Rio de Janeiro, Brazil — The global HIV response stands at a defining moment, with health leaders warning that decades of progress are at risk as international funding declines and prevention programmes are scaled back across some of the world’s hardest-hit countries.
Although new HIV infections and AIDS-related deaths have fallen to their lowest levels in more than three decades, UNAIDS says the world is not on track to end AIDS as a public health threat by 2030.
Its latest report, United to End AIDS, warns that the global HIV response has become increasingly fragile and that recent funding cuts threaten to reverse years of scientific and public health gains unless international solidarity is restored, financing stabilises, and inequalities are addressed.
The warning comes as delegates gather in Rio de Janeiro for the 26th International AIDS Conference under the theme “Rethink, Rebuild, Rise”, reflecting growing concern that the global response must adapt to a rapidly changing funding landscape.
IAS President and AIDS 2026 International Co-Chair Beatriz Grinsztejn said delegates were meeting “at a moment of real danger for the HIV response”.
She cited new analysis by UNAIDS and KFF showing donor government funding for HIV programmes in low- and middle-income countries fell by 25% in 2025 – the steepest annual decline since international reporting began. The report examines the state of the HIV response, the impact of today’s funding crisis on countries and communities, and the actions needed to keep the world on track.
“Never has donor funding fallen so far, so fast, and those most vulnerable are already paying the price,” she said.
“Donor countries are choosing to walk away while many high-burden countries remain shackled by debt they cannot escape. “We must rethink outdated models, rebuild what has been broken and rise to ensure the response gets the re
The conference comes just weeks after 149 countries adopted a new political declaration on HIV and AIDS, reaffirming their commitment to ending AIDS as a public health threat by 2030. The declaration is aligned with the UNAIDS Global AIDS Strategy 2026–2031 and builds on five pillars: sustained political commitment, domestic investment, community leadership, equitable access to innovation, and strong international cooperation. It commits countries to review progress at a High-Level Meeting in 2031.
UNAIDS estimates that if the new commitments are met in full, they would avert an additional 3.2 million new HIV infections and 1.3 million AIDS-related deaths by 2030.
A major aspect of the agreement is to bolster both national and international financing of HIV programs, facilitate local manufacturing of health products, broaden access to quality health care services, and ensure that affected communities continue to be at the forefront of shaping and delivering the HIV response.
UNAIDS Executive Director Winnie Byanyima presented the findings of the agency’s 2026 Global AIDS Update, United to End AIDS, framing it as a report that “tells two stories.”
The first, she said, is one of extraordinary scientific progress, prevention tools now effective enough that reaching everyone who needs them could realistically end AIDS as a public health threat. “The second story is a warning,” she said. “Funding cuts, rising inequality, attacks on human rights, shrinking civic space- together, they are putting decades of progress at risk.”
The world has made significant progress in reducing new HIV infections and AIDS-related deaths over the past two decades.
Byanyima said that since the peak of the epidemic, new HIV infections have fallen 65% and AIDS-related deaths have dropped 73%. More than 28.5 million lives have been saved through antiretroviral treatment, and 32.1 million people are now receiving that treatment – the highest number in history – which she called one of the greatest public health achievements of our lifetime.
Byanyima cautioned that the world should not mistake progress for victory.
“Progress is not the same as victory,” she said.
According to the report, 1.2 million people acquired HIV last year and 570,000 died from AIDS-related illnesses. Another 8.9 million people living with HIV still lack access to life-saving treatment, and nearly 45 percent of children living with HIV are not on treatment. Byanyima said new infections are rising in three of the world’s five regions and in 21 countries, with roughly 3,400 people newly infected and 1,600 AIDS-related deaths occurring every single day.
“The HIV pandemic is not over,” she said. “Without urgent action, it could resurge.”
A funding crisis already underway
The report describes not a looming funding shortfall but a crisis already in progress. Official development assistance for HIV programs declined by 25 percent in 2025 – the steepest fall on record, Byanyima said. Countries that had depended on that aid for nearly 60% of their HIV responses are already cutting services, closing community organizations, shrinking prevention programs, and laying off health workers.
