The World Health Organization once hoped to announce the end of the AIDS epidemic within five years. However, former U.S. President Trump's policies to cut foreign aid may have made this goal unattainable. The policy has disrupted efforts to control the growing AIDS epidemic in the Asia-Pacific region, leading to the suspension of some projects.
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02-22, 2025The Asia-Pacific region has the most severe AIDS epidemic outside of Africa, with 300,000 new cases and 150,000 AIDS-related deaths in 2023. Although some "life-saving" programs are temporarily exempt from the U.S. funding freeze, advocates fear that permanent cuts to prevention, education, and outreach programs will have a significant impact.
Eamonn Murphy, regional director of UNAIDS, said that the United States provides more funding and project implementation expertise for this cause than any other country. "We don't want to lose the critical support of the United States," he said. "Decades of effort invested in the right projects and the right understanding of what is needed will be wasted."
AIDS is a virus that attacks the immune system and is spread through direct contact with bodily fluids such as blood, semen, and breast milk. If left untreated, the body becomes very weak and susceptible to life-threatening infections and cancers, leading to a diagnosis of AIDS. Since the 1980s, HIV/AIDS has caused more than 42 million deaths. However, new treatments can effectively suppress HIV, prevent transmission, and enable infected people to live long and healthy lives.
Although the number of people infected with HIV worldwide in 2023 is lower than at any time since the mid-1990s, progress in the Asia-Pacific region is slowing. New cases have fallen by only 13% since 2010, compared to a global average of 39%. Epidemics are spreading in Papua New Guinea, the Philippines, Laos, Bangladesh, and Afghanistan. An estimated 6.7 million people in the region are infected with HIV, and some smaller countries, such as Fiji, are caught off guard by the rising number of infections.
Fijian Health Minister Ratu Atonio Rabici Lalabalavu even declared an official "outbreak" in January to reflect the "shocking reality that HIV is evolving faster than our current service capacity." Mr. Murphy of UNAIDS said that the region needs more support to ensure that countries can develop "sustainable" projects that leverage the latest scientific advances. "We are seeing a flattening of the epidemic in Asia-Pacific, and now is not the time to disinvest," he said.
Last month, U.S. President Trump signed an executive order freezing foreign aid for 90 days, causing chaos for health and aid projects around the world. The move raised concerns about the future of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Since its founding in 2003 by former Republican President George W. Bush, the program has invested more than $110 billion in the global fight against HIV/AIDS. PEPFAR is credited with saving more than 26 million lives, providing HIV treatment to 20.5 million people, preventing millions of new cases, and providing 70% of the funding for the global fight against HIV/AIDS.
Felicity Yost of Health Equity Matters, who worked in Washington, D.C., when PEPFAR was established, said that Americans "should be proud of its success." "It pioneered a whole new way of working on HIV, and it really grew," she said. "So, to see it dismantled in such a catastrophic and brutal way is very heartbreaking."
Following serious concerns from health professionals that the funding freeze could lead to deaths, a "waiver" was subsequently announced allowing the resumption of "life-saving" activities such as HIV treatment, testing, and efforts to prevent mother-to-child transmission. However, ambiguity over exactly what is considered "life-saving" has created confusion among providers and clients in the Asia-Pacific region, where aid tends to be more "strategic" rather than directly funding treatment.
Ms. Yost said that education, inclusive care, legal reforms, and stronger health care systems all help ensure effective treatment. "If all of that work goes away, it's a very fragile system," she said. "But I suspect many projects will not qualify for the waiver because they are not providing treatment. Projects are stopping, so communities are being cut off."
HIV advocate Maura Elaripe said there is "a lot of misinformation" in Papua New Guinea about which services will be actually affected by the funding freeze. "Communities are very panicked that there will be no drugs," she said. Antiretroviral therapy, which suppresses HIV and allows the immune system to repair itself, is essential to reducing transmission, improving quality of life, and preventing AIDS-related deaths.
The Papua New Guinea Health Department and UNAIDS said in a joint statement that testing and treatment services remain available and that the country has a 12-month supply of "essential HIV commodities," including antiretroviral drugs and test kits. "Papua New Guinea has no shortage of HIV drugs and reagents," said Ken Wai, Deputy Secretary of Public Health.
While the Papua New Guinea government funds antiretroviral drugs and distributes them free of charge to approximately 50,000 people living with HIV, some clinicians, trackers, and data entry personnel supporting HIV services are funded by USAID. Without this funding, proactive measures targeting "key populations" such as men who have sex with men, transgender people, and sex workers may disappear. Ms. Elaripe said that losing these services would be a "big problem" and called on other funders to help fill the gap. "We want Australia to step up," she said.
Australia is also a long-term funder of HIV projects in the Asia-Pacific region, including the India-Pacific HIV Partnership signed last year with UNAIDS and Health Equity Matters. This $12 million investment aims to strengthen health programs, promote harm reduction and build community capacity, and adds to the $25 million previously provided for HIV initiatives.
The Department of Foreign Affairs and Trade did not answer questions about whether its funded projects had been closed or suspended due to the U.S. funding freeze. "Australia's development program focuses on being the partner of choice for our neighbors. This is essential for the prosperity, stability and security of our region," a spokesperson said. "The decision to suspend U.S. foreign assistance for policy review is a matter for the U.S. government." The department also did not indicate whether Australia was considering increasing its own contributions.
Given the rapid changes in U.S. policy under the Trump administration, the future of HIV and broader aid funding remains uncertain. In addition to PEPFAR, other projects that rely heavily on U.S. funding may also be at risk, such as the Global Fund, which invests approximately $5 billion annually to fight AIDS, tuberculosis, and malaria. Ms. Yost said she is not optimistic that other donors will be able to make up the shortfall if the United States does not restore funding, because the U.S. contribution is so large. "We're trying to figure out who can adapt, who can respond, and start filling in some of those areas," she said. "But I suspect ultimately, some very difficult choices will be made, and some work will go away. And then we lose the confidence of the community and the host governments we work with. Momentum will be lost."
