TWN Info Service on UN Sustainable Development (Jul26/05)
31 July 2026
Third World Network

UN: Hard-won HIV gains in jeopardy amid renewed funding pressures
Published in SUNS #10493 dated 30 July 2026

Penang, 29 Jul (Kanaga Raja) -- Despite historic lows in new HIV infections and AIDS-related deaths, the global response is becoming extremely fragile, with reductions in international funding and cuts to HIV prevention and community-based services threatening to reverse hard-won gains, UNAIDS has warned.

In a special report released for the 26th International AIDS Conference taking place in Rio de Janeiro, Brazil from 27 to 31 July, UNAIDS said that although new HIV infections and AIDS-related deaths are at their lowest levels in more than 30 years, the current HIV response is extremely fragile.

In 2025, 1.2 million people acquired HIV, but progress is uneven. New HIV infections rose in three regions and 21 countries in 2025, it added.

Around 9 million of the 41 million people living with HIV were not on treatment and almost half of all children living with HIV did not have access to antiretroviral therapy in 2025. More than half a million people (570,000) died of AIDS-related illnesses in 2025.

On a positive note, seven countries (Benin, Eswatini, Kenya, Lesotho, Nepal, Rwanda and Zimbabwe) achieved an almost 80% reduction in new infections since 2010 and 11 countries achieved the 95-95-95 treatment targets showing that progress is possible, said UNAIDS.

[The treatment targets are: 95% of all people living with HIV who know their status, 95% of all people with diagnosed HIV infection accessing antiretroviral therapy (ART), and 95% of all people accessing ART who are virally suppressed.]

The world is on the cusp of an HIV prevention revolution in prevention medicines which offer close to vaccine- like protection against HIV, UNAIDS said in a press release.

Monthly and six-monthly injections are slowly trickling into the market, and monthly pills are in late-stage trials, it noted.

While what is coming to market and in the pipeline is extraordinary, the challenge remains scale and inequitable access, the UN agency underlined. 

"Scientific breakthroughs are giving us tools that previous generations could only dream of," said Winnie Byanyima, the Executive Director of UNAIDS.

"However, innovation without access is not innovation, it is injustice. The test of success is not whether medicines exist - it is whether the people who need them can get them, and at an affordable price."

Brazil has increased the number of people accessing HIV prevention medicines at least once in the past year by 41%, UNAIDS said.

Ethiopia and Uganda also took action to expand access through domestic and other funding, while South Africa is continuing to negotiate pricing deals for the twice-yearly prevention injections lenacapavir.

However, UNAIDS said that despite being part of the trials for lenacapavir, Brazil has not been granted voluntary licensing from producer Gilead to enable cost-effective pricing or the introduction of generic alternatives and is considering compulsory licensing.

It said UNITAID, the Global Fund to Fight AIDS, Tuberculosis and Malaria and partners have pulled money together to start rolling out lenacapavir to reach 3 million people by 2028, which is welcome news, but this remains a drop in the ocean, currently reaching just a few thousand people.

UNAIDS estimates that 20 million people need access to antiretroviral-based prevention to have a real impact in stopping new HIV infections.

It also pointed out that overseas development assistance (ODA) has collapsed. Global development assistance from multiple countries fell by 23% in 2025 - the sharpest drop on record - a large proportion of which was for global health, and HIV programmes have been hit hard.

High burden, highly indebted, low-income countries of Africa depended on ODA for the success of their AIDS responses, and many of these countries were more than 90% dependent on ODA for their HIV responses.

"The era of relying on international aid is over," said Byanyima. "Countries cannot wait and they cannot go backwards. The world must urgently fix the broken financial system and accelerate debt restructuring so that governments can invest in what matters most - the health, education and futures of their people."

Notably, UNAIDS said international financing for HIV from multiple countries declined by more than US$1.5 billion, from US$8.8 billion in 2024 to US$7.3 billion in 2025, an 18% reduction and the lowest level in nearly two decades.

HIV prevention services were largely funded from international funding. For example, in sub-Saharan Africa, 80% of prevention funding came from international aid. Community-led organizations received up to 25% of foreign HIV assistance in 2024, it pointed out.

Surveys show that in some countries, these organizations reached 22% of people living with HIV and up to 60% of marginalized populations with life-saving services.

With the absence of donor support and stronger domestic investment, HIV prevention and community-led HIV service delivery risk total collapse, UNAIDS cautioned.

Citing some examples of the impact of funding cuts, it said funding for condoms has been cut by more than 90% in some countries.

