Recent funding shifts in global HIV prevention programs have raised meaningful concerns among public health experts. The U.S.pullback from key initiatives supported by the President’s Emergency Plan for AIDS Relief, or PEPFAR, is a central part of this discussion.
Mulugeta Gebregziabher, Ph.D., a professor of public health at the Medical University of South Carolina, is among those voicing thes anxieties. He also holds a federal role with the Veterans administration.
In a candid interview with Managed Healthcare Executive, Dr. Gebregziabher clarified that his views are personal and do not reflect the official positions of his government employers. this distinction is vital as he shares his expertise.
He recently presented his insights at the IAS 2025 meeting in Kigali, rwanda. This gathering brought together leading researchers and professionals dedicated to advancing HIV prevention and treatment strategies.
Originally from Africa, Dr. Gebregziabher, now a U.S. citizen, emphasized PEPFAR’s critical role in the worldwide fight against HIV. The program has been instrumental in saving countless lives.
According to the 2025 UNAIDS report, PEPFAR supported HIV testing for an remarkable 84 million people and initiated treatment for 20.6 million in 2024 alone. Dr. Gebregziabher cautioned that reduced funding for prevention jeopardizes decades of hard-won progress.
“In the united States, there are approximately 1.2 million people living with HIV/AIDS, and 13% of them don’t even know it,” he stated. This highlights the ongoing need for widespread testing and awareness.
He further explained that HIV/AIDS continues to disproportionately affect certain communities. These include racial and ethnic minorities, and also gay and bisexual individuals. Men who have sex with men are also considerably impacted.
Dr. Gebregziabher expressed his expectation for the U.S. to maintain its leadership role in global health. This is particularly crucial at a time when the country is reviewing its commitments to organizations like the CDC, USAID, and the WHO. Infectious diseases, he noted, do not respect national borders, making international collaboration essential.
Despite these challenges, Dr. Gebregziabher remains optimistic about the future. He sees great potential in innovative prevention tools like PrEP.
He believes the global health community will unite to sustain progress toward ambitious goals. These include the 95-95-95 targets: diagnosing 95% of people with HIV,ensuring 95% of those diagnosed are on treatment,and achieving viral suppression in 95% of those treated.
Though, without consistent U.S. leadership and financial support, both domestic and international HIV efforts could face significant setbacks. This underscores the importance of continued investment.
What are yoru thoughts on the U.S. role in global health initiatives like PEPFAR? Share your views in the comments below.
What specific populations are most vulnerable to the resurgence of the HIV epidemic if PEPFAR funding is reduced?
Table of Contents
- 1. What specific populations are most vulnerable to the resurgence of the HIV epidemic if PEPFAR funding is reduced?
- 2. U.S. HIV Funding Cuts Threaten Global Progress on the Virus
- 3. The Impact of Reduced PEPFAR Funding
- 4. Understanding PEPFAR’s Role in Global HIV Control
- 5. Specific Regions at Risk: A continent-by-Continent Breakdown
- 6. The Cascade Effect: Consequences Beyond Direct Treatment
- 7. The Role of Prevention: PrEP and Beyond
U.S. HIV Funding Cuts Threaten Global Progress on the Virus
The Impact of Reduced PEPFAR Funding
Recent proposed cuts to U.S. funding for global HIV/AIDS programs, notably through the President’s Emergency Plan for AIDS Relief (PEPFAR), pose a meaningful threat to decades of progress in combating the virus worldwide. These reductions, impacting crucial initiatives in prevention, treatment, and research, could reverse hard-won gains and lead to a resurgence of the HIV epidemic, especially in vulnerable populations. The potential consequences extend beyond public health,impacting economic stability and global security. Understanding the scope of PEPFAR and the ramifications of diminished support is critical.
Understanding PEPFAR’s Role in Global HIV Control
PEPFAR, launched in 2003, has been instrumental in saving over 20 million lives globally. It operates in over 50 countries, primarily in sub-Saharan Africa, but also in Asia, Latin America, and the Caribbean.
Here’s a breakdown of PEPFAR’s key contributions:
Antiretroviral Therapy (ART): Providing life-saving ART to millions living with HIV.
Prevention Programs: Funding initiatives like condom distribution, voluntary medical male circumcision, and pre-exposure prophylaxis (PrEP).
Testing and Counseling: Expanding access to HIV testing and counseling services.
Laboratory Capacity building: Strengthening laboratory infrastructure for accurate diagnosis and monitoring.
Health Systems Strengthening: Investing in overall health system improvements in partner countries.
These programs aren’t just about treating illness; they’re about building resilient healthcare systems capable of sustained HIV control. Cuts to PEPFAR directly undermine these efforts.
Specific Regions at Risk: A continent-by-Continent Breakdown
The impact of funding reductions won’t be uniform. Certain regions are disproportionately reliant on U.S.assistance and will face more severe consequences.
Sub-Saharan Africa: The region most heavily impacted, accounting for nearly 70% of all people living with HIV globally. Cuts will severely limit access to ART, leading to increased morbidity and mortality.Countries like South Africa, Nigeria, and Uganda, with large HIV burdens, are particularly vulnerable.
Asia and the Pacific: While HIV prevalence is lower than in Africa,rising infection rates in countries like Thailand and the Philippines necessitate continued investment. Reduced funding could hinder prevention efforts targeting key populations, such as men who have sex with men and transgender individuals.
Eastern Europe and Central Asia: This region has seen a dramatic increase in HIV infections in recent years, driven by factors like injecting drug use. Funding cuts will jeopardize harm reduction programs and access to treatment.
Latin America and the Caribbean: increasing rates of HIV among young people and key populations require sustained prevention and treatment efforts. Reduced funding could reverse progress in these areas.
The Cascade Effect: Consequences Beyond Direct Treatment
The repercussions of reduced HIV funding extend far beyond the immediate impact on treatment access. A cascade of negative consequences is highly likely to unfold.
- Increased new Infections: Reduced prevention efforts will inevitably lead to a rise in new HIV infections.
- Drug Resistance: Interrupted ART regimens can lead to the growth of drug-resistant strains of HIV,making treatment less effective.
- Weakened Health Systems: Cuts to PEPFAR will strain already fragile health systems, impacting their ability to respond to other health challenges.
- Economic Instability: The HIV epidemic has significant economic consequences, reducing productivity and increasing healthcare costs. Reversing progress will exacerbate these issues.
- Security Implications: Uncontrolled epidemics can contribute to social unrest and political instability.
The Role of Prevention: PrEP and Beyond
Prevention remains a cornerstone of the global HIV response.Pre-exposure prophylaxis (PrEP), a daily pill that prevents HIV infection, has proven highly effective. However, access to PrEP remains limited in manny parts of the world, and funding cuts will further restrict its availability.
Other crucial prevention strategies include:
Condom Promotion: Increasing access to and promoting the consistent use of condoms.
Voluntary Medical Male Circumcision (VMMC): Expanding VMMC programs, which have been shown to reduce HIV transmission.
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