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A generation has passed since the peak of the global AIDS epidemic, when people died agonizing deaths from infections their bodies could no longer fight. Those losses drove a movement that pressured governments into action, leading to one of the most successful foreign aid programs in history: PEPFAR (President’s Emergency Plan for AIDS Relief).
For over 20 years, PEPFAR has kept millions alive by making HIV treatment widely accessible. But now, the Trump administration’s freeze on foreign aid is throwing that system into chaos. A temporary waiver for PEPFAR has done little to clear confusion, as U.S. workers, contractors, and payments remain in turmoil. The result: millions at risk of losing life-saving medication.
AIDS Could Surge Again
The U.S.-led response to HIV has been so effective that the sight of AIDS wards filled with dying patients has faded into the past. But health experts warn those days could return fast if the aid freeze continues.
“In the next five years, we could have 6.3 million AIDS-related deaths,” the U.N. AIDS agency told The Associated Press. The warning comes at a time of rising complacency around HIV, declining condom use among young people, and a growing reliance on PrEP (pre-exposure prophylaxis)—a medication some believe could end AIDS for good.
The U.N. has now begun publicly tracking new HIV infections linked to the aid freeze.
What Happens When HIV Treatment Stops?
HIV is spread through bodily fluids like blood, semen, and breast milk. It attacks the immune system, making the body vulnerable to deadly infections. The world first realized something was wrong in the 1980s when rare diseases—like fungal infections and severe pneumonia—suddenly appeared in otherwise healthy people.
Years of advocacy led to the creation of PEPFAR, but not before 20 million people had already died. Today, millions rely on antiretroviral therapy (ART) to suppress the virus.
Stopping HIV treatment has immediate and dangerous effects:
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Virus resurgence: HIV quickly rebounds in the blood within weeks, making people infectious again.
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Drug resistance: Without consistent treatment, HIV can mutate, making future medication less effective.
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Increased maternal and infant risk: Pregnant women with untreated HIV can pass the virus to their babies, while early treatment prevents this.
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Progression to AIDS: Without medication, a person with HIV typically survives about three years, according to the CDC.
An Unfolding Humanitarian Disaster
Across Africa—the continent most reliant on PEPFAR—the impact is already being felt. Clinics in Kenya and Ethiopia have laid off thousands of health workers, disrupting HIV testing and care. Some clinics have even turned away HIV patients, unable to provide medication.
Countries like South Africa, which has the highest number of HIV cases in the world, are particularly vulnerable. The rise of drug-resistant tuberculosis (TB)—already a major killer among people with HIV—could make the crisis even deadlier.
The Clock Is Ticking
For years, doctors have stressed that missing even a single dose of HIV medication can have consequences. Now, an entire global system is at risk.
Restoring PEPFAR’s operations will take time, even if the Trump administration reverses course. The 90-day review period for the aid freeze has created uncertainty, and experts warn that many don’t have time to wait.
Meanwhile, the head of U.N. AIDS, Winnie Byanyima, has warned that more drug-resistant strains of HIV could emerge, setting back decades of progress.
And beyond the immediate health crisis, an estimated 3.4 million children could be orphaned—an echo of the darkest days of the AIDS epidemic.
The world once united to fight AIDS. Now, unless urgent action is taken, it may soon be forced to fight it all over again.
