Deep cuts to the United Kingdom’s foreign aid budget threaten to derail the rollout of a revolutionary HIV prevention drug across sub-Saharan Africa, placing the lives of millions of women and girls at risk and jeopardising decades of hard-won progress against the virus.
The UK is reducing its Official Development Assistance (ODA) to 0.3% of Gross National Income by 2027, a cut of £4.7 billion compared to 2024 and its lowest level of spending since 2012. This includes a 56% reduction in direct bilateral aid to Africa, which will fall from £1.3 billion to £677 million annually over the next three years. Countries including Uganda, Kenya, Zambia, Malawi, Mozambique and Zimbabwe will be affected. While the government has protected funding for some areas like violence against women, HIV programming has not been afforded the same shield.
A destructive reversal of progress
The immediate consequences are already being felt. Reports from South Africa detail people struggling to access HIV medicines, medical appointments being cancelled, and community testing sites closing. This dismantling of services leads to a dangerous cycle: as testing declines, more people remain unaware of their status, infections go undetected, and transmission risks rise.
Modelling published in *The Lancet HIV* projects a devastating global toll if donor cuts are not reversed, estimating between 4.4 to 10.8 million additional new HIV infections and 770,000 to 2.9 million HIV-related deaths between 2025 and 2030, with sub-Saharan Africa bearing the brunt. UNAIDS separately predicts 3.3 million more new infections by 2030 if services are not restored. These projections underline that the cuts are not abstract fiscal decisions but actions with immediate, life-threatening impacts, actively unravelling an international effort that has saved millions of lives.
The breakthrough: ‘The closest we have come to a vaccine’
This retreat comes at a moment of unprecedented scientific advance. The drug lenacapavir, a long-acting injectable for HIV prevention, represents a paradigm shift. Administered just twice a year, it provides discreet and sustained protection, eliminating the need for a daily pill—a method that can carry stigma or be difficult to adhere to consistently.
Its efficacy is striking. In the PURPOSE 1 trial involving over 5,300 adolescent girls and young women in South Africa and Uganda, researchers observed zero HIV infections among participants who received the lenacapavir injection. For a demographic that bears a disproportionate burden of the epidemic, this 100% efficacy rate is transformative. The trial’s success, central to which were African women participants, demonstrates that the drug could be one of the most powerful tools yet to break the transmission cycle.
Agreements are in place to make this breakthrough accessible. Generic manufacturers aim to supply lenacapavir for approximately $40 (£30) per patient per year in 120 low- and middle-income countries from 2027. The pharmaceutical company Gilead has committed to supplying it at no profit for up to two million people in countries supported by major initiatives like the Global Fund and PEPFAR. Eight African countries have reportedly begun receiving initial shipments.
The UK’s pivotal role and a critical choice
Here lies the crux of the issue: the very partnerships and funding that can turn this scientific promise into reality are under threat. The UK has been a historic leader in global health, co-founding key multilateral institutions. One of these, Unitaid, has been instrumental in negotiating the affordability and accelerating the market entry of generic lenacapavir, thanks in part to significant past UK funding.
Furthermore, UK investment via Unitaid has supported work with the South African government to establish local production of the drug, which is essential for building resilient, sustainable health systems on the continent. However, Unitaid’s own funding has been cut by 21% due to the UK’s aid reductions. The Global Fund to Fight AIDS, Tuberculosis and Malaria, another UK-backed institution that has saved millions of lives, has also seen its UK contribution reduced by £150 million.
For women and girls in sub-Saharan Africa, who account for roughly two-thirds of all new HIV infections in the region, this funding crisis is particularly acute. Their vulnerability is compounded by economic insecurity and gender-based violence, a major driver of HIV transmission. A long-acting injectable that they control could be a lifeline, but only if it reaches them.
The UK now faces a defining choice. It can step back at this pivotal moment, allowing aid cuts to sever the delivery pipelines for a drug that African women helped prove and desperately need. Or it can reaffirm its role as a global health leader, sustaining the strategic investments in organisations like Unitaid that ensure breakthroughs in the laboratory become injections in the arms of those they were designed to protect. The decision will determine whether a historic opportunity is seized or squandered.