A 2026 study, across 47 countries, found steep reductions in community-led services - 50% for community-led support for prevention medicines and HIV care, 85% for services for gay men and other men who have sex with men, 82% for sex workers, and 72% for survivors of gender-based violence.

MOMENTUM FALTERING

According to the UNAIDS report, decades of hard work and global solidarity have reduced the annual numbers of people acquiring HIV and people dying from AIDS-related causes to their lowest levels in more than 30 years.

However, it said AIDS is not over. The world is not on track to achieve the 2030 goal of ending AIDS as a public health threat.

In 2025 alone, there were 1 million more new HIV infections and 400,000 more AIDS-related deaths than if the world were on track to reach the global targets, it added.

Since 2010, the estimated number of new HIV infections fell by 42% globally, with an even steeper decline of 59% in sub-Saharan Africa (which accounted for about half of new infections globally in 2025).

The number of new paediatric infections as a result of vertical transmission has dropped by 69% since 2010 to 93,000 in 2025.

The report said prevention of vertical transmission programmes averted nearly 4.8 million acquisitions of HIV in children between 2000 and 2025.

The number of AIDS-related deaths in 2025 was 57% lower than in 2010, decreasing from 1.3 million in 2010 to 570,000 in 2025, with a decline in deaths among adult women aged 15 years and older from 510,000 to 220,000 and among adult men from 590,000 to 290,000, said the report.

However, mortality remains unacceptably high for a treatable condition and progress is at risk of stalling, leaving the 2030 goal off-track without sustained acceleration, it stressed.

"Globally in 2024, there were an estimated 150,000 tuberculosis (TB)-related deaths among people living with HIV, a 76% decline compared with 2010. TB remained the leading cause of death among people living with HIV globally in 2024."

These achievements were supported by a 20% increase in total HIV resources since 2010, with US$17.6 billion available for the HIV response in low- and middle-income countries in 2025, said the report.

However, this was US$4.3 billion short of the estimated US$21.9 billion needed annually by 2030, a funding gap of nearly a quarter of the total need, it added.

More worryingly, it said the unprecedented funding reductions (18% of total external funding for HIV) in 2025 have made HIV programmes fragile in many low- and middle-income countries.

Moreover, it said domestic and international funding for HIV prevention programmes in sub-Saharan Africa was substantially reduced in 2025.

Pre-exposure prophylaxis (PrEP) programmes and condom purchases declined drastically and suddenly between 2024 and 2025 in some countries.

National data submitted to UNAIDS show major declines between 2024 and 2025 in PrEP in Cameroon, Nigeria and Zambia, with each country showing more than a 50% decline in the number of people receiving PrEP at least once during the year.

However, Ethiopia, and Uganda took action and substantially expanded access to PrEP through domestic and other funding.

The report said that South Africa, which has the largest number of people receiving PrEP globally, also had a considerable reduction in international financing for PrEP but managed to see only an 8% decline in the number of people reached between 2024 and 2025.

Brazil also increased the number of people receiving PrEP at least once in the past year from 165,000 to 233,000 (by 41%).

Moreover, in one bilateral donor programme, between 2024 and 2025, HIV testing declined by 22% in countries with a high level of HIV, funding for condom programming declined by 93%, and funding for programmes that ensure people can reach prevention services (e.g. supportive laws, regulations and policy environments) reduced by 80%.

An overall lack of domestic funding for prevention programmes and declines in donor HIV assistance have put HIV prevention services at risk, the report warned.

Prevention programmes have historically relied heavily on donor assistance in most regions, with especially high dependency in sub-Saharan Africa (83% in 2024), it noted.

It said that in 2024, HIV prevention represented 11% of all HIV funding (domestic and international) in low- and middle-income countries, with a large proportion (66%) coming from external financing.

REGIONAL DISPARITIES

According to UNAIDS, between 2010 and 2025, numbers of new HIV infections continued to decline in some regions but increased in others.

Declines occurred overall in Asia and the Pacific, the Caribbean, eastern and southern Africa, and western and central Africa, but this progress is fragile and at risk due to funding cuts, especially in sub-Saharan Africa, said the report.

"Increases were recorded in eastern Europe and central Asia, Latin America, and the Middle East and North Africa."

Notably, sub-Saharan Africa continues to be the region most heavily affected by HIV, representing half of new HIV infections.

In 2025, seven countries achieved at least a 78% reduction in the number of new HIV infections since 2010, placing them well on track towards the goal of a 90% reduction by 2030, said UNAIDS.

