Global funding for HIV programmes has recorded its largest single-year decline since international scale-up efforts began, raising urgent concerns over the future of HIV treatment and prevention, according to new reports released by the Joint United Nations Programme on HIV/AIDS (UNAIDS).
The reports, unveiled on Monday at the 26th International AIDS Conference (AIDS 2026) in Rio de Janeiro, show that international donor funding fell by 25 per cent in 2025—marking the sharpest annual decrease since global HIV financing began expanding.
UNAIDS and KFF, an independent US-based health policy research organisation, attributed the decline almost entirely to a sharp reduction in financial support from the United States, following funding delays and the cancellation of several global health programmes. The conference, organised by the International AIDS Society (IAS) and running from 27 to 31 July, has convened roughly 7,000 scientists, policymakers, healthcare providers, donors and advocates to chart the future of the global HIV response.
Domestic spending rises
Despite the drop in external support, UNAIDS reported that many countries have increased domestic spending on HIV programmes. Domestic HIV financing rose by four per cent in 2025 and now accounts for nearly 60 per cent of total global funding. More than 55 low- and middle-income countries have committed to further increasing domestic HIV investments in 2026.
However, UNAIDS warned that domestic funding alone cannot replace the scale of international assistance that has sustained vital treatment, prevention and community programmes for decades.
UNAIDS Executive Director Winnie Byanyima stated that countries can no longer depend solely on international aid, while stressing that lower-income nations require greater fiscal space to finance health.
“Countries cannot wait, and they cannot go backwards,” Ms Byanyima said. “The world must urgently fix the broken global financial system and accelerate debt restructuring so governments can invest in what matters most.”
Global targets slipping
The reports found that an estimated 1.2 million people acquired HIV in 2025, while 570,000 died from AIDS-related illnesses, indicating the world remains off track to end AIDS as a public health threat by 2030.
UNAIDS noted that new HIV infections increased in three regions and 21 countries in 2025. It also found that roughly nine million of the estimated 41 million people living with HIV were not receiving treatment. In contrast, nearly half of all children living with HIV lacked access to life-saving antiretroviral therapy.
While countries including Kenya, Lesotho, Rwanda, Zimbabwe and Eswatini have continued to make progress toward the 2030 targets, new HIV infections have risen in countries such as Brazil, Pakistan, the Philippines and Madagascar. Collectively, these reports suggest the global HIV response is facing its most severe financial strain in more than two decades.
Africa faces difficult transition
The warning comes at a critical juncture for many African countries, which remain heavily dependent on donor-funded programmes. According to UNAIDS, sub-Saharan Africa continues to bear the world’s highest HIV burden, with approximately two-thirds of all people living with HIV residing in the region.
Although several countries have increased domestic health spending, many remain reliant on international partners to finance HIV medicines, laboratory services, community outreach and prevention programmes. Earlier this year, several African nations reported disruptions to HIV services following reductions in US-funded programmes, prompting governments to seek emergency financing while exploring long-term domestic alternatives.
PREMIUM TIMES has previously reported how reductions in donor support have impacted HIV services in Nigeria. Investigations revealed that funding gaps disrupted community-based treatment and support programmes, raising concerns regarding treatment continuity for people living with HIV.
In response, the Nigerian government has intensified efforts to strengthen domestic financing. In June, it unveiled the National HIV and AIDS Strategic Plan (NSP) 2026–2030, a roadmap aimed at transitioning from donor-dependent interventions to a government-led, domestically financed response.
Calls for renewed commitment
Speaking at the conference, IAS President and AIDS 2026 International Co-Chair Beatriz Grinsztejn described the funding decline as an unprecedented threat to global progress.
“We come to Rio de Janeiro at a moment of real danger for the HIV response,” she said. “Never has donor funding fallen so far, so fast, and those most vulnerable are already paying the price.”
Ms Grinsztejn noted that while donor countries are withdrawing support, many high-burden nations remain shackled by debt. “We must rethink outdated models, rebuild what has been broken, and rise to ensure the response gets the resources it needs,” she added.
South Africa’s Deputy Minister of Health, Mathume Joseph, said African governments must continue increasing domestic investment while maintaining strong international partnerships. “At the same time, no country can replace the scale of international partnership that has driven the global HIV response for decades,” he said.
World Health Organisation (WHO) Director-General Tedros Ghebreyesus warned that although HIV infections and AIDS-related deaths are at their lowest levels in more than 30 years, those gains remain fragile without sustained political commitment. He emphasised that ending AIDS by 2030 remains achievable but requires consistent investment in prevention, testing and care.
“The challenge now is to sustain the commitment, investment and solidarity needed to reach every person who needs prevention, testing, treatment and care, and to finish the job,” he said.
