The HIV prevention landscape in sub-Saharan Africa is facing a major setback following aid cuts under U.S. President Donald Trump’s administration. The decision to pause foreign aid and halt grants under the U.S. Agency for International Development (USAID) severely impacted the availability of Pre-Exposure Prophylaxis (PrEP), a life-saving medication used to prevent HIV infections in high-risk groups.
Emmanuel Cherem, a 25-year-old gay man from Nigeria, tested positive for HIV just months after losing access to PrEP. “I blame myself… but I equally blame the Trump administration,” he said. PrEP, when taken daily, reduces the risk of HIV infection through sex by up to 99%.
The cuts affected funding for the President’s Emergency Plan for AIDS Relief (PEPFAR), which had been instrumental in scaling up access to PrEP across Africa. According to PrEPWatch, the number of people initiating PrEP in Africa soared from under 700 in 2016 to over 6 million by 2024—over 90% of these were funded by PEPFAR.
Sub-Saharan Africa, still bearing 62% of global AIDS-related deaths in 2023, had been making notable progress in reducing mortality and new infections. However, aid reductions have disrupted supply chains not only for PrEP but also for condoms and lubricants, further weakening prevention efforts.
Activists and health experts, including University of Cape Town HIV expert Linda-Gail Bekker, warn that this move could reverse hard-won gains. “It’s as predictable as if you take your eye off a smouldering bushfire,” she said. Many African governments lack the resources to fund comprehensive prevention programs on their own.
A brief waiver in February allowed the resumption of some PEPFAR activities—but only those preventing mother-to-child transmission. Key populations like gay men, sex workers, and drug users remain excluded from PrEP access under current policies.
With UNAIDS warning of 2,300 additional daily infections globally if PEPFAR support ends completely, experts fear a resurgence of the epidemic. “We were on a winning path,” Bekker lamented. “Now we’re at risk of losing ground.”