The report said these were the following high-burden countries in sub-Saharan Africa: Benin, Eswatini, Kenya, Lesotho, Rwanda and Zimbabwe, as well as Nepal.

Another 27 countries have reduced their numbers of annual new HIV infections by more than 60% since 2010 and with concerted efforts, they could achieve the target of a 90% reduction  by 2030, it suggested.

Conversely, it said 21 countries still face rising numbers of new HIV infections. "More effort is needed to reach people at the highest risk of HIV in these countries and to lift societal barriers such as stigma and discrimination and criminalizing laws that impede progress to end AIDS."

In other findings, the report said the number of new HIV acquisitions has declined faster among women than men outside of sub-Saharan Africa and globally. In sub-Saharan Africa, however, the number of new HIV acquisitions has declined faster among men than women.

"As funding for HIV prevention in Africa falters, women continue to be disproportionately affected by HIV in sub-Saharan Africa, accounting for 6 out of 10 new acquisitions."

The report further said adolescent girls and young women (aged 15-24 years) remain at high risk, especially in sub-Saharan Africa, where they represented about 160,000 new acquisitions in 2025, which is 3,000 new HIV acquisitions per week.

"Incidence among adolescent girls and young women is three to four times higher compared with their male counterparts in this region."

Meanwhile, service gaps in HIV programmes led to 93,000 children acquiring HIV in 2025, with 84% of these in sub-Saharan Africa.

In 2025, 87% of women living with HIV who were pregnant were receiving treatment - a very slow increase from 84% in 2020, said the report.

FUNDING GAP

Achieving the 2030 global HIV targets requires US$21.9 billion annually by 2030 in low- and middle-income countries - US$4.3 billion more than the US$17.6 billion available in 2025, said the report.

"The year 2025 marked a profound shock to global health financing, with abrupt reductions in international assistance destabilizing HIV responses across many countries."

Treatment sustainability is fragile, with strong reliance on external funding. The funding withdrawals observed in early 2025 have disrupted service delivery, supply chains and community-led systems, particularly those serving the most vulnerable populations, it emphasized.

The global landscape of external financing for HIV in 2025 is marked by growing uncertainty and increasing funding pressures, said UNAIDS.

Total financial resources for HIV in low- and middle-income countries were US$17.6 billion, of which 59% came from domestic resources.

Compared with 2024, the total resources for HIV fell by more than US$1 billion, a 6% decline in just one year.

The report said the overall decline was limited to 6% because increases in domestic resources for HIV partially offset a much steeper US$1.6 billion (18%) decline in international resources for HIV, the largest decline in almost two decades.

It said the reduction in international funding was driven primarily by declines in donor government financing.

When both bilateral disbursements to countries and donor government contributions to multilateral institutions are taken into account, the decline in donor government funding was substantially greater than the 18% decline observed in overall international HIV financing, it added.

The report also found that donor government financing for HIV through bilateral and multilateral channels in low- and middle-income countries has become "increasingly concentrated over the past 15 years."

Since 2011, HIV disbursements from European donor governments declined by 58%. Between 2011 and 2024, the United States steadily increased its share of international HIV financing by 48%, becoming the cornerstone of the global HIV response.

However, in 2025, the sharp reduction in total United States funding (bilateral and multilateral) accounted for most of the global decline in HIV financing, the report stressed.

It also said that in 2025, domestic financing represented 59% of total funding for the HIV response. From 2010 to 2025, domestic HIV financing in low- and middle-income countries increased by 38%, although that growth stalled and there were decreases attributed to efficiency improvements as a result of commodity price decreases, and sharper decreases due to COVID-19 and fiscal strain in 2020-2023, before increasing again in 2024 by 2.2% and again in 2025 by 4%.

UNAIDS said that the increases observed in 2025 in several countries were largely a response to the sudden reductions in international financing, with governments mobilizing additional domestic resources to sustain essential HIV services.

Although these efforts demonstrate strong domestic commitment, they were not sufficient to fully offset the scale of the decline in international financing, it pointed out.

Domestic resource mobilization is constrained in many countries by slow economic growth, rising debt-servicing obligations, inflationary pressures and competing development priorities, it said.

For instance, the report said that in several countries highly affected by HIV, debt servicing now exceeds public health expenditure, severely limiting fiscal space for HIV investment.

It said twenty-eight African countries spend more on debt than on health. In western and central Africa, for example, public debt service in some countries is on average 5.5 times greater than public health allocations, crowding out fiscal space for HIV investment. +