President Donald Trump’s 2025 executive orders, particularly the decision to freeze foreign aid for HIV/AIDS programs, mark a dangerous reversal in the global fight against the epidemic. The disruption of the President’s Emergency Plan for AIDS Relief (PEPFAR) places millions of lives at risk and threatens to roll back decades of progress.

For years, the United States has been a global leader in combating HIV/AIDS, largely through PEPFAR — a bipartisan initiative that has saved over 25 million lives since its launch in 2003. By providing essential treatment, prevention programs, and education efforts in more than 50 countries, including Cambodia, PEPFAR has been instrumental in reducing HIV transmission and improving health outcomes worldwide.

However, Trump’s foreign aid freeze not only threatens the sustainability of these efforts but also jeopardizes the United Nations Sustainable Development Goals (UNSDGs) —specifically UNSDG 3, which aims to end the AIDS epidemic by 2030.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria, a major partner of PEPFAR, is also facing uncertainty, as the U.S. remains its largest donor. Established in 2002, the Global Fund operates as a public-private partnership, pooling resources from governments, private donors, and international organizations to provide funding for life-saving health programs in more than 120 countries.

Over the years, it has played a crucial role in reducing HIV/AIDS-related deaths, expanding access to antiretroviral therapy, and financing prevention initiatives, particularly in low- and middle-income nations.

The U.S. has historically been the Global Fund’s largest donor, contributing nearly one-third of its total funding. In the last funding cycle alone, the U.S. pledged over $6 billion, an amount that not only supports direct interventions but also helps leverage additional contributions from other donor nations. The Global Fund follows a matching system in which U.S. donations incentivize commitments from other countries, meaning that a withdrawal or reduction in U.S. support could trigger a domino effect, discouraging other governments from maintaining or increasing their own contributions.

If these funding cuts persist, experts warn of a dramatic increase in HIV transmission rates, a surge in AIDS-related deaths, and the emergence of drug-resistant strains of the virus that could be even more virulent and difficult to control.

Temporary Relief: The Emergency Humanitarian Waiver

In response to mounting domestic and international backlash, U.S. Secretary of State Marco Rubio on January 29, issued an “Emergency Humanitarian Waiver” allowing continued access to U.S.-funded HIV treatment across 55 countries worldwide. This waiver provides a temporary reprieve to over 20 million people living with HIV, representing nearly two-thirds of all individuals receiving treatment globally, who depend on PEPFAR—the world’s largest and most effective HIV/AIDS relief program.

While this intervention ensures that existing HIV treatment programs can continue, it does not address the broader funding freeze that has halted new HIV prevention programs, testing initiatives, and public health outreach. Without sustained investment, experts warn that HIV transmission rates could rise, AIDS-related deaths could surge, and healthcare infrastructure in developing nations could collapse.

Cambodia: A Case Study in Progress and Risk

One of the countries most vulnerable to the impact of the U.S. funding freeze is Cambodia. Once one of the most HIV-affected countries in Asia, Cambodia has made remarkable progress in reducing HIV prevalence.

In the late 1990s, HIV/AIDS posed a major public health crisis in Cambodia, with infection rates surpassing 2 percent. However, through aggressive prevention campaigns, community outreach efforts, and international support—especially from PEPFAR and the Global Fund—Cambodia has reduced its HIV prevalence to approximately 0.6 percent by 2023.

Cambodia’s response to the epidemic has been guided by the UNAIDS 95-95-95 targets, which aim to ensure that by 2030, 95 percent of people living with HIV know their status, 95 percent of those diagnosed receive ART, and 95 percent of those on treatment achieve viral suppression. As of 2023, Cambodia had made significant strides toward these goals with 90 percent of people living with HIV aware of their status;  83 percent receiving ART; and 78 percent achieving viral suppression.

This success has been driven by international funding, which covers nearly 90 percent of Cambodia’s HIV/AIDS budget. Without U.S. support, the country will struggle to sustain these gains. Clinics that provide free HIV testing and ART could face closure, leaving thousands without access to lifesaving treatment. Prevention programs aimed at high-risk populations—such as sex workers, men who have sex with men, and people who inject drugs—may also be scaled back, increasing the likelihood of new infections.

Many Cambodian clinics and hospitals rely on a steady supply of ART to maintain treatment adherence among patients. If these medications are no longer available, thousands of HIV-positive individuals may be forced to interrupt their treatment, leading to dire consequences.

The Danger of Viral Mutations and Drug Resistance

One of the most concerning consequences of these policy changes is the potential for drug-resistant HIV strains to emerge and spread. ART is effective because it suppresses the replication of the virus in the body. However, if a patient’s treatment is interrupted—whether due to lack of medication or difficulty accessing healthcare—HIV can continue replicating, increasing the likelihood of mutations. Some of these mutations can cause resistance to existing medications, making the virus more difficult to treat.

The emergence of drug-resistant HIV strains would pose an enormous challenge not only for Cambodia but for the entire global health community. Currently, first-line ART regimens are relatively affordable and widely available, but drug-resistant strains would necessitate second- and third-line therapies, which are far more expensive and harder to access in low-income countries.

The global implications of such mutations are severe. Drug-resistant HIV strains do not respect national borders; they can spread rapidly through migration and international travel. Southeast Asia, where cross-border movement is common, could see a regional surge in hard-to-treat HIV cases. The need for more costly treatments would strain already overburdened healthcare systems, diverting resources from other critical health initiatives.

The Broader Implications: A Step Back for Global Health

The Trump administration’s foreign aid freeze threatens to undermine not only UNSDG 3 but also several other development goals, including those related to poverty (UNSDG 1), inequality (UNSDG 10), and partnerships for sustainable development (UNSDG 17). The decision to cut HIV/AIDS funding reflects a broader trend of U.S. disengagement from international health efforts, which could have cascading effects beyond HIV/AIDS.

The funding freeze also raises concerns about the credibility of the United States as a global health leader. For decades, the U.S. has been the driving force behind major health initiatives, from smallpox eradication to the fight against Ebola. By withdrawing from these efforts, the U.S. risks weakening multilateral partnerships and discouraging other donor countries from stepping up to fill the gap.

Furthermore, scaling back funding for HIV/AIDS programs contradicts broader economic and diplomatic interests. Countries with high HIV burdens often face reduced workforce productivity, economic stagnation, and increased healthcare costs—all of which contribute to regional instability. Ensuring that people have access to HIV treatment is not just a humanitarian imperative; it is also a matter of global economic stability and security.

The Human Cost: A Looming Catastrophe

Beyond the statistics and policy implications, it is crucial to recognize the human cost of these decisions. Every delay in treatment translates to lives lost. Without ART, people living with HIV face deteriorating health, opportunistic infections, and premature death. Parents will leave children orphaned. Young people who should be leading productive lives will be robbed of their futures.

For those already marginalized—such as sex workers, LGBTQ+ individuals, and people who inject drugs—losing access to HIV treatment and prevention services further pushes them to the fringes of society, increasing stigma and reducing their ability to seek help.

The international community must act swiftly to mitigate the damage, secure alternative funding sources, and reaffirm its commitment to ending the AIDS epidemic by 2030. The fight against HIV/AIDS is far from over, and now is not the time for the world’s largest donor to turn its back on those in need.