U.S. foreign aid cuts might devastate global progress against HIV/AIDS
HIV could explode worldwide in the wake of U.S. cuts to foreign aid, resulting in millions of AIDS deaths and soaring rates of infection, a new analysis says.
President Donald Trump has floated the notion of ending the President's Emergency Fund for AIDS Relief, a program created under President George W. Bush that combats HIV and AIDS in the developing world.
The Trump Administration paused all foreign aid funding Jan. 20, ostensibly for a 90-day review and evaluation, with only limited exception. Authorization for PEPFAR lapsed Tuesday, according to CBS News, and the world is now watching and waiting to see what will come next.
Such funding cuts could undo decades of progress made to end HIV/AIDS as a public health threat, researchers argue in a study published Wednesday in The Lancet HIV.
That study came at the same time Britain's Prince Harry withdrew from an AIDS/HIV charity he led in Africa for 19 years.
If U.S. aid is cut, researchers estimate that new HIV infections could surge to as many as 10.8 million additional cases, and HIV-related deaths to 2.9 million, by 2030.
"The United States has historically been the largest contributor to global efforts to treat and prevent HIV, but the current cuts to PEPFAR and USAID-supported programs have already disrupted access to essential HIV services including for antiretroviral therapy and HIV prevention and testing," co-lead researcher Debra ten Brink, a senior research officer at Australia's Burnet Institute, said in a news release.
"Looking ahead, if other donor countries reduce funding, decades of progress to treat and prevent HIV could be unraveled," ten Brink said. "It is imperative to secure sustainable financing and avoid a resurgence of the HIV epidemic which could have devastating consequences, not just in regions such as sub-Saharan Africa, but globally."
Five nations provide more than 90% of total international HIV funding, and the U.S. pays nearly three-quarters of that, researchers said in background notes.
To estimate the potential effects of cuts to HIV funding, researchers projected infection and death rates in 26 countries that currently receive funds to hold the line against the virus.
As much as a six-fold increase in new infections could occur, with between 4.4 million and 10.8 million additional new HIV infections by 2030.
The cuts could also result in between 770,000 to 2.9 million HIV-related deaths by 2030, results show.
"There could be an even greater impact in sub-Saharan Africa, where broader prevention efforts, such as distributing condoms and offering pre-exposure prophylaxis (PrEP is a medication that reduces the risk of getting HIV.) are at first risk to be discontinued," co-lead researcher Rowan Martin-Hughes, a senior research officer with the Burnet Institute, said in a news release.
"This is in addition to disruptions in testing and treatment programs [that] could cause a surge in new HIV infections, especially in some of the areas where the greatest gains have been made, such as preventing mother-to-child transmission of HIV and pediatric HIV deaths," Martin-Hughes added.
Between 2010 and 2023, countries that receive foreign aid made significant progress against HIV, with an average 8% annual decrease in new infections and a 10% decrease in HIV-related deaths, researchers noted.
Researchers said if foreign aid is greatly reduced, new infections and deaths could be expected to rise back to levels not seen since 2010, potentially undoing all progress made since 2000.
Even a temporary cut in funding of one to two years could represent a setback that would require an additional 20 to 30 years of investment before HIV/AIDS is ended as a public health threat, researchers wrote.
The U.S. action dovetailed with news that a management dispute prompted Prince Harry to step down as a patron of Sentebale, a charity he set up to help young people with HIV and AIDS in the African nations of Lesotho and Botswana.
Reuters noted that he co-founded the charity in 2006 in memory of his mother Princess Diana, who helped combat stigma surrounding HIV/AIDS.
More information
The U.S. Department of Health and Human Services has more on HIV/AIDS.
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Means turned to alternative approaches to address what she has described as widespread metabolic dysfunction driven largely by poor nutrition and an overabundance of ultra-processed foods. She co-founded Levels, a nutrition, sleep and exercise-tracking app that can also give users insights from blood tests and continuous glucose monitors. The company charges $199 per year for an app subscription and an additional $184 per month for glucose monitors. Means has argued that the medical system is incentivized not to look at the root causes of illness but instead to maintain profits by keeping patients sick and coming back for more prescription drugs and procedures. 'At the highest level of our medical institutions, there are conflicts of interest and corruption that are actually making the science that we're getting not as accurate and not as clean as we'd want it,' she said on Megyn Kelly's podcast last year. But even as Means decries the influence of money on science and medicine, she has made her own deals with business interests. During the same Megyn Kelly podcast, Means mentioned a frozen prepared food brand, Daily Harvest. She promoted that brand in a book she published last year. What she didn't mention in either instance: Means had a business relationship with Daily Harvest. Influencer marketing has expanded beyond the beauty, fashion and travel sectors to 'encompass more and more of our lives,' said Emily Hund, author of 'The Influencer Industry: The Quest for Authenticity on Social Media.' With more than 825,000 followers on Instagram and a newsletter that she has said reached 200,000 subscribers, Means has a direct line into the social media feeds and inboxes of an audience interested in health, nutrition and wellness. Affiliate marketing, brand partnerships and similar business arrangements are growing more popular as social media becomes increasingly lucrative for influencers, especially among younger generations. Companies might provide a payment, free or discounted products or other benefits to the influencer in exchange for a post or a mention. But most consumers still don't realize that a personality recommending a product might make money if people click through and buy, said University of Minnesota professor Christopher Terry. 