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Up to 2.9 million more children and adults will die from HIV-related causes before 2030 because of aid cuts by countries including the US and Britain, a new study has found.
A resulting resurgence of the HIV epidemic would have “devastating consequences” globally, researchers warned, after estimating between 4.4m and 10.8m extra new infections in the next five years due to the cuts.
This would mean up to a six-fold increase in new infections among at-risk groups, compared with a scenario where funding levels remained consistent.
Dr Debra ten Brink, of Melbourne’s Burnet Institute and a co-lead author of the study, said: “Decades of progress to treat and prevent HIV could be unravelled.”
The modelling, published in the Lancet HIV, is the first to analyse the potential combined impact of funding cuts from leading donors, and projects a 24% reduction in global international HIV funding by 2026.
The US, UK, France, Germany and the Netherlands together provide about 90% of international funding for HIV but have all announced, or already implemented, plans to reduce overseas aid spending.
Anneliese Dodds resigned as the UK’s international development minister over a decision to cut the aid budget from 0.5% of gross national income to 0.3% in the next two years.
HIV and Aids around the world: in numbers
Show630,000
The number of people who died from Aids-related illnesses in 2023 – more than one every minute. Since the epidemic began, a total of 42.3 million people have died.
1.3 million
The number of new infections in 2023, mainly in sub-Saharan Africa. Women and girls accounted for 44% of these.
39.9 million
The number of people around the world living with HIV. Of these, 30.7 million are accessing antiretroviral therapy.
51%
The percentage by which the death rate has fallen in just over a decade. The risk of an HIV-positive mother passing the virus on to her baby is now less than 1%.
$19.8bn
The amount of funding available for Aids response in low and middle-income countries by the end of 2023. Of this, 59% came from domestic sources. International funding dropped by 7.9% between 2020 and 2023.
Since 2015, overseas donors have been responsible for about 40% of HIV funding in low and middle-income countries. The US has historically been the largest donor but earlier this year announced an almost-immediate halt to most spending, including many projects supported by the US President’s Emergency Plan for Aids Relief (Pepfar).
Those cuts have already disrupted essential HIV services covering prevention, testing and treatment globally.
The study used a mathematical model that took in data from 26 countries to produce its estimates. In a worst-case scenario covering an immediate halt to Pepfar support, wider aid reductions and no mitigation, it estimated there would be between 770,000 and 2.9 million additional HIV-related deaths by 2030 – a return to levels not seen since the early 2000s.
Dr Rowan Martin-Hughes, co-lead author, said sub-Saharan Africa could see an even greater impact, where prevention efforts such as distributing condoms and offering preventive drugs were “at first risk to be discontinued”.
He said: “This is in addition to disruptions in testing and treatment programmes [which] could cause a surge in new HIV infections, especially in some of the areas where the greatest gains have been made, such as preventing mother-to-child transmission of HIV and paediatric HIV deaths.”
Ten Brink said: “It is imperative to secure sustainable financing and avoid a resurgence of the HIV epidemic, which could have devastating consequences, not just in regions such as sub-Saharan Africa, but globally.”
The team called for countries to instigate innovative financing strategies and integrate HIV services into wider health systems.
Campaigners said the study should prompt a rethink of plans to cut aid. Anne Aslett , of the Elton John Aids Foundation, said: “This report demonstrates the critical and urgent need for donors to recognise the cumulative impact of their decisions to cut aid budgets.
“If funding for the global HIV response falls away to the extent this report suggests it could, millions more people will get sick, and health budgets will simply not be able to cope.”
Meanwhile, Save the Children warned that UK aid cuts would see deaths linked to malnutrition rise worldwide. Charities have called for the British government to pledge £3bn in nutrition-linked spending at the fourth Nutrition For Growth summit in Paris this week, though it has yet to make any commitment.
