A new study in The Lancet has issued a dire warning: if the US reduces support for the PEPFAR programme in Africa, decades of progress in the fight against HIV/AIDS could unravel.

Launched in 2003, PEPFAR (US President’s Emergency Plan for AIDS Relief) has transformed healthcare in sub-Saharan Africa — saving over 26 million lives and preventing 7.8 million HIV-positive births. But with recent US foreign aid freezes and political uncertainty, its future hangs in the balance.

Researchers estimate that if funding stalls or stops:

  • 500,000 children could die from AIDS-related illnesses by 2030

  • 1 million new child infections could occur

  • 2.8 million children might become orphans within five years

    • Beyond HIV, PEPFAR has built up health systems, supported child welfare, and helped shield young girls from sexual violence. It has also improved diplomatic and trade ties between the US and African nations.

    However, a 90-day freeze on US foreign aid — including PEPFAR — has already disrupted health services in multiple regions.

    Experts are urging the US to chart a clear five-year roadmap, ensuring continued support while gradually empowering African nations to take the lead in healthcare delivery.

    “If support ends suddenly, we could witness a surge in preventable deaths and infections,” warned Prof. Lucie Cluver (Oxford). Co-author Dr. Susan Hillis emphasized the programme’s broader impact on child protection and health services.

    African leaders remain committed to strengthening local systems but stress that international help is vital to ultimately defeat HIV/AIDS.

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