HIV prevention services hit hardest by funding cuts, UNAIDS warns

Devastating donor funding cuts to the HIV response have hit prevention services the hardest. If this continues, it could lead to an additional 3.9 million new infections over the next five years, even if treatment coverage is maintained, UNAIDS warned in a new report for World AIDS Day 2025. In Burundi, the number of people receiving preexposure prophylaxis, or PrEP, declined by 64% from December 2024 to August 2025. In Nigeria, the number of male condoms distributed fell by 55% between December 2024 and March 2025. Voluntary medical male circumcision, which reduces the sexual transmission of HIV, fell by 65% in Uganda between December 2024 and June 2025, and as much as 88% in Botswana from January to May 2025. Across sub-Saharan Africa, 450,000 women have lost access to mentors and health services that help ensure the prevention of HIV transmission among their children. Many clinics focused on providing HIV prevention services for key populations have also closed, and the provision of post-exposure HIV prophylaxis declined in places such as the Democratic Republic of Congo, where thousands of sexual violence cases have been reported in recent years in the eastern part of the country. The crisis is taking place amid a “deteriorating human rights environment globally,” UNAIDS Executive Director Winnie Byanyima said during a press conference at the report’s launch on Tuesday. Byanyima said this is the first time since 2008 — when UNAIDS began tracking punitive laws — that there has been an increase in countries criminalizing same-sex sexual activity and gender expression. As of 2025, 168 countries criminalize some aspect of sex work, 64 countries criminalize same-sex relations, 14 countries criminalize transgender people, and 152 countries impose criminal penalties for the possession of drugs. The UNAIDS leader called on governments to uphold human rights, and for funders to put more resources into HIV prevention, including in the rollout of lenacapavir, the long-acting HIV prevention injectable that’s been shown to be highly effective in preventing HIV infection in trials. The U.S. has announced its support for the rollout of lenacapavir in select countries, in collaboration with Gilead and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to reach 2 million people over the next two years. Eswatini and Zambia have already received their first shipments of the drug, and regulatory submissions are underway in several African countries, including Rwanda, Tanzania, and Botswana, Byanyima said. She added that in Zimbabwe, the medicines control authority has fast-tracked clearance of the drug. Byanyima said this could avert 50,000 new HIV infections over three years, but “is still a drop in the ocean” of need. UNAIDS estimates that 20 million people will need access to lenacapavir to achieve the global target of reducing HIV infections by 90% by 2030. Unitaid and the Gates Foundation have announced deals in recent months that would bring the price of generic versions of lenacapavir to $40 per year, the same price as daily oral PrEP. But Byanyima said Gilead should license more companies, including in Africa and Latin America, to further bring down the price of the drug and ensure every region can produce it. This, she said, could help drive down new infections fast and bring the world close to ending AIDS as a public health threat. China is also stepping up its support for countries. Last week, China announced $3.49 million to support HIV prevention in South Africa. Byanyima said China is engaging several other countries in similar agreements, including Zimbabwe, Lesotho, Uganda, Tanzania, and Cuba. “We encouraged and catalyzed this funding for a number of countries as additional support by China to developing countries, and we are providing technical support for the money to have its highest impact,” Byanyima said, adding that the countries China is supporting are those where it already has programs and “strong relationships.” That support, however, doesn’t include funding for the purchase of lenacapavir. “Lenacapavir is an American product, and the Chinese government will spend its money on products from Chinese companies. That has to be expected,” she said. Delayed evidence Byanyima warned that the decisions governments make today will have serious consequences in the years ahead. There have been reports of people dying due to the U.S. funding cuts, after failing to access treatment — although Washington has vehemently denied that. UNAIDS also previously warned that if funding is not fully restored, 4 million people could die from AIDS-related deaths between 2025 and 2029. Byanyima said evidence on the impact of the cuts on mortality will only be known in a year or two. “If people are suddenly off treatment, we also know that the virus that has been suppressed becomes live, and that can happen in a few weeks. But in those few weeks, that patient will not die, but will start to weaken because of the viral load. So we really will see the evidence of this or the impact of these sudden cuts and the reversal in rights … much later,” she explained. “So it’s so important that governments are taking decisions well aware that they are not going to see the negative impact, the deaths now,” she said. However, if they don’t take action now, “some people will die in some years to come, and that's not good,” she added.