Aid cuts by Donald Trump and Sir Keir Starmer could trigger a resurgence in HIV cases, with up to 10.8 million more people infected globally. Modelling published in the Lancet HIV medical journal shows the cuts could reverse decades of progress in slowing the epidemic that still kills around one person per minute. It says there will be between 4.4m to 10.8m additional new infections by the end of this decade in low-and-middle income countries unless the funding shortfall can be filled. The peer-reviewed study also estimated there could be between 0.8m and 2.9m HIV-related deaths in children and adults by 2030. Overall new infections and deaths from HIV will return to those last seen in the early 2000s. The grim forecast comes only days after the chief of the United Nations Aids agency made her own warning that US funding cuts could lead to an additional 6m deaths in the next four years. Winnie Byanyima this week said she feared a return to the 1990s, when HIV medication was scarcely available in poorer countries, and infections and deaths soared. Foreign donors provide around two-fifths of all anti-HIV funding in low and middle-income countries, with America, the UK, France, Germany, and the Netherlands between them making up 90 per cent of that. Yet each of these countries has recently announced significant aid cuts, giving reasons including the cost of rearming and reacting to the war in Ukraine, the desire to slim down public spending, or ideological opposition. America’s cuts are potentially the steepest, after the Trump administration paused all foreign aid for a 90-day review into programmes. The US Pepfar anti-HIV programme is a cornerstone of the global fight against the virus and the largest commitment by a country ever to address a single disease. In the 20 years since it was introduced by George W. Bush, it is credited with saving 26m lives in more than 50 countries. The Trump administration has vowed to keep “lifesaving” parts of it, but other parts have been scrapped and it remains unclear how much will survive. ‘Decades of progress’ could unravel Foreign aid goes to pay for everything from research into new vaccines and treatments, to giving anti-retroviral drugs to those already infected, to providing anti-HIV preventative jabs and tablets to those most at risk of catching the virus. Taken across all five donors, the cuts are between them projected to see a 24 per cent fall in global international HIV funding by next year. Dr Debra ten Brink, a scientist at Australia’s Burnet Institute and one of the paper’s lead authors, said: “The current cuts to Pepfar and USAID-supported programmes have already disrupted access to essential HIV services including for antiretroviral therapy and HIV prevention and testing. “Looking ahead, if other donor countries reduce funding, decades of progress to treat and prevent HIV could be unravelled.” “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 modelling looked at the impact on 26 countries and then extrapolated across all lower and middle income countries. If the funding reductions continue as planned, they found there could be between 4.4m to 10.8 million extra new HIV infections by 2030. That would represent a 1.3 to six-fold increase in new infections for people at higher risk of acquiring HIV, compared to if funding levels remained consistent. Dr Rowan Martin-Hughes, also of the Burnet Institute, said: “There could be an even greater impact in sub-Saharan Africa, where broader prevention efforts, such as distributing condoms and offering pre-exposure prophylaxis (PrEP – a medication that reduces the risk of getting HIV) are at first risk to be discontinued. “This is in addition to disruptions in testing and treatment programmes 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.” The billions of foreign aid poured into anti-HIV efforts have contributed to significant progress in treating and preventing the virus. There has been an average 8.3 per cent yearly decrease in new infections and a 10.3 per cent decrease in HIV-related deaths, the researchers said. If that trend continued, many countries would be on track to meet global targets to eliminate HIV/Aids as a public health threat by around 2036. That could now go into reverse, the modelling suggests. “There is an urgent need for innovative, country-led financing strategies and an integration of HIV services into broader health systems, however, this can’t happen overnight,” said Dr Nick Scott, also of the Burnet Institute (Australia). “Long-term strategic planning is required for countries to transition from internationally supported to domestically financed programmes. Our study highlights how important international collaboration and investment have been in maintaining progress against HIV.” Global Health Security