That the international financing for HIV fell by 18 per cent in 2025, from $8.8 billion to $7.3 billion, its lowest level in nearly two decades, has been lamented by UNAIDS as a potential reversal of the progress that drove down new infections and AIDS-related deaths to their lowest level in more than 30 years.
The scale of the unfinished task makes the decline indefensible. An estimated 41 million people were living with HIV in 2025, 1.2 million acquired the virus, and 570,000 died from AIDS-related illnesses. Although treatment reached 32.1 million people, nearly nine million remained without it, while almost half of all children living with HIV still lacked antiretroviral therapy. Total resources available in low- and middle-income countries stood at $17.6 billion, almost one-fifth below the $21.9 billion needed annually to remain on course for the 2030 target.
Funding cuts also distort what statistics appear to show. Fewer diagnoses can consequently be mistaken for fewer infections. By the time surveillance systems register the damage, the services capable of containing it may already have disappeared.
The first casualties are often programmes serving people whom formal health systems struggle to reach. Community organisations received up to a quarter of foreign HIV assistance in 2024 and, in some countries, reached as much as 60 per cent of marginalised populations.
To add to the tragedy, all this has coincided with science producing six-monthly injectable lenacapavir, shown in trials to avert almost all infections among people at risk. Yet only a few thousand people receive it, while UNAIDS estimates that 20 million need antiretroviral-based prevention. A breakthrough confined to wealthy markets and pilot schemes does not amount to a global prevention revolution.
Pakistan cannot make light of this warning as distant. WHO and UNAIDS estimated 350,000 people were living with HIV in the country in 2024, while only about 21 per cent knew their status. Unsafe injections, poorly regulated blood transfusions and weak surveillance have allowed a concentrated epidemic to expand in the shadows, revelling in stigmatisation.
Donor governments must not abruptly abandon treatment and prevention systems they helped build. No qualms about that. Still, countries like Pakistan would do well to ring-fence antiretroviral procurement, regulate blood banks and injections, and integrate HIV screening with antenatal, tuberculosis and hepatitis services. HIV did not retreat because the virus weakened. It retreated because governments and donors financed the systems that contained it. Dismantling those systems would return the apparent savings as a far larger bill in infections and deaths.
