The World Health Organization (WHO) has called for continued funding of global HIV programmes following the recent decision by US President Donald Trump to freeze foreign aid, a move that threatens treatment and testing for millions worldwide.

The funding suspension puts at risk access to HIV diagnostics, medicines, and treatment in low- and middle-income countries, according to WHO officials. The organisation warned that halting these programmes could lead to severe health consequences, particularly in regions heavily impacted by HIV/AIDS.

Dire Consequences of Funding Cuts

“A funding halt for HIV programmes can put people living with HIV at immediate increased risk of illness and death and undermine efforts to prevent transmission in communities and countries,” the WHO said in a statement.

Health officials fear that an extended pause on foreign assistance could undo decades of progress in the fight against HIV/AIDS, potentially returning the world to conditions seen in the 1980s and 1990s when millions died annually due to lack of treatment.

As of 2023, nearly 39.9 million people worldwide were living with HIV, with two-thirds residing in sub-Saharan Africa. Despite a significant reduction in AIDS-related deaths—from 2.1 million in 2004 to 630,000 in 2023—the disease remains a leading global health crisis.

Impact on PEPFAR and Global HIV Efforts

The most affected programme by the funding freeze is the President’s Emergency Plan for AIDS Relief (PEPFAR), which has been instrumental in saving more than 26 million lives since its launch in 2003 under then-President George W. Bush.

In 2024, PEPFAR provided antiviral HIV treatment to 20.6 million people across 55 countries. The programme also initiated 2.5 million individuals on pre-exposure prophylaxis (PrEP), a preventive measure against HIV infection, and facilitated testing for 83.8 million people.

Beyond direct patient care, PEPFAR supports 342,000 health workers worldwide whose jobs are now in jeopardy due to the funding suspension. The freeze also affects additional US-backed foreign aid initiatives that collectively provide HIV treatment to 30 million people.

US Pullback from Global Health Leadership

President Trump’s decision to freeze foreign aid for health initiatives marks another step in scaling back US global health commitments. In addition to pausing PEPFAR funding, he has initiated the process of withdrawing the US from the WHO and reinstated the Mexico City Policy, which restricts US funding to foreign organisations that provide abortion-related services or information.

Trump has cited dissatisfaction with the WHO’s handling of the COVID-19 pandemic and concerns over the disproportionate US financial contributions to the organisation as reasons for these decisions.

Calls for Exemptions and Humanitarian Waivers

WHO officials have been working with nations benefiting from PEPFAR to develop long-term strategies for reducing dependency on US aid by 2030. However, the abrupt funding halt threatens to derail these efforts, putting millions of lives at risk, according to the organisation.

The WHO is advocating for exemptions to allow the continued delivery of essential HIV treatment and care. US Secretary of State Marco Rubio has reportedly granted a humanitarian waiver to maintain critical health services impacted by the freeze. According to The Washington Post, the waiver covers “core lifesaving medicine, medical services, food, shelter, and subsistence assistance.”

However, it remains unclear whether the exemption will apply to PEPFAR, leaving the future of millions of HIV patients in uncertainty. Global health advocates continue to urge the US government to reinstate funding for these essential programmes to prevent a major health crisis.

President Donald Trump has reinstated the Mexico City Policy, commonly known as the “global gag rule,” sparking concerns about significant ripple effects on global health services, particularly in developing countries.

The policy prohibits U.S. funding for international non-governmental organizations (NGOs) that perform, promote, or provide information about abortions, even with non-U.S. funds. The reinstatement marks a continuation of Trump’s expansion of the rule, first introduced in the 1980s and traditionally toggled depending on the political party of the sitting U.S. president.

Broader Scope and Consequences

Trump’s version of the policy goes beyond its original scope, applying the funding ban to all U.S. global health assistance programs, including those addressing HIV, malaria, tuberculosis, and maternal and child health. This has raised alarm among NGOs and health experts about a potential “chilling effect” on sexual and reproductive health services.

Michael Jennings, a professor of global development at SOAS University of London, warned that organizations adhering to the rule may scale back services out of caution, leading to a “cascading” impact on healthcare delivery.

Impact on Global Health Funding

As the largest funder of global health programs, the U.S. plays a pivotal role in shaping international health initiatives. In 2022 alone, the U.S. allocated €15.1 billion to global health programs, dwarfing contributions from Germany, Japan, and the U.K. Combined, these three nations contributed less than €10 billion.

The policy’s reinstatement is expected to create funding shortfalls, particularly in reproductive health and family planning programs. NGOs like MSI Reproductive Choices, which refused to comply with the gag rule, anticipate losing millions in U.S. funding. MSI, which provides 20% of Zimbabwe’s contraception services, has already signaled potential service cuts in five African countries.

Human and Health Costs

Health experts warn of dire consequences. Studies indicate that previous implementations of the gag rule led to reduced contraceptive use, increased unintended pregnancies, and higher abortion rates. A recent review estimates that the 2017–2021 enforcement resulted in 108,000 additional maternal and child deaths and 360,000 new HIV infections across 30 countries.

Frances Longley, head of the International Federation of Gynecology and Obstetrics (FIGO), emphasized the interconnected nature of services provided by affected clinics, including contraception, prenatal care, and HIV treatment. “Doctors will face preventable crises they cannot address due to punitive restrictions,” she said.

European Response

European governments and donors may face heightened pressure to mitigate the funding gap. In 2017, EU countries raised €460 million to offset the policy’s effects. However, current financial strains, including the war in Ukraine and NATO obligations, may limit Europe’s ability to respond similarly.

“While some donors, including Japan and South Korea, may step up, the shortfall is unlikely to be fully addressed,” said Jennings.

The reinstated policy not only reshapes global health funding but also challenges international cooperation in addressing critical healthcare needs.