Donald Trump’s slashing of foreign aid has derailed the projected end of the Aids pandemic and could lead to four million extra deaths by 2030, The Independent can reveal.
New figures show the number of Aids-related deaths could jump from six million to 10 million in the next five years unless funding is reinstated, according to forecasts from the UN Aids agency (UNAIDS).
The unprecedented disruption to global HIV programmes by the US is also projected to lead to more than three million more Aids orphans than previously expected by the end of the decade.
Only last year, the UN said a goal to end the Aids pandemic by the end of the decade was in reach, equating to a 90 per cent reduction in new infections and deaths.
According to the UN figures, there will be 3.4 million more orphans, defined as children who have lost at least one parent to Aids. In addition, 600,000 more newborns could be infected with HIV by 2030 – more than double the number originally feared. That will bring the total number of infant infections to a million by the end of the decade, analysis of the figures by The Independent shows.
Responding to the grim statistics, Professor Francois Venter, a leading HIV doctor at the University of Witwatersrand in Johannesburg, says: “All the gains that we’ve seen over the last 20 years will start being steadily reversed.
“Our hospitals when I was training 25 years ago were absolutely, absolutely overwhelmed. People were dying on the floor and at the moment hospitals are full, but they will be easily overwhelmed with what’s coming.”
Due to the funding pause, testing programmes for groups at high risk of HIV in South Africa are “falling apart”.
“Key population programmes are completely shuttered,” he adds. “Overnight, just stopped. HIV testing in the community has almost completely stopped.”
On Trump’s first day in office, he froze almost all US foreign assistance funds for 90 days, while projects were reviewed to make sure they were aligned with “American interests”. That deadline runs out this weekend, though many contracts have already been cancelled.
Timeline of HIV and aid funding cuts under Trump
- January 20: Trump orders a freeze on all foreign aid with a 90-day review
- January 24: A stop-work order is issued to US aid-funded programmes
- February 1: Limited exceptions are granted for "urgent lifesaving HIV treatment”, but a lack of clarity and loss of staff mean services are still disrupted
- February: Funding decisions are challenged in various courts; the Trump administration fights orders to pay aid partners.
- By March 10: Most aid grants and contracts are cancelled worldwide
- March 25: Authorisation for world’s largest HIV programme, funded by US, expires
- By March 28: US Agency for International Development (USAID) shutdown confirmed, nearly all staff sacked
- April 19: 90-day freeze and review period ends
This disruption, which has included contradictory information on exceptions to the ban, has had a profound impact, with records being lost and patients missing out on medicine.
Some 35,000 estimated deaths have already been linked to the sweeping freezes to HIV funding, according to forecasts from academics working on the US-funded HIV programme.
Now, UNAIDS data shared with The Independent gives a window into the worst-case scenario if no funding is restored to the President’s Emergency Plan for Aids Relief (Pepfar) – the largest effort to combat HIV on the planet. By 2029, the number of Aids-related deaths could reach more than three-times higher than previous projections – jumping from 490,000 to 1.6 million.
Set up in 2003 by George W Bush in response to a spiralling pandemic, Pepfar forms the backbone of the global response to HIV, funding drugs, prevention and research in more than 50 countries.
People receiving effective HIV treatment can live a virtually normal life span, and they are also protected from passing the infection on. Without it, their risk of becoming very ill and of infecting others goes up.
As well as treatment, Pepfar also funds testing, condoms and PrEP (pre-exposure prophylaxis) which help prevent new infections. If Pepfar services are completely ended, by the end of this year the number of all new annual infections – across the age spectrum – will have already doubled to 1.6 million, compared to the 830,000 projected for 2025.
The UNAIDS projections of the number of infections and deaths are in the worst-case scenario, where the US funded HIV-programme is not reinstated and none of the work it currently funds is picked up by other donors or governments.
The Independent reached out to the US State Department, which would not publicly confirm that Pepfar would be fully reinstated. Secretary of state Marco Rubio has said he wants Pepfar to continue, but that it should get smaller over time. Limited services, including for pregnant women and new mothers, have already been told they can continue working. But on the ground, a lack of clarity and resources means those services are still disrupted.
In recent years, HIV infections in newborn babies, contracted in the womb or through breastfeeding, have been going down. Pepfar cuts mean they are expected to surge, and fast. Without treatment, more than half of babies born with or contracting HIV in the first months of life will not survive to their second birthday.
In southern Uganda, The Independent met Hadja, a mother-of-three who was infected with HIV before becoming pregnant with her fourth child. US cuts have severed her access to the life-saving medication that suppresses the virus. Without it, she is terrified she will pass HIV on to her unborn baby.
“As soon as medication stops, the virus rebounds rapidly,” says Professor Lucie Culver at Oxford University. “Children will become sick faster, compared to adults, as their immune system is weaker.
“I got sent a photo a few days ago of a little girl in a hospital in Liberia and there were no antiretrovirals left, so she was born HIV positive. She’s got two years to live, probably, this little girl.”
Huge strides have been made in tackling HIV in the last 20 years and there had been “the end in sight”, says Angeli Achrekar, the deputy director of UNAIDS.
But without US support, she adds: “When we’re talking about an additional 2,300 new infections every single day, there’s no way we can get to the end of Aids. With these numbers of new infections, we cannot turn off the tap.”
Some countries are more reliant on the US Pepfar funding than others. In Tanzania, for example, 94 per cent of HIV services are paid for through Pepfar.
Our reports on the ground show that in Zimbabwe, where Pepfar paid for 60 per cent of HIV services, supplies are running low and government hospitals are being forced to turn patients away.
“There are no facilities to help control or reduce the number of infections, yet there is no medication,” volunteer health worker, Promise Masawi, says.
The impact can be measured not just in cost to lives and health but in how much harder HIV could become to treat.
Disrupting treatment makes it more likely that when people go back on their previous medication, their infection will have developed a resistance to the drug and it will no longer work.
Doctors have limited other medications in their toolboxes and the drugs they usually reach for after “first-line” treatments fail are more expensive.
A year’s supply of the most common HIV drugs costs $64 (£48) per person, compared with $300 for the medicines used after those drugs fail. By the time doctors are having to try a third drug, the cost is $405, six times higher.
It’s another way that decades of hard-won progress towards ending the Aids pandemic could falter.
“That’s what’s really devastating,” says Achrekar. “Because in the end, these are people’s lives that we’re talking about”.
This article is part of The Independent’s Rethinking Global Aid project
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