HIV infection is 100% fatal; however, antiretroviral therapy prevents illness, death and transmission—delaying access to treatment is a death sentence while also leading to the spread of HIV. More recently, antiretroviral chemoprophylaxis (commonly known as pre-exposure prophylaxis or PrEP) has been shown to prevent HIV infection among individuals at high risk. In 2003, President George W Bush established the President’s Emergency Plan for AIDS Relief (PEPFAR), the largest commitment by any nation to address a single disease. Over the last two decades, PEPFAR provided antiretroviral treatment to more than 20 million people, saved over 25 million lives, enabled more than 7 million babies to be born free of HIV and helped cut new HIV infections by half in the most impacted countries. Earlier last year, the US administration drastically cut overseas development funding, severely compromising PEPFAR’s ability to deliver life-saving HIV services. UNAIDS modelling shows that if the funding permanently disappears, there could be an additional 6 million HIV infections and an additional 4 million AIDS-related deaths by 2029. We urge the US administration and the G7 leadership to reflect carefully on the likely and grave consequences of dismantling one of the most successful initiatives in the history of global health.