Africa can end Aids on its own terms. Will the world back us to finish the job?
Jean Kaseya and Amma Adomaa Twum-Amoah
With aid funding falling by 70%, a change to HIV response is needed. The continent must treat health as a matter of sovereignty rather than charity
The Bundibugyo Ebola outbreak now being fought across the region shows again what Africa already knows. When an emergency arrives, the continent cannot wait on distant supply chains or other people’s goodwill. It must make and move the things that keep its people alive. The fight to end Aids by 2030 runs on the same truth
Africa has earned the right to set the terms of that fight. Over two decades the continent helped turn the epidemic around. Aids-related deaths have fallen by 59% since 2010 and new infections by 68%. Nearly 22 million Africans are alive today on daily treatment. Keeping them alive is a permanent commitment
That obligation now meets a hard fact. External health aid to Africa was estimated to have fallen by 70% between 2021 and 2025. The model that brought the response this far, in which Africa delivered while others financed and directed, is ending whether or not anyone plans for it. The only real choice is whether the continent leads the transition or absorbs the shock
The Common Africa Position for this week’s 2026 High-Level Meeting at the UN in New York on HIV/Aids is Africa’s answer. Agreed across member states, experts and institutions, it speaks with one voice. It is built on the Africa Health Security and Sovereignty agenda, which heads of state adopted to treat health as a matter of sovereignty rather than charity. The political declaration should take it forward. It rests on three main demands
It begins with money. Domestic HIV financing has risen over the past decade, and now it has to rise faster, moving inside national budgets, primary healthcare, universal health coverage and social protection, where it can last. Finance and health ministers will have to plan that shift together
International solidarity is still needed, above all in countries facing conflict and fiscal strain, but the terms have changed. Every dollar should back one national plan, one budget, and one monitoring framework. Africa CDC’s target is concrete: at least 20 countries financing half or more of their own health spending by 2030. Partners are asked to fund that future, not to run it
Then comes access. No continent can lead a public health emergency response while depending on distant factories for the medicines that decide who lives. Africa needs reliable supply of antiretrovirals, diagnostics, and innovative prevention tools such as long-acting pre-exposure antiretroviral prophylaxis (eg, lenacapavir), and it needs to make more of them locally. Innovation that does not reach people is innovation that misses the goal and one-off donations of ARV supply will not build a factory.
Lenacapavir could reach 9 to 11 million people and accelerate progress towards ending Aids by 2030, but only at a price an African budget can bear
On price and supply – the African pooled procurement mechanism (APPM), led by Africa CDC, turns scattered demand into a continent’s bargaining power
The African Medicines Agency supports African manufacturing of health products. The continent’s aim is to locally manufacture at least 60% of its health product needs by 2040. That takes political commitment to promote manufacturing and a permanent, binding route for real technology transfer to African manufacturers
Then come the systems that hold it together. The Aids response is won in clinics and communities, not in communiques. People do not experience their health in vertical programmes, so HIV care has to be folded into primary healthcare, with testing, treatment and maternal health reaching people through one door rather than a dozen. Communities living with HIV have led this response from the start, and need funding and formal standing to keep doing so. Rights belong at the centre too
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Stigma, gender-based violence and punitive laws keep people from care, and a serious declaration will defend the dignity of everyone who needs these services, including migrants and refugees. The data must be African as well, held in country-owned systems under African control. The systems also have to hold under pressure, so that the next outbreak, as with the one the continent is fighting now, does not erase a decade of progress
The direction is already set. The 2026 political declaration should meet it: finance the transition, secure access to the science, defend rights, and build a global health order that answers to African leadership rather than around it
For 25 years the world asked whether Africa could deliver the Aids response. It can, and it has. The question this June is different. It is whether the world will back Africa to finish the job on African terms, or spend another generation managing the continent’s dependence. The continent has made its choice. The declaration should make the same one
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Dr Jean Kaseya is director general,Africa Centres for Disease Control and Prevention; and HEambassador Amma Adomaa Twum-Amoah iscommissioner for the African Uniondepartment ofhealth,humanitarianaffairs andsocialdevelopmentUnion Commission
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