Hontelez JACGoymann HBerhane YBhattacharjee PBor JChabata STCowan FKimani JKnox JLora WSLungu CManne-Goehler JMauti JMoshabela MMpembeni RMWa Mwanza MNdung'u TOmondi EPhiri SSiedner MTanser FCde Vlas SJBärnighausen TW2025-07-102025-May10.1016/j.eclinm.2025.103233https://pubs.cidrz.org/handle/123456789/10817BACKGROUND: On January 24, 2025, the United States government issued an executive order to freeze all foreign aid programs, including The President's Emergency Plan for AIDS Relief (PEPFAR), for 90 days. A limited waiver option became available, but its implementation remains incomplete. We estimated the impact of these policy changes on HIV deaths and new infections in seven sub-Saharan African (SSA) countries-Ethiopia, Kenya, Malawi, South Africa, Tanzania, Zambia, and Zimbabwe -, which together account for about half of all people living with HIV in SSA. METHODS: We used STDSIM, an established individual-based simulation model, and previously published quantifications for the seven countries. We predicted changes in HIV deaths and new infections over the period 2025-2030 for four scenarios: (1) FINDINGS: A 90-day funding freeze would result in 60 thousand [95% UI: 49-71 thousand] excess HIV deaths for the INTERPRETATION: The sudden cessation of PEPFAR funding likely results in tens of thousands of HIV deaths and new infections. These losses of life and health should compel the United States government to rapidly and fully re-instate one of the most successful health programs in history. FUNDING: None.https://pubmed.ncbi.nlm.nih.gov/40626258/