“We are no longer facing a future funding crisis,” Byanyima said. “We are living through one now.”
She warned the consequences were predictable: when prevention programs disappear, infections rise; when treatment is interrupted, people die. “This is not inevitable,” she added. “It is the result of political choices.”
“When prevention disappears, infections rise. When treatment is interrupted, people die. We’ve seen this before.”
Despite these setbacks, Byanyima said the world is also witnessing one of the most exciting periods in HIV science. Long-acting prevention medicines, monthly pills, monthly injections, and six-monthly injections are approaching vaccine-like effectiveness, she said, making the elimination of new infections “no longer simply an aspiration” but “scientifically achievable.”
However, she warned that their impact will depend on whether they are made affordable and accessible to everyone who needs them.
“Scientific breakthroughs alone will not end AIDS. Access will. Innovation without access is not innovation. It is injustice,” she said.
UNAIDS estimates approximately 20 million people will need access to long-acting prevention tools for the scientific breakthroughs to meaningfully change the course of the epidemic. Reaching them, Byanyima said, will require affordable pricing, rapid voluntary licensing, generic competition, regional manufacturing, technology transfer, and fast rollout into national health systems.
“The end of AIDS is no longer limited by science. It’s limited by inequality,” Byanyima said.
The report also highlights a worsening global human rights environment. Byanyima said that, for the first time since UNAIDS began monitoring legal environments, criminalisation of key populations is increasing rather than declining. Dozens of countries continue to criminalise same-sex relationships, sex work, drug use and transgender people, while many require parental consent before adolescents can access HIV services.
She said shrinking civic space and discriminatory laws discourage people from seeking healthcare, making it harder to control the epidemic.
Byanyima argued this is not simply a matter of justice but of public health effectiveness: when people fear arrest, violence, or discrimination, they avoid health services, allowing HIV to spread. “Human rights are not separate from the HIV response,” she said. “Human rights are the HIV response… Human rights save lives.”
Despite the challenges, Byanyima expressed optimism that the world can still achieve the goal of ending AIDS by 2030. She pointed to the recent adoption of a new United Nations Political Declaration on HIV and AIDS by 149 member states, saying its commitments could prevent millions of new HIV infections and AIDS-related deaths if fully implemented. UNAIDS estimates that if fully implemented, the declaration’s commitments could prevent 3.2 million new infections and 1.3 million AIDS-related deaths, putting the world back on track to meet the 2030 target.
“The roadmap exists. The science exists. The communities exist. The commitments exist,” said Byanyima. “Now we must deliver.”
She called on governments, partners, civil society, and communities to protect HIV financing, scale up prevention, guarantee equitable access to new prevention medicines, support community-led responses, and defend human rights.
“The world is at a crossroads. We have the science to end AIDS. The question is no longer whether we can end AIDS. The question is whether we choose to end AIDS,” said Byanyima.
South Africa‘s Deputy Minister of Health, Dr Joe Phaahla, said the findings of the UNAIDS Global AIDS Update reflect the reality that health ministers across Africa have been confronting over the past year as international funding for HIV programmes declines.
“A 25% drop in donor government funding in a single year is unprecedented. It is not just an abstract figure,” he said. Phaahla said the consequences are visible at the frontline of healthcare delivery, affecting the availability of medicines, HIV prevention commodities such as pre-exposure prophylaxis (PrEP), community health workers, as well as surveillance and data systems that countries rely on to plan evidence-based HIV responses.
Phaahla said that South Africa, like many African countries, has built its HIV response on a combination of domestic financing and international partnerships. However, the speed and scale of the recent funding decline have placed that model under significant strain, forcing governments to make difficult decisions about which services to prioritise.
