JOHANNESBURG, South Africa — Decades of progress in the fight against HIV/AIDS are in danger of unraveling, the United Nations Aids Agency (UNAIDS) warned Thursday in its annual report, citing sharp funding cuts from major donors.
The report, launched in South Africa by UNAIDS, says those cuts — especially the sudden withdrawal of U.S. funding — are threatening to reverse gains that have saved millions of lives over the past two decades.
"If the world doesn't plug this hole," said Winnie Byanyima, executive director of UNAIDS, "we estimate that an additional six million people will be newly infected in the next four years. We could have four million additional AIDS-related deaths."
The reports warning comes five months after the Trump administration halted most funding for the President's Emergency Plan for AIDS Relief (PEPFAR) — the largest single contributor to the global HIV/AIDS response. The decision was made with little warning.
"The sudden withdrawal of the single biggest HIV donor is putting this progress at risk," Byanyima said during a press briefing in Johannesburg.
Since the start of the epidemic, UNAIDS says 26.9 million lives have been saved through treatment efforts — many of them in sub-Saharan Africa, the region most affected by the virus.
Fallout in South Africa and beyond
South Africa, which has the world's largest population of people living with HIV, has made major strides. Most of those infected now receive life-saving antiretroviral drugs.
But the fallout is already being felt. At the report's launch, South Africa's Health Minister Aaron Motsoaledi called the U.S. cuts "a wake-up call" — and warned of the dangers of depending on a single donor.
"This type of relationship where we depend on one country, and when that country is in some type of negative mood, the whole world collapses — yes, it's scary," he said.
Scientific setbacks and a call to action
South African researchers have been at the forefront of global HIV breakthroughs as well as COVID-19 studies. But many trials are now being suspended due to lack of funds.
Dr. Helen Rees, head of the Wits Reproductive Health and HIV Institute in Johannesburg, said the implications are global.
"The research being done for HIV and tuberculosis in South Africa has not only had an impact here, but a huge global impact," she said.
Rees was recently honored by the World Health Organization for her "outstanding contribution to public health," but her institute is now facing major U.S. funding cuts.
"Not charity" — a shared fight
Trump has said the shift away from U.S. aid reflects a new emphasis on "trade over charity" in Africa. But UNAIDS' Byanyima says the sudden withdrawal of U.S. support in February has left UNAIDS with nearly 50% less funding — and no time to prepare for the gap.
"This is not charity," she said. "This is solving a global problem together. As long as it festers in some parts of the world, it will come back to hit everybody else."
For longtime HIV activist Nombeko Mpongo in Cape Town, the cuts have felt deeply personal.
"I remember for a few days I felt suffocated, I felt like being choked… It was like a volcano came and took everything away. It felt like a death penalty," she said.
But after the shock, Mpongo says she rallied.
"I realized — no man, nonsense. Let me fight. Let me reach out to the communities," she said. "We've fought this virus before. We'll do it again, because hope is what is going to carry us through."
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