A wave of funding cuts initiated by former U.S. President Donald Trump has dealt a severe blow to HIV prevention efforts across Africa, with vulnerable groups like gay men, sex workers, and injecting drug users now losing access to life-saving medication.
Emmanuel Cherem, a 25-year-old from Awka, Nigeria, is among the growing number of people newly diagnosed with HIV after losing access to Pre-Exposure Prophylaxis (PrEP), a daily pill that reduces the risk of HIV transmission by up to 99%. “I blame myself… but I also blame the Trump administration,” he said. “These things were available, and then, without notice, they were cut off.”
The crisis stems from Trump’s early 2025 directive halting USAID-funded grants, including those under PEPFAR (President’s Emergency Plan for AIDS Relief), the world’s largest HIV/AIDS relief initiative. The suspension halted PrEP distribution to at-risk populations, especially in Sub-Saharan Africa, which accounted for 62% of global AIDS-related deaths in 2023, according to UNAIDS.
PEPFAR had financed over 90% of PrEP initiations in Africa by the end of 2024, expanding access from fewer than 700 people in 2016 to over 6 million. But with funding frozen, PrEP supplies have dwindled, and access to other preventive tools like condoms and lubricants has also declined, according to a recent UNAIDS fact sheet.
“This is incredibly short-sighted,” said Prof. Linda-Gail Bekker, an HIV expert at the University of Cape Town. “We were on a winning path, and now we risk reversing years of hard-fought gains.”
The U.S. government, which disbursed $65 billion in foreign aid last year, has defended the cuts as part of a broader strategy to reduce spending and encourage recipient nations to take greater ownership of public health programs. “Aid dependency doesn’t help these people,” argued Max Primorac, a former USAID official now with The Heritage Foundation.
However, health experts say most African governments lack the financial capacity to independently sustain PrEP programs alongside ongoing HIV treatment. A February 1 State Department waiver partially reinstated PEPFAR activities, but only for mother-to-child transmission prevention, leaving key populations excluded.
UNAIDS warns that if the cuts become permanent, an additional 2,300 HIV infections could occur daily, compounding the 3,500 new cases already being recorded each day in 2023. Frontline health workers and activists say the true scale of rising infections is difficult to quantify, as many community organizations have been defunded and data collection disrupted.
For now, people like Cherem must grapple with the personal and public health consequences of a decision made thousands of miles away. “We had the tools to prevent this,” he said. “Now, we’re losing lives that didn’t need to be lost.”
Written By Rodney Mbua
