U.S. foreign aid cuts are preventing the world’s most vulnerable populations from accessing lenacapavir, a breakthrough HIV prevention medication, according to experts at the Aids 2026 Conference in Rio de Janeiro, Brazil.
US Funding Cuts and the Dismantling of USAID
The lack of access stems from a significant decline in international funding. A joint report from KFF and the Joint United Nations Programme on HIV and AIDS (UNAIDS) found that donor government funding for HIV decreased by $2.1 billion, or 25%, in 2025 compared to the previous year. This $2.1 billion drop matched the exact amount cut by the U.S. government.
These cuts were driven by Trump administration changes to foreign assistance, which included the dismantling of the US Agency for International Development (USAID) and the transfer of foreign aid management to the State Department. These actions temporarily halted and then slowed U.S. HIV disbursements in 2025. The impact is severe because USAID provided 73% of donor-funded resources for global HIV prevention, according to a study in the Lancet Global Health.
By 2025, the U.S. accounted for 74% of total donor government funding, a sharp increase from 59% in 2011. During that same period, funding from other nations fell by half, from $3.2 billion to $1.6 billion. Consequently, total donor government funding for HIV fell to $6.2 billion, a level below what was seen before 2008.
Impact on Prevention and Outreach
The financial shortfall has led to what experts describe as a system-wide breakdown.
A report by AMFAR, Funders Concerned About AIDS, Data Etc., and the Johns Hopkins Bloomberg School of Public Health utilized the PEPFAR Pulse study, which surveyed 166 organizations across 46 countries between November 2025 and April 2026. The findings revealed that less than 2% of these organizations could replace their lost funding.
Forty-three percent of the surveyed organizations reported stopping at least one prevention activity, including condom programs and PrEP. Beatriz Grinsztejn, president of the International Aids Society and a researcher at Fiocruz, stated during a press conference that these cuts are decreasing the number of people engaged in prevention services and care.
Beyond medication, the cuts have decimated the workforce used to reach high-risk groups. Ailish Brennan, a policy analyst at Harm Reduction International, noted that peer outreach workers—essential for building trust and engaging people who use drugs—have been heavily impacted. The International Network of People Who Use Drugs reported that organizations are responding to funding losses by cutting outreach services and shutting down mobile locations.
The Stakes for Global Health
The loss of lenacapavir access is particularly critical given its potential impact. A mathematical modeling study from the UN and WHO estimated that widespread availability of the drug could prevent 41% of new HIV infections in western Kenya, Zimbabwe, and South Africa. South Africa currently has the highest number of people living with HIV of any country, exceeding eight million.
While the World Health Organization recommended that governments prioritize expanded access to lenacapavir in 2025, advocates point out that people in the affected countries were instrumental in the clinical trials used to test the medication.
Additional Barriers to Rollout
In addition to funding gaps, health experts are battling misinformation. Ahead of a scheduled June 5 launch in South Africa, Brendan Maughan-Brown of the University of Cape Town warned that online conspiracy theories are circulating. These unsupported claims suggest the injection causes infertility, cancer, death, or that it actually gives the patient HIV.
Maughan-Brown stated that these claims are not supported by science and mirror theories seen during the COVID-19 pandemic, including beliefs that the drug is a weapon designed to sterilize Black women or depopulate certain groups. He warned that such misinformation could discourage people from using a tool that could dramatically reduce new infections.
| Metric | 2024/Pre-2025 | 2025 |
|---|---|---|
| Total Donor Funding | $8.3 Billion (Approx.) | $6.2 Billion |
| U.S. Share of Funding | N/A | 74% |
| Other Nations’ Funding | N/A | $1.6 Billion |
