2024 and 2025 — an 18 percent decline, the steepest in nearly 20 years.
A Legacy Under Threat
At the heart of the crisis is PEPFAR — the President’s Emergency Plan for AIDS Relief — launched by President George W. Bush in 2003. The program has saved more than 26 million lives and transformed the trajectory of the HIV pandemic worldwide. But the second Trump administration has dramatically reversed course.
The administration slashed 30 percent of PEPFAR’s bilateral funding last year. Congress attempted to restore funding to previous levels, but according to NPR’s reporting, the State Department spent only 70 percent of available funds. Now, the White House has announced it will permanently cease PEPFAR funding by early 2027.
The consequences are already visible. An amfAR survey conducted between November 2025 and April 2026 found that 1,714 clinics, drop-in centers and other providers have shut down globally. The International AIDS Society reports that 1,010 public health facilities, 325 access points, and 126 drop-in centers have closed. Prevention programs serving marginalized groups — including men who have sex with men, transgender people, sex workers, and people who inject drugs — have been hit hardest.
“The PEPFAR that survived is not necessarily the PEPFAR that existed before,” Elise Lankiewicz, a policy associate for amfAR, told NPR.
New Domestic Funding Cuts
On the same day the conference opened, the Washington Blade reported that the Office of Management and Budget has decided to discontinue $46 million in direct federal funding for 96 community-based organizations providing HIV prevention services. The funds will be redirected to states, raising concerns among advocates that local programs serving vulnerable populations could be disrupted.
“Not all states send their money to the communities that really need it most,” said Carl Schmid, executive director of the HIV+ Hepatitis Policy Institute. “And not all states are fast in getting money to the community-based organizations.”
Scientific Breakthroughs Meet Access Barriers
Despite the funding crisis, the conference has showcased remarkable scientific advances. Trials presented this week demonstrate that lenacapavir, a twice-yearly injectable PrEP, shows superior efficacy in preventing HIV transmission compared to daily oral medications. A weekly pill has also proven as effective as daily dosing with fewer side effects.
Yet these breakthroughs may remain out of reach for those who need them most. Brazil, which played a key role in clinical trials for lenacapavir, was excluded from voluntary licensing agreements for generic production — meaning the patented version costs over $20,000 per patient per year, while domestic manufacturing could bring the cost to approximately $75.
“The last year has been a year of mixed feelings,” Dr. Kenneth Ngure, president-elect of the International AIDS Society, told NPR. “We have had very good scientific advances of the new products, yet the funding cuts have also taken us back.”
UNAIDS at a Crossroads
Even UNAIDS — the United Nations agency leading the global fight against HIV — faces an uncertain future. As part of the UN Secretary-General’s UN80 reform efforts, a proposal to sunset the organization by year’s end was floated but has not been finalized after significant pushback.
Winnie Byanyima, UNAIDS’ executive director, delivered a stark warning at the conference: “The question is no longer whether we can end AIDS — the question is whether we choose to end AIDS.” She added, “When prevention disappears, infections rise. When treatment is interrupted, people die.”
What’s at Stake
The numbers tell a sobering story. While AIDS-related deaths fell to 547,000 in 2025 — the lowest in 30 years — 1.2 million people still acquired HIV last year, and 22 percent of those living with the virus are not receiving treatment. New infections increased across three regions and in 21 countries during 2025, according to UN data.
Beatriz Grinsztejn, president of the International AIDS Society and co-chair of the conference, summed up the paradox facing the global HIV community: “Science is moving fast, giving us more powerful HIV prevention and treatment tools. But these advances cannot save lives if they never reach the people who need them. That requires robust, stable financing and steadfast political commitment.”
As the conference continues through July 31, delegates are grappling with fundamental questions about the future of global health cooperation. The 2030 target for ending AIDS as a public health threat — once seen as ambitious but achievable — now appears increasingly out of reach. The choice, as Byanyima framed it, is no longer about capacity but about political will.