Protecting Lives, Sustaining Progress

Overview

Investments in global health over the last several decades have resulted in monumental progress toward both controlling the HIV epidemic and preventing maternal and newborn deaths. These investments go beyond improving health outcomes—they are vital to boosting economies, promoting political stability, and strengthening global health security.

New HIV infections have decreased by 61% since their peak in 1996, and deaths related to HIV have decreased by 70% since 2004. There are several factors essential to this achievement: advancements in medication have led to more effective prevention and treatment of HIV, including reducing vertical transmission—also referred to as mother-to-child transmission— along with a focus on prevention and treatment for women and girls, who are especially vulnerable to HIV.

Despite these gains, there are still considerable gaps in global HIV prevention and treatment efforts. While infants and children make up just 3% of HIV infections, they comprise 12% of all HIV- and AIDS-related deaths. Women and girls are 53% of people living with HIV, form 45% of all new infections globally, and constitute 63% of all new infections in sub-Saharan Africa. And while overall maternal and newborn deaths have decreased (40% and 44% respectively), they are both significantly higher in low-income countries compared to high-income countries, with socioeconomic inequities playing a significant role in the risk of maternal and child mortality and morbidity.

Additionally, substantial efforts are needed to meet the 2030 health targets detailed in the Sustainable Development Goals (SDGs). Goal 3, to ensure healthy lives and promote well-being at all ages, necessitates reducing global maternal mortality to fewer than 70 deaths per 100,000 live births, ending preventable deaths of newborns and children under 5 years of age, and stopping the epidemics of HIV and AIDS, tuberculosis, malaria, and neglected tropical diseases.

Current progress shows that we will fall short of these goals.

Today’s projections indicate that by 2030, the maternal mortality ratio will be 177 deaths per 100,000 live births—2.5 times higher than the SDG targets. Currently, 60 countries are at risk of missing the SDG under five mortality target, which would result in the projected deaths of 30 million children under five by 2030. At the end of 2024, the world was on target to meet the 2030 goal of ending the HIV and AIDS epidemics. Seventy-seven percent of people living with HIV were on lifesaving treatment, and the number of new infections had decreased by 40% globally between 2010-2024. That progress has not only stalled—it is actively backsliding. There could be as many as 1.4 million new cases of HIV per year by 2030 due to funding cuts enacted in 2025. An estimated $29 billion annually in
ow- and middle-income countries is needed to eliminate AIDS as a global public health threat.

A significant factor of improved maternal health and HIV outcomes is investment in global health. Historically, the United States has been the largest donor to global health activities in low- and middle-income countries, providing around $12 billion each year. The most impactful avenue for U.S. investment in global health has been the President’s Emergency Plan for AIDS Relief (PEPFAR). This initiative has saved more than 25 million lives and prevented millions of new HIV infections worldwide. The Global Fund to Fight AIDS, Tuberculosis, and Malaria, to which the United States is the largest contributor, has saved 70 million lives since 2002. And from 2012-2023, the U.S. government invested more than $28 million to prevent maternal and child deaths, with United States Agency for International Development’s (USAID) maternal and child survival programs credited with saving 7.4 million lives.

Investment has contributed to global economic progress, promoted educational opportunities, and strengthened global health security. However, reduced investments from the United States and other high-income countries have contributed to stalled progress. The dismantling of USAID and deep cuts to global health funding are already reversing decades of health gains, with significant repercussions anticipated for HIV and maternal and newborn health outcomes.

The current U.S. America First Global Health Strategy prioritizes increased country ownership of costs, government to government agreements, and a push to self-reliance. This shift has altered the HIV and maternal and child health landscape drastically. Working within these new U.S. aid guidelines demands innovative and pragmatic ways of streamlining prevention, diagnosis, and treatment for pediatric HIV prevention, child health, and maternal health—all inextricably linked—to effectively remain prioritized. This is crucial to ensure the progress made toward an AIDS-free generation continues, and people living with HIV continue to be seen and prioritized by the U.S. Congress.

This landscape analysis was prepared by Sarah B. Barnes, Rebecca Avigad, and Deekshita Ramanarayanan as part of the Common Ground for Global Health project, in collaboration with colleagues across EGPAF. Editorial support by Stephanie Bowen; design by Kelsey Brosnan.

This work was made possible through the generous support of the Gates Foundation. The findings and conclusions within are those of the authors and do not necessarily reflect the positions or policies of the Gates Foundation.