Imagine a world where decades of hard-fought progress against deadly diseases like HIV and tuberculosis suddenly hangs in the balance—all because of slashed funding. That's the stark reality we're facing this World AIDS Day, and it's a wake-up call we can't ignore.
As we mark World AIDS Day, the Forum of International Respiratory Societies (FIRS) is sounding the alarm: true progress against the rising tide of tuberculosis (TB) demands unwavering teamwork across borders and sectors. It's a reminder that no single country or organization can tackle these global threats alone.
On December 1, 2025, we're reflecting on how the early 2025 reductions in USAID funding have shaken the foundations of international health systems. The World Health Organization (WHO) paints a grim picture, explaining that these financial hurdles have led to widespread disruptions in HIV services. Think staffing gaps that leave clinics understaffed, broken supply chains that delay life-saving medications, and new obstacles that make it harder for people to get preventive care or treatment. For beginners unfamiliar with global health logistics, this means everyday people in vulnerable communities are left waiting longer for tests and drugs, which can turn a manageable condition into a crisis.
This year, on World AIDS Day, the Global Initiative for Asthma and FIRS partners are calling on governments, health activists, and NGOs to join forces. Their goal? To curb the comeback of infectious diseases like HIV and TB. You can dive deeper into their resources here: (https://craftprd1.blob.core.windows.net/documents/advocacy-patients/patient-resources/tuberculosis-2.pdf). This united front is crucial for achieving the WHO's ambitious target of ending the AIDS epidemic as a public health threat by 2030. But here's where it gets controversial: in an era of tight budgets, should wealthier nations prioritize domestic issues over global health aid, or is that a shortsighted move that could boomerang back to haunt us all?
Take South Africa as a real-world example. There, the Department of Health handles most of the frontline work, from delivering services to buying essential drugs. But they rely heavily on outside help from groups like USAID and the Centers for Disease Control. As Professor Moherndran Archary, a specialist in pediatric infectious diseases at the University of KwaZulu-Natal, points out, this external support covers everything from gathering reliable health data to predicting drug needs, training medical staff, bolstering overall health systems, and actively seeking out cases for early intervention. "Even though the Department of Health has taken on some of these responsibilities internally," he notes, "the abrupt pullout of this vital assistance leaves an enormous gap that's hard to fill quickly." For those new to this, imagine a hospital suddenly losing its data analysts and trainers—it's like trying to run a marathon with half your team missing.
The American Thoracic Society (ATS) has deep roots in this fight; it started back in 1905 as the National Association for the Study and Prevention of Tuberculosis. Fast forward to today, and ATS, alongside other FIRS members—the top respiratory organizations worldwide—is pushing hard to enhance lung health everywhere. But U.S.-led funding cuts are hitting this mission hard, especially since America has been a powerhouse in controlling TB globally. And this is the part most people miss: these cuts don't just affect far-off places; they weaken the entire international network that protects us from pandemics.
Here's a sobering fact: TB is the leading killer among people with HIV, claiming more lives than any other illness in this group. In high-HIV areas, TB often shows up as the first red flag that someone might be HIV-positive. Shockingly, the WHO reports that nearly half of those dealing with both HIV and TB don't even know about their dual diagnosis, meaning they're missing out on treatments that could ward off severe sickness and even save their lives. To clarify for newcomers, co-infection means having two diseases at once, which complicates everything from symptoms to medication, but early detection changes the game.
If funding dries up in lower- and middle-income countries, we risk not just pausing but undoing years of breakthroughs in TB care and research. Among the innovations on the chopping block are:
- Smarter integration of TB services to match how people actually seek healthcare, making it easier and more accessible.
- Diagnostic tools that are far more precise and user-friendly, catching cases earlier.
- Streamlined treatment plans—down to just six months for drug-resistant TB (compared to the old 18-24 months) and even four months for drug-sensitive cases, which means fewer side effects and better adherence.
- Fresh drugs and repurposed ones that make regimens for resistant TB more effective and tolerable.
- Updated preventive strategies, including new vaccines on the horizon to stop TB before it starts.
- Greater focus on the social and economic factors driving TB, like poverty and overcrowding, plus accounting for the huge financial burden it places on families and economies.
These game-changers didn't happen by accident. As ATS member Dr. Philip Hopewell, a globally respected TB authority, shares in materials provided to the society, they stemmed from ramped-up investments at both international and national levels—much of it courtesy of U.S. contributions. Dr. Hopewell breaks down what losing this funding could mean in an eye-opening ATS Breathe Easy podcast from earlier this year (https://youtu.be/y8jmFPzJtfc). Listening to it feels like peering into a cautionary tale of what might come next.
Right after AIDS burst onto the scene, it sparked a worldwide TB revival that's still raging in many poorer nations. The WHO highlights that folks with HIV are a staggering 12 times more prone to developing active TB than those without it. On a brighter note, new treatments—especially antiretroviral therapies—have slashed AIDS-related deaths by 70% since their peak in 2004 (https://www.unaids.org/en/resources/fact-sheet). It's a testament to science's power, but fragile without steady support.
Professor Archary adds that South Africa's stock of antiretroviral drugs remains stable for now. Yet, in other parts of Sub-Saharan Africa, shortages are cropping up, hitting access hard. The 2025 UNAIDS fact sheet drives this home: in that region, women and girls make up 63% of new HIV cases (https://www.unaids.org/sites/default/files/mediaasset/UNAIDSFactSheet_en.pdf). Why the disparity? Experts point to social inequalities, but addressing it requires targeted funding that some argue is being deprioritized amid broader cuts—a point ripe for debate.
Ultimately, bridging these funding shortfalls calls for a worldwide team-up to safeguard the hard-won victories in preventing HIV spread and reducing deaths from related illnesses. Without it, we might see history repeat itself in the worst way.
What do you think—should global health funding be ring-fenced from political shifts, even if it means tough choices at home? Or is there a better way to balance it all? Drop your thoughts in the comments; I'd love to hear if you agree that collaboration is our best shot or if you've got a counterpoint to share.
Contact for Media:
Dacia Morris, American Thoracic Society, dmorris@thoracic.org
Helen Dugdale, Forum of International Respiratory Societies, Helen.Dugdale@firsnet.org
About the Forum of International Respiratory Societies
The Forum of International Respiratory Societies (http://www.firsnet.org/) (FIRS) brings together the planet's premier respiratory groups to boost lung health on a global scale. With over 70,000 members united in purpose, FIRS amplifies efforts to combat respiratory challenges through shared advocacy and action.
Its lineup includes heavy hitters like the American College of Chest Physicians (CHEST), American Thoracic Society (ATS), Asian Pacific Society of Respirology (APSR), Asociación Latino Americana De Tórax (ALAT), European Respiratory Society (ERS), International Union Against Tuberculosis and Lung Diseases (The Union), Pan African Thoracic Society (PATS), Global Initiative for Asthma (GINA), and Global Initiative for Chronic Obstructive Lung Disease (GOLD).
Check out their landmark report, The Global Impact of Respiratory Disease (https://www.firsnet.org/resources/publications), which breaks down the biggest threats to breathing health and offers practical steps for worldwide response.
