KVIG Informative

The United States pulled funding from the global HIV/AIDS program it had sustained for two decades. UNAIDS projects more than 6 million additional infections and 4 million more deaths by 2029 as a result. The program being dismantled has saved more lives per dollar than almost anything the federal government has ever funded.

In 2025, the Trump administration dismantled PEPFAR — the President’s Emergency Plan for AIDS Relief — the U.S. program that had delivered antiretroviral treatment, prevention, and care to millions of people living with HIV across sub-Saharan Africa, Southeast Asia, and the Caribbean since 2003. The disruption to PEPFAR funding delivered what UNAIDS called a huge and shocking blow to the global HIV/AIDS effort.

UNAIDS, the United Nations program coordinating the global HIV response and the organization to which the United States had been the largest donor, could be shuttered in 2026 — four years ahead of schedule — as a direct result of the funding withdrawal. UNAIDS projections indicate that if PEPFAR funds permanently disappear, there could be over 6 million additional HIV infections and an additional 4 million AIDS-related deaths by 2029.

What PEPFAR Actually Was

PEPFAR was created under President George W. Bush in 2003 and has been reauthorized by every subsequent administration, Republican and Democrat. It is widely considered one of the most effective and cost-efficient public health programs in American history. Over the past 50 years, immunization and treatment programs funded substantially through U.S. foreign aid have saved an estimated 154 million lives globally, according to public health researchers.

PEPFAR specifically has provided antiretroviral therapy to more than 20 million people, preventing the transmission of HIV from mothers to children on a scale that has effectively eliminated pediatric HIV in parts of sub-Saharan Africa where it was once endemic. The program operated at a cost of approximately $7 billion annually — less than one-tenth of one percent of the federal budget — and produced measurable, peer-reviewed outcomes that public health researchers consistently describe as among the best returns on government investment ever documented.

The Domestic Consequences

The HIV crisis is not only a foreign policy issue. More than 1.2 million people in the United States are currently living with HIV. An estimated 13 percent do not know their status. New infections in the U.S. are concentrated in the South and in communities of color, with Black Americans accounting for approximately 40 percent of new HIV diagnoses despite representing 13 percent of the population.

At the same time that PEPFAR was being dismantled abroad, domestic HIV prevention funding through the Centers for Disease Control was also subject to cuts and restructuring. The CDC’s Division of HIV Prevention, which funds community-based testing, treatment navigation, and prevention programs in high-burden cities, faced significant uncertainty in 2025 as broader agency cuts swept through the federal public health infrastructure.

Nevada consistently ranks among the states with higher rates of new HIV diagnoses relative to population. Clark County, which includes Las Vegas, accounts for the vast majority of new cases in the state. Community health organizations in Las Vegas that receive CDC pass-through funding for HIV testing and prevention services were among those facing potential disruption as the federal health infrastructure reorganized in 2025.

What the Projections Mean

UNAIDS Executive Director Winnie Byanyima said at a press briefing that the sudden withdrawal of lifesaving support is having a devastating impact. The 6 million additional infection projection is not a worst-case scenario — it is the baseline projection based on current funding gaps. It assumes that some replacement funding will emerge from other sources. If it does not, the number could be higher.

For context: the entire AIDS epidemic from 1981 to today has killed approximately 40 million people globally. The projected additional deaths from the PEPFAR funding withdrawal — 4 million by 2029 — represent roughly 10 percent of the epidemic’s entire historic death toll, concentrated into four years, caused not by the virus outrunning science but by the withdrawal of funding for treatments that already exist and already work.

The drugs that prevent HIV transmission are not experimental. The programs that deliver them are not experimental. The outcomes are documented. What changed is not the science. What changed is the decision about whether American resources would continue to support it. That decision has a projected cost. The projection is 4 million people.