The former head of the US government’s global flagship HIV program warned that the Trump administration’s cuts to health assistance risks reversing decades of progress in Africa against the virus that causes AIDS.

The disruptions to the US President’s Emergency Plan for AIDS Relief, or Pepfar, could reverse gains made over almost 25 years of international cooperation, John Nkengasong said. The interruptions to treatment are particularly dangerous because HIV has no cure and the virus can rebound when patients stop taking antiretroviral medicines, he said.

While Pepfar hasn’t ended — Congress provided $4.8 billion for the program for fiscal 2026 — its operating environment has changed. President Donald Trump’s administration is fundamentally reshaping global health assistance and is negotiating bilateral health agreements that envisage local governments increasing domestic spending while US support declines over time. Trump has also dismantled the United States Agency for International Development and scrapped most grants.

In a statement, the US State Department said the administration has “strengthened PEPFAR through clear strategic direction, promoting greater recipient-country ownership, and sharpening the program’s focus on measurable health outcomes.” Nkengasong said African governments need to respond by treating health as an investment in human capital. Africa produces only about 1% of the vaccines it uses and imports roughly 80% of its medicines, he said.