I just read a headline that I can’t stop thinking about: global aid cuts could lead to 23 million deaths by 2030, according to a study reported by CIDRAP. Twenty-three million people is an estimate from researchers looking at what happens when the money that keeps people alive simply disappears.

I want to talk about why this makes me sick. This is from my own personal experience of living 45 years with HIV. 

I Know What Happens When You Stop Your Medicine

Over the decades I have seen what happens when you take medicine, vs when you do not. The difference isn’t subtle. It shows up in the numbers and it shows up in how you feel.

When the medicine is working, the virus is held down. When it stops, things change drastically. 

So when I read that aid cuts could cut people off from treatment, I don’t picture a statistic. I picture the suffering I have lived with for 45 years. 

Twenty-Three Million Is Not an Abstract Number

It’s easy for a number that big to lose meaning. So try this: every one of those estimated deaths is a person who, in many cases, could have been kept alive by medicine and programs that already exist. These are treatments that already exist and work and we are ripping them away from people who rely on them. 

What is so disturbing to me is it’s a choice.

The science to keep people alive already exists. Cutting off access to it is a choice.

Undetectable Means Untransmittable, and That Protects Everyone

Here’s the part I don’t think most people understand. Modern HIV treatment doesn’t just keep the person taking it alive. When someone’s viral load is suppressed to undetectable levels they effectively don’t transmit HIV. That’s the principle known as U=U: Undetectable = Untransmittable.

Treatment is prevention.

So think about what happens when millions of people lose access at the same time:

• Their viral loads go up fast.
• They start transmitting the virus again.
• New infections rise, in communities that had been making real progress.
• And they will all die from this eventually. 

The Drug Resistance Nightmare

This is what genuinely scares me the most.

HIV mutates. It’s one of the reasons it’s been so hard to fight. When treatment is interrupted, especially when it’s on-again, off-again because supplies come and go, the virus gets chances to replicate in the presence of partial drug levels. That’s the kind of situation where drug-resistant strains can develop.

And drug-resistant HIV doesn’t stay with one person. It can be transmitted. Someone could be newly infected with a strain that already shrugs off some of the medications we depend on.

I’m not a virologist, and I’d encourage anyone to look at what the experts say about exactly how likely and how fast this could happen. But the basic risk is well known in the HIV world, and the idea of millions of interrupted treatments happening at once terrifies me.

Decades of Progress Could Be Undone

People who weren’t around in the early days may not realize how far we’ve come. HIV went from a near-certain death sentence to a manageable chronic condition. That happened because of decades of research, activism, clinical trials, and people who fought like hell for access to treatment.

A widespread outbreak of drug-resistant HIV could drag us backward. Treatment could get more complicated and more expensive. Research that should be moving toward better options and, someday, a cure, could be forced into playing catch-up just to get back to where we already were.

And viruses don’t respect borders. Anyone who thinks this is only a problem for “somewhere else” hasn’t been paying attention.

Why I’m Writing This

I’m writing this because I’m angry and I’m scared, and because I don’t think most people understand the stakes. This isn’t just about money in a budget line. It’s about people’s lives, about the spread of HIV, and about whether the medicines so many of us depend on keep working in the years ahead.

If you take one thing from this post, let it be this: keeping people on treatment protects everyone. Cutting them off endangers everyone.

Please read the full article and the study it’s based on, share it, and talk about it. I’ve only touched on the headline number here, so check the source for the details and methodology.

Source: CIDRAP: Global aid cuts could lead to 23 million deaths by 2030, study estimates