The AIDS pandemic is likely to make a “global resurgence”: How many new HIV infections will there be in 2030?

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The study estimates that if funding cuts proposed by five major donors, including the United States and the United Kingdom, are not eased, there could be 4.4 million to 10.8 million new HIV infections and 770,000 to 2.9 million AIDS-related deaths among children and adults worldwide between 2025 and 2030.

Those most affected are likely to be in sub-Saharan Africa and among marginalized groups already at higher risk of HIV infection, such as people who inject drugs, sex workers, men who have sex with men, and children.

Since 2015, international donors have contributed approximately 40% of HIV funding in low- and middle-income countries (LMICs), which are critical to global HIV treatment and prevention efforts. Five countries—the United States, the United Kingdom, France, Germany, and the Netherlands—together account for more than 90% of international HIV funding.

However, all of these countries have recently announced plans to slash foreign aid, global international AIDS funding is expected to decrease by 24% by 2026. In addition, the US government, the largest contributor of foreign aid, suspended almost all foreign aid funding (with limited exceptions) on January 20, 2025 for a 90-day review and evaluation.

Foreign aid programs, such as PEPFAR), provides HIV treatment and prevention services, including funding for health clinics that provide antiretroviral therapy (ART), HIV testing and essential laboratory services.

These programs also provide health services beyond HIV treatment and prevention, including health system strengthening, health care workforce training, and integration of HIV services with other health services (such as tuberculosis treatment and prevention, and maternal and child health programs) to improve overall health outcomes.

To understand the potential impact of foreign aid funding cuts, the authors used a mathematical model covering 26 countries to estimate the impact of expected international aid cuts, including an immediate halt to all countries currently relying on foreign aid to support HIV diagnostics.and PEPFAR support for prevention programs.

When extrapolated to all LMICs, they found that if funding cuts continue as planned, there could be between 4.4 million and 10.8 million new HIV infections by 2030, a 1.3- to 6-fold increase in new infections among high-risk groups compared with a scenario in which funding levels remain stable. These cuts could also result in between 770,000 and 2.9 million AIDS-related deaths among children and adults by 2030.

“In sub-Saharan Africa, broader prevention efforts, such as condom distribution and provision of pre-exposure prophylaxis (PrEP) – a medication that reduces the risk of contracting HIV – are at risk of being discontinued in the first place,” added co-lead author Dr Rowan Martin-Hughes of the Burnet Institute in Australia.

“In addition, disruptions in testing and treatment programs could lead to surges in new HIV infections, particularly in areas where the greatest progress has been made, such as preventing mother-to-child transmission of HIV and childhood AIDS deaths.”

Many countries currently receiving PEPFAR or other foreign aid support have made significant progress in HIV treatment and prevention, with new infections falling by an average of 8.3% per year and AIDS-related deaths falling by 10.3% from 2010 to 2023. If this trend continues, many countries are on track to achieve the global goal of eliminating HIV as a public health threat by around 2036.

However, by 2026, if foreign aid were significantly reduced or PEPFAR funding ceased entirely without an equal amount of replacement funding, new infections and deaths could rebound to levels not seen since 2010 and could reverse all progress made since 2000.

Even if support for HIV treatment were restored after 12 to 24 months, the study suggested that the number of new HIV infections would likely stabilize at close to 2020 levels, which the authors noted would still represent a setback and that an additional 20 to 30 years of investment might be needed to end HIV as a public health threat.

“Innovative, country-led financing strategies and integration of HIV services into wider health systems are urgently needed; however, this cannot be achieved overnight. Countries need long-term strategic planning to transition from international support to domestically funded programmes. Our study highlights the importance of international collaboration and investment in sustaining progress on HIV,” said study author Nick Scott from the Burnet Institute in Australia.The doctor said.

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