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Years of American-led investment into AIDS programs has reduced the number of people killed by the disease to the lowest levels seen in more than three decades and provided life-saving medicines for some of the world’s most vulnerable.

But in the last six months, the sudden withdrawal of U.S. money has caused a “systemic shock,” U.N. officials warned, adding that if the funding isn’t replaced, it could lead to more than 4 million AIDS-related deaths and 6 million more HIV infections by 2029.

A new UNAIDS report released Thursday said the funding losses have “already destabilized supply chains, led to the closure of health facilities, left thousands of health clinics without staff, set back prevention programs, disrupted HIV testing efforts and forced many community organizations to reduce or halt their HIV activities.”