HIV infections look set to significantly increase in sub-Saharan Africa as a result of funding for HIV pre-exposure prophylaxis (PrEP) being halted under the US President’s Emergency Plan for AIDS Relief (PEPFAR), according to a modelling study published today in Lancet HIV.
PrEP funded by PEPFAR was received by nearly 700,000 people living across 28 sub-Saharan African countries by late 2024. Funding for this medicine was halted in January 2025. The study indicates that if maintained for a year, this funding cut could lead to nearly 7,000 extra HIV infections over a year and over 10,000 new HIV infections over the next 5 years. More than 2,900 of the additional infections are projected to be among gay and bisexual men who have sex with men, while more than 2,000 will be among female sex workers.
Findings of the study also estimated increases in new HIV infections will exceed 5% in 8 countries for men who have sex with men, 2 countries for people who inject drugs, 5 countries for transgender women and 6 countries for female sex workers.
Lead author Dr Jack Stone, Associate Professor in Infectious Disease Mathematical Modelling at the University of Bristol said:
“Ceasing PEPFAR’s funding for PrEP in sub-Saharan Africa will remove approximately 700,000 individuals from using oral PrEP. If this continued for 1 year, then over 10,000 additional HIV infections could occur over the next 5 years, with many of these infections being among gay and bisexual men who have sex with men and female sex workers.
“It is crucial that funding is found to continue and expand PrEP services in sub-Saharan Africa.”
Senior author Professor Peter Vickerman added:
“These funding cuts will have most impact on extremely vulnerable groups in sub-Saharan Africa, such as gay and bisexual men who have sex with men, female sex works and transgender women. These groups already have disproportionately high levels of HIV infection and reduced access to HIV prevention and treatment interventions. These cuts could reverse the progress made on reducing the HIV epidemic in Africa.”
The study was funded by Bristol and UKHSA’s NIHR Health Protection Research Unit (HPRU) in Evaluation and Behavioural Science and the Wellcome Trust.
Paper
‘The impact of cuts in the US President’s Emergency Plan for AIDS Relief funding for HIV pre-exposure prophylaxis in sub-Saharan Africa: a modelling study’ by Jack Stone et al in The Lancet HIV
