Changes to US policy jeopardises the lives of 500,000 children living with HIV by 2030
8 April 2025. Related: Early access, Treatment access.
Simon Collins, HIV i-Base
The impact of cancelling PEPFAR on HIV treatment and prevention programmes in sub-Saharan Africa includes the potential for one million children to become HIV positive and 500,000 children to die from HIV within five years. Another 2.8 million children could be orphaned.
The modelling paper is published in the Lancet on 8 April reporting the benefits from the last 20 years and the vulnerability if US funding is cancelled, calling for a new five-year plan. [1]
The US President’s Emergency Plan for AIDS Relief (PEPFAR) currently provides ART for 20 million people globally and since 2003 has saved 26 million lives and enabled 7.8 million babies to be born without HIV. Life expectancy has also been dramatically restored in countries which had been most decimated by the HIV pandemic.
However, since 20 January 2025, PEPFAR projects have been suspended, closing thousands of community clinics, many providing services to key populations, and there is no guarantee or perhaps even likelihood that funding will be resumed.
A linked letter from the health officials in 11 African countries includes a transition to long-term sustainable country ownership, but still refers to partnership with the US. [2]
Despite the continued reliance on US funding and the slow transition in many countries to treating their own citizens, a recent briefing from amfAR reported that domestic government spending was significantly increased in PEPFAR compared to non-PEPFAR countries (by approximately 350% vs 190%). [3]
References
- Cluver L and Toska E et al. Protecting Africa’s children from extreme risk: a runway of sustainability for PEPFAR programmes. The Lancet. (8 April 2025).
https://doi.org/10.1016/S0140-6736(25)00401-5 - Accelerating domestic investments to end AIDS in Africa. The Lancet. (8 April 2025).
https://www.thelancet.com/journals/lancet/S0140-6736(25)00685-3 - amfAR briefing. Domestic Funding Contributions to Health: Comparing Changes in Domestic Financing in PEPFAR and Non-PEPFAR Supported Countries. March 2025.
https://www.amfar.org/wp-content/uploads/2025/04/IB-World-Bank-Country-Analysis.pdf