US Aid Cuts Threaten Global HIV Prevention: What It Means in 2026

HIV prevention programmes in dozens of countries have collapsed or shrunk sharply after the United States froze key foreign aid. UNAIDS and several research groups warn that new HIV infections could rise for the first time in years. The cuts affect testing, PrEP, condom distribution and treatment for millions of people.

This article explains what changed, what the latest data show, and what it means for gay and bisexual men, transgender people and sex workers worldwide.

What happened with US funding

In January 2025, the Trump administration ordered a freeze on most foreign aid. That included money from PEPFAR, the US President's Emergency Plan for AIDS Relief. PEPFAR was started in 2003 by President George W. Bush. It is the largest HIV programme in history.

PEPFAR has paid for HIV medicine, testing and prevention in more than 50 countries. According to the US State Department, the programme has saved over 25 million lives. It supports about 20 million people who take HIV treatment every day.

After the freeze, many clinics closed within weeks. Some services restarted under a limited waiver for life-saving treatment. But prevention work, including PrEP for gay men and transgender women, was largely stopped.

What the latest data show

UNAIDS reported in mid-2025 that HIV testing dropped by more than half in several African countries. PrEP starts fell by up to 80 percent in some regions. The Global Fund and WHO confirmed similar trends.

A modelling study published in The Lancet HIV in 2025 estimated that, without quick action, the cuts could lead to between 4.4 and 10.8 million extra HIV infections by 2030. The same study projected up to 2.9 million additional AIDS-related deaths.

The hardest-hit groups are people who already face barriers to care. That includes gay and bisexual men, transgender women, sex workers and people who inject drugs. In many countries, PEPFAR-funded clinics were the only places where these groups could get HIV care without stigma.

Why prevention matters as much as treatment

HIV treatment keeps people alive and stops the virus from spreading. Someone on effective treatment cannot pass HIV to a sexual partner. This is known as U=U, or undetectable equals untransmittable.

Prevention tools are just as important. PrEP is a daily or on-demand pill that stops HIV before it starts. Studies show it is more than 99 percent effective when taken correctly. Long-acting injectable PrEP, like cabotegravir, works for two months per shot.

When prevention programmes stop, the effect is delayed but serious. People who would have started PrEP instead get infected. They then need lifelong treatment. The cost, in money and in lives, grows over time.

You can read more about ongoing vaccine research in our article on HIV vaccine research in 2026.

Which countries are most affected

PEPFAR money goes mostly to sub-Saharan Africa. Countries like South Africa, Uganda, Kenya, Mozambique, Tanzania and Nigeria depend heavily on it. South Africa, which has the largest HIV epidemic in the world, gets about 17 percent of its HIV budget from PEPFAR.

Some countries have started to use their own budgets to fill the gap. South Africa's government announced extra funds in 2025. But most low-income countries cannot replace the lost money quickly.

Eastern Europe and Central Asia also face problems. HIV rates there were already rising before the cuts. Programmes for men who have sex with men and people who use drugs have shrunk further.

What this means for gay and bisexual men

Globally, gay and bisexual men are about 23 times more likely to get HIV than the general adult population, according to UNAIDS. In many countries, PEPFAR funded the only friendly clinics for this group.

Without those clinics, men may avoid testing because of stigma or fear. They may run out of PrEP. They may stop treatment if supply chains break. All of this raises the risk of new infections, not only locally but also through travel and migration.

In the Netherlands and most of Europe, HIV services are funded nationally. So the direct effect on Dutch readers is small. But experts warn that a global rise in HIV will eventually affect every country. New variants and resistance patterns also spread across borders.

What experts say should happen now

UNAIDS, the WHO and the Global Fund have all called for emergency funding. They want donor countries to fill the gap and for governments to invest more in their own HIV responses.

The Aidsfonds in the Netherlands has warned that years of progress could be lost. The organisation supports community-led groups in affected countries. It argues that local groups, including LGBTQ+ organisations, are essential for reaching people who avoid government clinics.

Researchers also point to cheaper tools. Generic PrEP costs less than 5 dollars per person per month in many countries. Self-testing kits cost about 1 dollar. Scaling these up could soften the blow.

What you can do

If you live in the Netherlands or another European country, your own HIV care is not directly affected. But you can still help.

• Keep using prevention tools that work. If you are at risk, talk to your GP or sexual health clinic about PrEP. Learn more about other prevention tools in our article on Doxy-PEP for bacterial STIs.
• Get tested regularly. In the Netherlands, the GGD offers free testing for gay and bisexual men.
• Support organisations that fund global HIV work, such as Aidsfonds or the Global Fund.
• Stay informed. Reliable sources include UNAIDS, the WHO, RIVM and Aidsfonds.

The bottom line

The US aid cuts have created the biggest setback in global HIV prevention in two decades. The science is clear: without funding, infections rise and people die. Whether other donors and governments can close the gap will shape the HIV epidemic for years to come.