After HIV antiretroviral therapy (ART) became available in Rakai, Uganda, rates of orphanhood due to HIV/AIDS dropped 70%, from 21.5% in 2003 to 6.3% in 2022, highlighting the importance of continued US funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) and similar organizations in sub-Saharan Africa.

An estimated 10.3 million children in sub-Saharan Africa have lost a parent to HIV-related causes, making up 75% of such orphans in the world, said the Columbia University–led authors of the Uganda study, published last week in The Lancet Global Health. And cuts to PEPFAR and other HIV/AIDS programs by the US government could lead another 2.8 million children to lose their parents to the virus.

“Scale-up of ART in this Ugandan setting drove substantive declines in orphanhood incidence,” the study authors wrote. “Yet, a considerable burden of orphanhood persisted in 2022, particularly among adolescents. To consolidate these gains, sustained investment and adaptation of HIV programmes are crucial to mitigate the ongoing risk of orphanhood for this vulnerable population.”

In Africa, an estimated 387,000 people died of AIDS-related conditions in 2024, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). This is just one example of the potentially deep and wide-ranging detriments that slashing US aid to not only Africans but infected and at-risk people around the world, HIV experts warn.

‘Advancements remain precarious’

Shortly after taking office, US President Donald Trump issued executive actions that upended many foreign-assistance programs, such as the shuttering of the United States Agency for International Development (USAID), a major funder of HIV/AIDS prevention and treatment in developing countries since 1961. USAID was the primary government implementer for PEPFAR, which has incurred dramatic cuts to its funding.

The announcement of the cuts prompted warnings from around the world about the potential consequences. In the Journal of Epidemiology and Global Health, researcher Christopher Jimu in Zimbabwe said that the cuts jeopardize the significant global HIV milestones achieved in the past few decades.