Rigat Bishaw, a health worker, speaks with a victim of rape living with HIV at Ayder hospital in Mekele in the Tigray region of northern Ethiopia, 13 Feb 2025. (Keystone/AP Photo/Amanuel Birhane)

In 2023, $19.8bn was provided for the HIV response, with the United States covering roughly one quarter. The Trump administration’s decision to pause all foreign aid and then terminate thousands of contracts has caused severe disruptions across HIV care services, forcing clinics to close, disrupting supply chains and putting prevention programmes on hold. The impact has been particularly harsh in Africa, home to 65 per cent of the global HIV-positive population, and where countries like Mozambique, Tanzania and the Democratic Republic of the Congo rely on US funding for more than half of their health budgets.

UNAids issued a stark warning on Monday, estimating that without US support, HIV-related deaths could rise by an additional 6.3 million over the next four years – a 10-fold increase from the last count – and new infections could climb by 8.7 million. The Lancet offered more conservative figures on Thursday, but painted an equally bleak picture. UNAids executive director Winnie Byanyima cautioned: “We will see a resurgence of…this disease. We’ll see it come back, and we’ll see people dying the way we saw them in the 90s and in the 2000s.”

But the alarmism in Geneva feels too distant from reality for frontline actors like Florence Riako Anam, the executive director of the Global Network of People Living with HIV. Riako Anam, who is based in Kenya, says she doesn’t have the luxury to wait for the US to come around. “We need our treatment now,” she tells Geneva Solutions.

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