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Let’s imagine Daniel, a 35-year-old living with HIV. For years, his life has been stable—he’s been taking antiretroviral therapy (ART) consistently, which has led to his viral load to be so low that it has become undetectable, meaning that Daniel cannot pass on the virus to his partner through sexual intercourse. The low viral load also means that his CD4 count remains strong, which is essential, as this determines the immune system’s ability to fight off infections and illnesses. Despite living with HIV, Daniel has been living a full life. He works full-time, exercises regularly, and rarely gets sick. His medication is part of his daily routine, keeping him healthy and ensuring HIV remains manageable.
But one day, when he goes to his local clinic to collect his monthly supply of ART, he is told, “Sorry, we can only provide medication to people who pay the full cost.” Confused, he starts talking to a group of other individuals nearby, only to learn that a recent global funding freeze means that the subsidized medication his government has been co-funding is no longer available. Designated as a low-to-middle income country, Daniel’s government is not able to cover the cost of the medication as before. But the out-of-pocket cost is more than Daniel can afford. This means that due to sudden reversals or holds of global funding, Daniel’s life sustaining medication is no longer available to him. Daniel leaves the clinic without any medication.
What does this mean for Daniel’s health over the next 90 days. At first, nothing seems different. Daniel still feels fine and continues with his routine. But inside his body, HIV is no longer being suppressed. Within just a few days of stopping ART, the virus begins multiplying rapidly. His viral load spikes, and his CD4 count begins to drop, even though he doesn’t notice any immediate symptoms. If he had continued his medication, his immune system would have stayed strong. But now, HIV is gradually weakening his body’s defenses.
By the second month, Daniel starts feeling more tired than usual. His workouts become harder, and he finds himself needing more sleep than before. A mild cold he caught from a coworker lingers for weeks, and he develops a mouth sore that just won’t heal. These are early warning signs that his immune system is struggling. His CD4 count has declined further, making it harder for his body to fight infections. Meanwhile, his viral load remains high, increasing the risk of transmitting the virus to his sexual partner if no protection is used. Desperate, he tries to find a solution. He contacts other clinics that might provide ART at a reduced cost. But he has no success, and he’s still without treatment.
By the third month, Daniel’s health takes a serious hit. He has lost noticeable weight and is constantly exhausted. His cough, which started out mildly, has worsened. It could be a bacterial infection—or something more serious, like tuberculosis (TB), which is known to thrive in individuals with weakened immune systems. Because he has been left without ART for more than 2 months, his CD4 count may now be below 200, officially putting him at risk for AIDS-defining illnesses, such as Pneumocystis pneumonia, a severe lung infection that can be life-threatening.
Daniel’s life is now at critical risk—not because he chose to stop treatment, but because access was taken away from him. He is too weak to go to work and quickly uses up his annual sick leave and has to apply for unpaid leave. Daniel is reeling, how will he pay his rent and monthly bills, and his children’s school fees? How will he provide food for his family? And more pressing, will he be able to access ART again before he is too sick to recover?
If ART access is restored in time, Daniel’s immune system can recover, his viral load can drop again, and his health can stabilize. But if he goes too long without medication, the damage could become permanent, increasing his risk of severe complications or even death from an opportunistic infection.
Daniel’s story isn’t just a hypothetical—it’s the reality for many people who lose access to life-saving HIV treatment. We have made huge strides over the past 40 years since the start of the HIV/AIDS epidemic. Today, HIV is no longer a death sentence—but only if treatment remains accessible and uninterrupted. When ART is disrupted, lives are put at risk. It will not become a matter of if people will die, but rather how many.
Imagine waking up one morning to the news that funding for HIV treatment has been slashed. Across the globe, millions of people living with HIV who rely on daily ART suddenly find themselves without access. The consequences wouldn’t be gradual—they would be catastrophic. For individuals like Daniel, with previously controlled HIV, their immune system would still hold up for a short time, but their CD4 counts would begin declining. For those already immunocompromised, the decline would be rapid and dangerous. After one month, millions of people would unknowingly have high viral loads, increasing HIV transmission rates. Pregnant women living with HIV would face increased risks of mother-to-child transmission, reversing decades of progress.
Meanwhile, in regions with high HIV prevalence, mortality rates would start climbing—not just due to HIV-related illnesses but also due to secondary effects like malnutrition, untreated co-infections, and healthcare collapse. The world would witness a return to the early days of the epidemic, when people were dying in overcrowded hospitals, and entire communities were devastated. Healthcare systems in low- and middle-income countries would collapse first, with hospitals running out of beds and antibiotics (sound familiar?). HIV transmission would explode, undoing decades of prevention work. Even people on PrEP would be at greater risk, as more partners would unknowingly have high viral loads.
ART is not just medicine—it is survival. The global health community must ensure ART access remains stable, equitable, and uninterrupted, because the alternative is unacceptable.