A new report by the United Nations Children’s Fund and the Joint United Nations Programme on HIV/AIDS has shown that the provision of pre-exposure prophylaxis—the medicine taken by people at risk of HIV to prevent infection from sex or injection drug use—has abruptly declined in Nigeria, Togo, and Uganda.
The report, exclusively obtained on Friday and titled “Their future is on the line: Cost of inaction on HIV for children,” presents new modelling by UNAIDS, UNICEF, and Avenir Health on the potential impact of a 50 per cent reduction in intervention coverage— a plausible outcome if current funding cuts and related disruptions continue.
The analysis quantifies the human cost for children by comparing projected new HIV infections and AIDS-related deaths across multiple scenarios.
Released ahead of the 2025 World AIDS Day, the report showed that high-impact HIV prevention programmes have succeeded in reducing by half the number of adolescent girls and young women acquiring HIV since 2010.
However, prevention programmes, including those focused on protecting adolescent girls and young women, have lost significant funding.
“Individuals at risk, including women, can protect themselves against acquiring HIV by taking antiretrovirals as a pre-exposure prophylaxis (PrEP), but reductions in donor funding have reduced availability and access to this prevention tool, with the exception of pregnant and breastfeeding women.
“Almost one quarter of the 56 countries surveyed in late April 2025 reported having less than six months of condom or PrEP stocks, and almost half reported supply chain management difficulties. PrEP provision has fallen in Botswana, Burundi, Ghana, and Lesotho, and steeply declined in Nigeria, Togo, and Uganda (among nine African countries reporting recent monthly data).
“HIV treatment coverage among pregnant women living with HIV rose to a remarkable 93 per cent [81–>98 per cent] in eastern and southern Africa in 2024. The situation is very different in western and central Africa, where only about 56 per cent [47–71%] of pregnant women living with HIV were receiving antiretroviral therapy in 2024.”
The report noted that while governments have committed to increasing access to HIV testing and treatment, sudden changes in funding stand in the way.
It said women are experiencing reduced access to testing, delayed HIV diagnosis and treatment initiation, and disrupted prevention services.
“The number of pregnant women diagnosed with HIV and new initiations on treatment has declined in several countries. These declining numbers do not reflect a decline in HIV prevalence but reduced access to services.
“In many settings, HIV testing and treatment for mothers and children are offered through maternal and child health services, an integrated service modality that has contributed to high rates of HIV diagnosis and treatment for pregnant and breastfeeding women and HIV-exposed children. Reduced donor funding to these essential services jeopardises efforts to provide these critical services,” the report noted.
The findings indicated that at the current rate of progress, by 2040, the world would still see 1.9 million new HIV infections and 990,000 AIDS-related deaths in children.
“But if funding for HIV prevention and treatment continues to fall as current trends suggest, the world could face an additional 1.1 million new HIV infections and 820,000 additional deaths by 2040.
“In this worst-case scenario, by 2040, three million children would acquire HIV, and nearly 1.8 million would die of AIDS-related causes — the vast majority in sub-Saharan Africa. These are not statistics; they are children with dreams, families, and futures. They represent our shared humanity — and our collective failure if we do not act,” it warned.
On countries’ responses, the report said that despite significant funding cuts, nations are demonstrating leadership and innovation to safeguard hard-won gains in the paediatric HIV response.
“The Government of Nigeria approved $3.12 million for procuring HIV treatment and plans an AIDS Trust Fund. Ministries of Health simplified data management and reporting systems and harmonised supply chain systems for HIV, TB, and malaria; mobilised state resources to provide support; reassigned human resources; and adjusted drug quantities to limit the risk of stockouts,” it said.
It emphasised that global investments in the HIV response have prevented millions of new infections and deaths, but the job is not yet done.
“In 2024, an estimated 200 children died every day from AIDS. This loss of life is unacceptable. The time to act is now. We must close the current funding gap and prevent future funding shortfalls to ensure that every child, adolescent, and mother has access to life-saving HIV prevention and treatment services.
“This study provides the evidence needed to guide policymakers, donors, and global health leaders toward urgent, sustained investment — because action for children is the only option. Their future — and ours — depends on it,” it added.