US cuts threaten HIV/AIDS fight

A dramatic reduction in US global health funding is threatening to reverse decades of progress in the fight against HIV/AIDS – and Malta cannot afford to look away.

Under the Donald Trump-aligned leadership currently influencing the US State Department, a 90-day pause was imposed in late January on foreign assistance programmes, particularly those supporting vulnerable populations like LGBTQ+ communities, adolescent girls, sex workers and people who inject drugs.

At the heart of this crisis is the President’s Emergency Plan for AIDS Relief (PEPFAR), an American initiative launched in 2003 under President George W. Bush.

Once hailed as a rare bipartisan success story, PEPFAR has saved more than 26 million lives and provided vital HIV prevention and treatment to over 20 million people, mainly in sub-Saharan Africa. It has helped prevent mother-to-child transmission, enabled children to be born HIV-free and strengthened health systems in some of the most fragile parts of the world.

Now, that progress is under serious threat, and the consequences could be felt globally, including here in Malta. As a member of the European Union, Malta is part of a shared commitment to end the AIDS epidemic by 2030, in line with the United Nations Sustainable Development Goals (SDGs).

2.8 million children could become orphans in sub-Saharan Africa

The EU is one of the main contributors to the Global Fund to Fight AIDS, Tuberculosis and Malaria – a crucial international mechanism for tackling HIV. While Malta doesn’t contribute to the Global Fund directly, as countries like Germany or France do, it plays a role through its contributions to the EU budget, a portion of which supports these essential global health initiatives.

The timing of the US funding pause is especially alarming given the scientific breakthroughs now within reach. After years of research, the global health community is finally seeing promising developments in HIV prevention, including new vaccines and long-acting treatments. These innovations offer genuine hope for drastically reducing transmission rates and eventually ending the epidemic.

But expanding access to these breakthroughs – particularly in low-resource settings – demands sustained funding and international cooperation. Cutting support for programmes like PEPFAR and the Global Fund in current times could undermine decades of progress and derail some of the most promising advances in HIV prevention in a generation

The potential fallout from the US funding cuts is stark. A recent study published in The Lancet by a multidisciplinary team at the University of Oxford – including Prof. Lucie Cluver and Dr Seth Flaxman – warns that, if PEPFAR support is not restored, sub-Saharan Africa could see up to one million new paediatric HIV infections and nearly half a million AIDS-related child deaths by 2030.

The study also estimates that 2.8 million children could become orphans because of preventable, HIV-related deaths. “This is a humanitarian crisis that will affect generations,” Prof. Cluver said. “The future of global HIV efforts, particularly for children and adolescents, hangs in the balance.”

The review of US foreign aid is set to conclude on April 24, a date that could prove to be a turning point for global health. The international community – including Malta – now finds itself at a crossroads. Will it remain silent as one of the most successful global health programmes in history is potentially dismantled? Or will it join others in calling for continued investment in what has become a cornerstone of international public health and solidarity?

This is not merely a distant issue affecting faraway countries – it is one that has direct relevance for Malta. As a nation internationally recognised for its progress on LGBTQ+ rights and its commitment to inclusive healthcare, Malta is firmly aligned with the European Union’s core values of health equity, social justice and human dignity.

Malta’s geographic proximity to sub-Saharan Africa and the nation’s role as a key migration hub in the Mediterranean mean that regional health developments are also matters of national interest.

Added to this, rising HIV infection rates abroad can have ripple effects, influencing migration patterns, public health protocols at Malta’s borders and inducing broader regional stability concerns.

Ultimately, this moment is a test of global cooperation – of our shared commitment to protecting the most vulnerable and of Malta’s role on the world stage as a small country with a strong voice in support of health justice.

Damian Spiteri is a lecturer in social work at the University of Malta. He has previously lectured at the University of York and the University of Strathclyde.