'A lot of people watch those influencers, and they take what those influencers say as gospel,' said Terry, who teaches media advertising and internet law. Even his own students don't understand that influencers might stand to benefit from sales of the products they endorse, he added. Many companies, including Amazon, have affiliate marketing programs in which people with substantial social media followings can sign up to receive a percentage of sales or some other benefit when someone clicks through and buys a product using a special individualized link or code shared by the influencer. Means has used such links to promote various products sold on Amazon. Among them are books, including the one she co-wrote, 'Good Energy"; a walking pad; soap; body oil; hair products; cardamom-flavored dental floss; organic jojoba oil; a razor set; reusable kitchen products; sunglasses; a sleep mask; a silk pillowcase; fitness and sleep trackers; protein powder and supplements. She also has shared links to products sold by other companies that included 'affiliate' or 'partner' coding, indicating she has a business relationship with the companies. The products include an AI-powered sleep system and Daily Harvest, for which she curated a 'metabolic health collection.' On a 'My Faves' page that was taken down from her website shortly after Trump picked her, Means wrote that some links 'are affiliate links and I make a small percentage if you buy something after clicking them.' It's not clear how much money Means has earned from her affiliate marketing, partnerships and other agreements. Daily Harvest did not return messages seeking comment, and Means said she could not comment on the record during the confirmation process. Means has raised concerns that scientists, regulators and doctors are swayed by the influence of industry, oftentimes pointing to public disclosures of their connections. In January, she told the Kristin Cavallari podcast 'Let's Be Honest' that 'relationships are influential.' 'There's huge money, huge money going to fund scientists from industry," Means said. "We know that when industry funds papers, it does skew outcomes.' In November, on a podcast run by a beauty products brand, Primally Pure, she said it was 'insanity' to have people connected to the processed food industry involved in writing food guidelines, adding, 'We need unbiased people writing our guidelines that aren't getting their mortgage paid by a food company.' On the same podcast, she acknowledged supplement companies sponsor her newsletter, adding, 'I do understand how it's messy.' Influencers who endorse or promote products in exchange for payment or something else of value are required by the Federal Trade Commission to make a clear and conspicuous disclosure of any business, family or personal relationship. While Means did provide disclosures about newsletter sponsors, the AP found in other cases Means did not always tell her audience when she had a connection to the companies she promoted. For example, a 'Clean Personal & Home Care Product Recommendations' guide she links to from her website contains two dozen affiliate or partner links and no disclosure that she could profit from any sales. Means has said she invested in Function Health, which provides subscription-based lab testing for $500 annually. Of the more than a dozen online posts the AP found in which Means mentioned Function Health, more than half did not disclose she had any affiliation with the company. Means also listed the supplement company Zen Basil as a company for which she was an 'Investor and/or Advisor.' The AP found posts on Instagram, X and on Facebook where Means promoted its products without disclosing the relationship. Though the 'About' page on her website discloses an affiliation with both companies, that's not enough, experts said. She is required to disclose any material connection she has to a company anytime she promotes it. Representatives for Function Health did not return messages seeking comment through their website and executives' LinkedIn profiles. Zen Basil's founder, Shakira Niazi, did not answer questions about Means' business relationship with the company or her disclosures of it. She said the two had known each other for about four years and called Means' advice 'transformational,' saying her teachings reversed Niazi's prediabetes and other ailments. 'I am proud to sponsor her newsletter through my company,' Niazi said in an email. While the disclosure requirements are rarely enforced by the FTC, Means should have been informing her readers of any connections regardless of whether she was violating any laws, said Olivier Sylvain, a Fordham Law School professor who was previously a senior adviser to the FTC chair. 'What you want in a surgeon general, presumably, is someone who you trust to talk about tobacco, about social media, about caffeinated alcoholic beverages, things that present problems in public health,' Sylvain said, adding, 'Should there be any doubt about claims you make about products?' Means isn't the first surgeon general nominee whose financial entanglements have raised eyebrows. Jerome Adams, who served as surgeon general from 2017 to 2021, filed federal disclosure forms that showed he invested in several health technology, insurance and pharmaceutical companies before taking the job — among them Pfizer, Mylan and UnitedHealth Group. He also invested in the food and drink giant Nestle. He divested those stocks when he was confirmed for the role and pledged that he and his immediate family would not acquire financial interest in certain industries regulated by the Food and Drug Administration. Vivek Murthy, who served as surgeon general twice, under Presidents Barack Obama and Joe Biden, made more than $2 million in COVID-19-related speaking and consulting fees from Carnival, Netflix, Estee Lauder and Airbnb between holding those positions. He pledged to recuse himself from matters involving those parties for a period of time. Means has not yet gone through a Senate confirmation hearing and has not yet announced the ethical commitments she will make for the role. Hund said that as influencer marketing becomes more common, it is raising more ethical questions, such as what past influencers who enter government should do to avoid the appearance of a conflict. Other administration officials, including Homeland Security Secretary Kristi Noem and Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz, have also promoted companies on social media without disclosing their financial ties. 'This is like a learning moment in the evolution of our democracy,' Hund said. 'Is this a runaway train that we just have to get on and ride, or is this something that we want to go differently?'
