The Consequences of Halting HIV Medication for Millions
A generation has passed since the peak of AIDS-related deaths, when devastating losses forced activists into the streets, pressuring governments to act. The U.S. ultimately responded with PEPFAR, the President’s Emergency Plan for AIDS Relief—one of the most successful global health initiatives in history. Today, HIV is manageable, though still incurable.
Now, the Trump administration's decision to freeze foreign aid, citing concerns over waste, has disrupted a system that has sustained millions of lives for over two decades. Confusion over a temporary waiver for PEPFAR and the logistical difficulties of restarting suspended programs have left countless people without essential HIV medication. As U.S.-funded workers, contractors, and clinics face upheaval, the consequences are mounting.
The effectiveness of the global HIV response has meant that the once-common sight of AIDS patients wasting away in hospital wards has largely faded. But health experts warn those days could return if the funding freeze isn’t reversed—or if another global power doesn’t step in quickly.
"In the next five years, we could see 6.3 million AIDS-related deaths," the U.N. AIDS agency told the Associated Press. This warning comes amid growing complacency about HIV, declining condom use among younger populations, and the emergence of medications that some believe could help end AIDS altogether.
In response to the crisis, the U.N. has begun publicly tracking new HIV infections since the aid freeze.
What Happens to the Body When HIV Treatment Stops
Immune System Collapse
HIV spreads through bodily fluids such as blood, breast milk, and semen. Over time, it weakens the immune system, leaving the body defenseless against infections—even those rarely seen in healthy individuals. The emergence of these unusual infections in the 1980s first signaled the start of the AIDS epidemic.
Decades of advocacy and heartbreaking losses—especially among children and young adults—led to the creation of PEPFAR. Before the program began, 20 million people had already died. Today, millions rely on antiretroviral therapy (ART) to suppress HIV, keeping it from replicating and spreading.
Without treatment, the virus quickly rebounds, often becoming drug-resistant. HIV can reach detectable levels in the bloodstream within weeks, increasing the risk of transmission to sexual partners. Pregnant women with untreated HIV are also far more likely to pass the virus to their babies.
If left unchecked, the disease progresses to its final stage—AIDS—marked by a complete immune system collapse.
Increased Vulnerability to Infections
"Without HIV treatment, people with AIDS typically survive about three years," according to the Centers for Disease Control and Prevention (CDC).
Early on, an HIV-positive person might not experience noticeable symptoms. However, they can still spread the virus, and their immune system becomes highly vulnerable to opportunistic infections.
The National Institutes of Health (NIH) identifies some of the most common opportunistic infections as fungal diseases, pneumonia, salmonella, and tuberculosis (TB). The impact in heavily affected regions like South Africa—home to the world’s largest HIV-positive population and a high TB burden—could be catastrophic.
Without consistent ART, the immune system progressively weakens, making everyday activities like eating, traveling, and social interactions fraught with potential exposure to life-threatening germs.
The Urgency of Daily Treatment
For years, healthcare workers have emphasized the critical need for daily adherence to HIV medication. Now, that routine has been upended for many.
Across Africa, where PEPFAR has provided life-saving care, thousands of healthcare workers in countries like Kenya and Ethiopia have been laid off due to the aid freeze. Clinics have turned away patients, leaving them without the medication necessary to suppress the virus.
Even if aid is restored, reversing the damage will take time—time that many don’t have. The Trump administration’s 90-day review period and the uncertainty surrounding PEPFAR’s waiver have created a dangerous gap in care.
Meanwhile, the head of the U.N. AIDS agency, Winnie Byanyima, has warned that the disruption could lead to the emergence of more drug-resistant HIV strains.
In addition, an estimated 3.4 million more children could become orphans—evoking memories of the early AIDS crisis, when the world scrambled for solutions with far fewer medical tools at its disposal.
The stakes are clear: without immediate intervention, the global fight against HIV could suffer a devastating setback.