Despite the financial pressures, Phaahla said African governments are not standing still. He said South Africa has continued to strengthen domestic investment to protect the gains made over the past two decades while focusing resources on interventions that have the greatest impact on reducing new HIV infections and AIDS-related deaths. As part of that strategy, he highlighted South Africa’s recent rollout of long-acting lenacapavir as an additional HIV prevention option, launched with support from partners including the Global Fund, UNITAID and the Children’s Investment Fund Foundation.
Phaahla said the latest UNAIDS report, which shows that domestic financing now accounts for nearly 60 percent of HIV funding across the region, reflects a deliberate shift by African governments towards greater ownership of their HIV responses.
However, he cautioned that domestic renight
“Domestic financing can grow, and it must grow, but we have to be honest and say that no African finance ministry can fully replace overnight the scale, the predictability and the technical depth that international partnership has provided over two decades,” he said.
He said that African countries were not asking for charity but for continued partnership during a managed transition to more sustainable financing. “This is not a request for charity. It is a call for shared responsibility,” Phaahla said. He urged donor governments, philanthropic organisations and the private sector to remain engaged, arguing that Africa has repeatedly demonstrated it can lead the HIV response when equipped with the necessary re
“Africa has shown repeatedly that it can lead in this response when it has the tools,” he said. “What we are asking for is for partners to stand with us as we adapt, not to watch from a distance, but partner with us as we ensure that we can indeed reach the goal of defeating AIDS as a public health threat by 2030.”
HIV activist warns funding cuts are costing lives
Transgender rights activist and HIV advocate Erica Castellanos delivered a deeply personal account of what those decisions mean for people living with HIV.
Castellanos, Executive Director of the Global Action for Trans Equality (GATE), said she was speaking not only as an advocate, but as a transgender woman from Belize who has lived with HIV for more than three decades.
“I have lived through more than 30 years of promises, of breakthroughs and funerals. I have watched medicines transform HIV from a death sentence into a manageable health condition. But I have also watched people die while those medicines existed.” She said the tragedy was not a failure of medical science but of political leadership.
“Science did not fail my friends,” she said. “Politics did.”
She argued that recent funding cuts were the result of political decisions, not unavoidable events. She warned that reductions in donor support lead directly to clinic closures, fewer outreach workers, and interrupted treatment.
Castellanos said survival for people like her depends on whether “a healthcare system recogniz[es] our humanity,” whether a government considers their lives worth protecting, and whether the world is willing to pay the cost of keeping them alive. Entering health systems not built with people like her in mind, she said, raises basic and constant questions: “Will my name be respected? Will my body be judged? Will I be humiliated? Will I be safe? Will I receive care at all?”
She also challenged the narrative that declining reing crisis is the result of deliberate political decisions
“This was not an earthquake or a natural disaster,” she said. “The funding was cut.” She said the United States’ decision to withdraw significant support for global HIV programmes, together with the failure of other wealthy donor governments to fill the gap, has had immediate consequences for communities around the world. According to Castellanos, those decisions translate into clinics closing, outreach workers losing their jobs and life-saving medicines becoming unavailable for the people who need them most.
She warned that shrinking budgets disproportionately affect communities already facing discrimination, including transgender people, sex workers, gay and bisexual men, people who use drugs, migrants, women and girls. She said that when funding disappears, services for trans people, sex workers, gay and bisexual men, people who use drugs, migrants, other criminalized communities, and women and girls are effectively treated as expendable.
“I am alive today because of science, because of activism and a community that came together,” she said. “People like me have survived because communities organised, because we organised care for one another, because we challenged governments and refused to disappear.”
She credited organisations such as UNAIDS, the International AIDS Society and the Global Fund with helping ensure that people living with HIV continue to receive treatment and support. However, she argued that people living with HIV must have a seat at the table where funding and policy decisions are made, not simply be informed of them afterward.
“Fund the response like lives depend on it, because they do,” she said. “People living with HIV are not a line item in a report. We are the ones holding this response together, while decisions are made far from their consequences.”
“If governments choose not to act, they should at least have the courage to call that choice what it is – a decision about whose lives they think are expendable,” said Castellanos.
