The executive director of UNAids has issued a grave warning that HIV infections and AIDS-related deaths are set to soar in the coming years following what she describes as “seismic” cuts to US aid spending.
Winnie Byanyima, head of the global agency tackling HIV and AIDS, said in an interview at the UN international development summit in Seville that if the funding loss becomes permanent, the world could face an additional 6 million HIV infections and 4 million AIDS-related deaths by 2029.
“This is a deadly funding crisis, a global response knocked off course,” said Byanyima. “This is a pandemic, and pandemics have no borders.”
The cuts centre on the halting of Pepfar, the President’s Emergency Plan for AIDS Relief, which was established in 2003 by Republican President George W. Bush. The programme had become the world’s largest initiative to combat HIV/AIDS globally, providing treatment, prevention, and care for millions. In February, Donald Trump abruptly suspended the funding, dealing a catastrophic blow to UNAids, which depended on Pepfar for 60% of its budget.
“I am devastated. Appalled. Shaken and disgusted,” Byanyima said. “I don’t have the English words to use.”
Byanyima, a Ugandan engineer and former politician, said the devastating impact of the cuts nearly caused her to resign. “But I can’t run away. I told myself I was going to fix it. I need to take my gloves off.”
Over the past few years, US global health funding has stagnated. Simultaneously, traditional donors such as the UK have backed away from their commitment to spend 0.7% of GDP on aid, a target agreed by UN member states in 2015. The war in Ukraine and global economic pressures have further diverted international attention and resources.
Experts say that although the US later issued a vaguely worded waiver for parts of the Pepfar funding, it has not improved conditions on the ground. Byanyima noted the immediate consequences of the cuts: “Dedicated people are losing jobs, loyal support is gone, research has ended, vulnerable people are being abandoned. What went away first was prevention services, now we’re seeing the rise in infections and deaths.”
UNAids decries challenges
She described how clinics have closed, research has stalled, and vital services for at-risk groups, including young girls and men who have sex with men, have disappeared. “These are people who hide, who are shunned. And now they’ve lost lifelines,” she said.
“I had to have therapy to stay strong for others. The remaining staff are stretched thin, we are at real risk of burning out.”
The crisis, she stressed, is not only financial but also political. “This is a huge shift because it is so connected to geopolitics and power shifts. It is seismic,” she said. “But after the first wave of panic and pain, we must now work with less than half of what we had to save lives.”
Byanyima also criticised the broader global system, calling out the structural inequalities in how African countries are treated in financing, debt, and international aid.
“We lost 12 million people who didn’t need to die because antiretroviral drugs weren’t shared, pharmaceutical companies held onto them to make money. Now we face even more deaths,” she said. “Health is a human right. No one should die when we can prevent it.”
She added, “African countries aren’t lying down or holding out a begging bowl. They are making huge efforts to fill the gaps. But we need debt justice. We need tax justice. For too long, more money has flowed from the global south to the north than the other way around. That must end.”
In her closing remarks, Byanyima called for a complete rethinking of the global aid model: “It’s too unpredictable. The future must be less about charity and more about international solidarity.”
