By Michael Gwarisa
Estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS) warn of a surge in HIV infections and AIDS-related deaths over the next four years if the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) permanently shuts down.
The forecast follows the partial suspension of PEPFAR projects and the closure of USAID-funded HIV and AIDS programs worldwide.
Responding to a question during a virtual meeting, Mary Mahy, UNAIDS Director of Data for Impact, confirmed that an additional 6.3 million AIDS-related deaths could occur over the next four years.
So, let’s start with the deaths. We estimate 6.3 million AIDS-related deaths between 2025 and 2029 across all 54 PEPFAR-supported countries, based on our model. This estimate is calculated by considering the additional mortality that will occur among people who lose access to treatment,” said Mahy.
The mortality rate is based on data from PEPFAR-supported countries, where outcomes may vary. UNAIDS used different methods to arrive at the estimates.
“For example, if we think of a country with 100 people on treatment, and 50 of those are receiving PEPFAR-supported treatment, we would apply an additional mortality rate to those 50 people and calculate the additional AIDS-related deaths,” she explained.
A mathematical model was used, relying primarily on data from PEPFAR.
“PEPFAR has done an amazing job of collecting data over time on the HIV response. We use that data to understand how many people were reached with HIV prevention and treatment services. We then incorporate data from the Spectrum model, supported by UNAIDS, which countries use to estimate the impact of not having these services in place,” Mahy added.
Meanwhile, UNAIDS has also estimated that 8.7 million additional new HIV infections could occur over the same period.
“In 2023, we had 1.3 million new infections. An additional 8.7 million would significantly worsen the epidemic. To calculate the number of new infections, we used a similar approach as for mortality, but this time focused on individuals who had been reached with prevention services. The data comes from the former PANORAM site that PEPFAR produced.”
In making these calculations, UNAIDS examined five key factors contributing to new infections.
“The first and biggest contributor is that without treatment, viral loads will increase, making people more likely to transmit the virus. The second is vertical transmission from mother to child. The third is the absence of Pre-Exposure Prophylaxis (PrEP), leading to more new infections. The fourth is the lack of voluntary medical male circumcision. Finally, outreach to key populations, which helps them access prevention services, would also be lost,” Mahy said.
UNAIDS says it will continue supporting countries in calculating these estimates while monitoring the actual impact of the situation on the ground.
