The global AIDS response is at a paradoxical point.
On the one hand, the world is on the cusp of a “prevention revolution” with long-acting HIV prevention drugs, most notably the six-monthly injectable, lenacapavir, which is expected to be rolled out in South Africa by mid-2026. On the other hand, countries are looking for ways to keep HIV programmes running after the U.S withdrew development funding earlier this year.
“There is a funding crisis. We must find ways to plug the gaps left by the withdrawal of donor aid. Countries need to look at their domestic budgets for where they can divert funding towards HIV programmes,” says UNAIDS Executive Director Winnie Byanyima.
Byanyima was speaking at the launch of the 2025 Global AIDS Update report at Bertha Gxowa Hospital in Germiston on Thursday. She called on countries to reprioritise and tailor programmes towards the integration of multiple diseases to ensure the most economic use of limited funds.
“The data in this report show that up to December last year, there were remarkable achievements. We were not completely on target, but this is one of the most successful public health responses in history, saving more than 26 million lives. It’s showing what is possible when the world comes together to fight a disease,” says Byanyima.
“But the sudden withdrawal by the single biggest HIV donor, along with other cuts of aid from other governments that were happening more gradually, is putting this progress at risk, particularly for the low-income, highly burdened countries, again, mostly on this continent.
“If the world doesn’t plug this hole, we estimate that an additional six million people will be HIV infected in the next four years, and we could have four million additional AIDS-related deaths.”
Beyond HIV
“Globally, particularly in the African region, the funding cuts will have a huge impact and not just on HIV. So many other humanitarian aspects of support were funded by the generosity of many countries, and particularly the U.S government,” says Professor Helen Rees, founder and Executive Director of Wits RHI.
”When we’re thinking about the impact of those funding cuts, including HIV, we must just remember that HIV isn’t just a disease. It’s the disease that, in itself, if untreated, exposes individuals and populations to many other diseases.”
Rees explains that at a societal level, the lifelong and chronic illness caused by untreated HIV has a knock-on effect on development. This, in turn, has a negative impact on stability and security.
“We’ve had huge root support for research from many structures, including from the U.S government, and we’re very much hoping that those relationships will continue. The research that’s been done for HIV and TB has not only had an impact on the country, but a huge global impact as well.”
Research done in South Africa has contributed to key global policies in HIV and TB prevention and community interventions.
“We need to continue those partnerships because they are a global benefit, and we can’t have a pandemic treaty that we all agreed to and then say, let’s stop the research.”
Countries stepping up
“But we also see that countries, governments, and civil society are not lying down and waiting to die, that there is action, that there is transformation,” says Byanyima.
Some of the strategies countries have come up with include reallocation of existing monies. Others have created new sources of domestic funding such as health levies.
“We also see more cost-effective ways of delivering services as governments integrating HIV into the mainstream of health service delivery.”
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Byanyima says South Africa, which has the highest number of people living with HIV in the world and boasts the biggest HIV treatment programme, is a good example of how governments are stepping up.
In the Health Budget Vote speech delivered in parliament this week, health minister Dr Aaron Motsoaledi announced that the government had made additional funding of over R700m available for HIV and TB programmes and research. – Health-e News
