IAS 2025: Early focus on impact of the international funding crisis

12 July 2025. Related: Conference reports, Treatment access, IAS 13th Kigali 2025.

Simon Collins, HIV i-Base

On 8 July 2025, a press briefing held a week before the IAS 2025 conference brought an appropriate focus on the current crisis in international funding. [1]

Dr Beatriz Grinsztejn, IAS President, emphasised the importance of the conference being held in Rwanda this year, because Africa is one of the regions where devastating global funding cuts will be felt most deeply. The conference will be a chance for all stakeholders – scientists, researchers, advocates, affected communities and governments to focus on how to resist these cuts.

“On the one hand we are witnessing scientific breakthroughs that could transform prevention and treatment and even bring us closer to a cure. But on the other, these very advances are under threat from massive funding cuts that risk stalling clinical trials, slowing our progress, and jeopardising the progress we have fought so hard to achieve.”

The press briefing included four late-breaking studies and a plenary talk on global funding. For full details please see full abstracts. [2]

Impact of stopping PEPFAR-funded PrEP in southern Africa

The first study modelled the impact on key populations of the loss of PEPFAR-funded PrEP in sub-Saharan countries and was presented by Dr Jack Stone from University of Bristol.

Until January 2025, PEPFAR was providing PrEP to roughly 720,000 people in 28 countries (although this was still less than 5% of those in need). They modelled that this cancelled access will directly lead to 6,700 new transmissions – 85% in key populations – and a one-year pause would lead to a further 10,000 secondary transmissions by 2030.

Even without details of the full study it is important to stress that impact will be far worse if these PrEP programmes are not re-funded because this model was only about pausing for a year.

HIV goals already destabilised in Mozambique: children suffer most

The second presentation included real-time evidence of funding cuts in Mozambique, together with modelled predictions of the long-term impact. This study was presented by Anna Grimsrud from IAS on behalf of the lead author Dr. Dorlim Uetela at the Instituto Nacional de Saude in Mozambique.

In February 2025 there were significant drops in all key metrics. This included 25% fewer people starting ART, 38% less viral load monitoring on ART, a 37% drop in test results received and, perhaps most alarming, a 33% reduction in viral suppression – all compared to 2024.

The results disproportionately affected children <15 years old, in whom these last three indicators were reduced by 44%, 71% and 43%, respectively.

If these trends continue, the study predicted up to 90,000 new transmissions (up by 23%) and 28,000 more deaths (a 33% increase) by 2030.

Losing PEPFAR in South Africa

The impact of losing PEPFAR funding in South Africa was reported by Khensani Chauke from the Gauteng Provincial Department of Health. This was evaluated in a cohort of roughly 620,000 people living with HIV and included the immediate loss of key health workers, including peer counsellors. Since January 2025, both HIV diagnoses and ART initiations have dropped by almost one-third compared to 2024.

PEP services dismantled in Latin America and the Caribbean

For the fourth study, Meg Stevenson of the Johns Hopkins School of Public health presented results from a survey of 21 HIV community organisations in 13 countries in Latin America and the Caribbean who had lost US funding since January 2025. These 21 groups reported that over 150,000 people have already lost access to HIV treatment and prevention services.

The most affected groups include people living with HIV, transgender people, people engaged in sex work, men who have sex with men and migrant populations. The group has little confidence that programmes will be funded by national governments, who show little concern for these populations.

Activist demand for restructuring international debt

Finally, global activist Zackie Achmat, founder of Treatment Action Campaign in South Africa and the Global HIV Treatment Coalition, presented the urgent case for the responsible restructuring of international debt.

Currently, African countries pay more than US$89 billion in loan repayments (compared to the US$43 billion previously spent by the US in international aid). Speaking directly, Achmat said he never expected to be pulled from retirement to have to speak about HIV again, but that 20 million people are now living on death row because of the new authoritarian US regime led by the criminally convicted new US President.

The impact of cancelled funding will further destabilise African countries in addition to the personal harms and impact on increased mortality, especially among key populations who will not access government services.

His own HIV clinic has been closed, there is no access to condoms or PrEP, and even HIV activists are running out of ART.

comment

Please note that these reports are only based on limited information available in the abstracts and at the press conference.

For full details, please see the full presentations when they are presented at the conference.

References

Unless stated otherwise, all references are to the programme and abstracts of the 13th IAS Conference on HIV Science (IAS 2025), 14 to 17 July 2025, Kigali, Rwanda.
www.iasociety.org/conferences/aids2025

1. IAS 2025 Press Conference 1 – Scientific Highlights (Virtual Only). 8 July 2025.
   https://mbooth.zoom.us/rec/play/x6wpe_iPeHhxKi60T0JXs0V1CRAaCNDA0xWfR5LGU79VVnEpYl9invVb5EkAOVlQfP8qjkWWbn12FHUU.Jjc2Bxq2Qct-BsN8
2. Stone J et al. Modelling the impact of cuts in PEPFAR funding for HIV pre-exposure prophylaxis among key populations in sub-Saharan Africa. IAS 2025. Co-chairs’ choice. Oral late-breaker abstract OAS0103LB.
   https://programme.ias2025.org/Abstract/Abstract/?abstractid=6731
3. Moiana Uetela D et al. The impact of the U.S. funding interruption on HIV services and the HIV epidemic in Mozambique. IAS 2025. Co-chairs’ choice. Oral late-breaker abstract OAS0102LB.
   https://programme.ias2025.org/Abstract/Abstract/?abstractid=6810
4. Chauke K et al. Termination of the USAID APACE award in Johannesburg, South Africa: impact on the number of people living with HIV tested, diagnosed and initiated on anti-retroviral therapy (ART) (January-March 2023-2025). IAS 2025. Oral late-breaker abstract LB25.
   https://programme.ias2025.org/Abstract/Abstract/?abstractid=6823
5. Stevenson M et al. Impact of US-funding suspensions on HIV response in the Latin America and Caribbean region. IAS 2025. Oral late-breaker abstract LB47.
   https://programme.ias2025.org/Abstract/Abstract/?abstractid=6842