Global HIV gains at risk as funding crisis sparks urgent call to action
The 2025 Global Aids Update report titled Aids, Crisis and the Power to Transform, emphasises the urgent need for countries to implement radical changes in their HIV programming and funding strategies.
The report highlights the impact that the sudden, large-scale funding cuts from international donors are having on countries most affected by HIV. Yet, it also showcases some inspiring examples of resilience, with countries and communities stepping up in the face of adversity to protect the gains made and drive the HIV response forward.
Some 25 of the 60 low- and middle-income countries included in the report have indicated increases in domestic budgets for their HIV responses in 2026.
The estimated collective rise among the 25 countries amounts to 8% over current levels, translating to approximately US$180 million (over R3.193b) in additional domestic resources.
'This is promising, but not sufficient to replace the scale of international funding in countries that are heavily reliant,' the report says.
Global emergency
Although there was significant progress in the HIV response in 2024, UNAIDS reported that a weakening consensus on aid and substantial, sudden funding shortfalls in 2025 caused widespread disruptions in health systems.
These challenges led to cuts in frontline health workers, halted HIV prevention programmes, and jeopardised HIV treatment services.
According to data, in Mozambique alone, over 30 000 health personnel were affected. In Nigeria, pre-exposure prophylaxis (PrEP) initiation has plummeted from 40 000 to 6 000 people per month.
If United States-supported HIV treatment and prevention services collapse entirely, UNAIDS estimates that an additional six million new HIV infections and four million additional Aids-related deaths could occur between 2025 and 2029.
'This is not just a funding gap – it's a ticking time bomb.
'We have seen services vanish overnight. Health workers have been sent home, and people, especially children and key populations, are being pushed out of care,' said UNAIDS Executive Director Winnie Byanyima.
Even before the large-scale service disruptions, the reported data for 2024 shows that 9.2 million people living with HIV were still not accessing life-saving treatment services last year.
Among those were 620 000 children from birth to 14 years living with HIV but not on treatment, which contributed to 75 000 AIDS-related deaths among children in 2024.
In 2024, 630 000 people died from Aids-related causes, 61% of them in sub-Saharan Africa. Over 210 000 adolescent girls and young women, aged 15 to 24, acquired HIV in 2024 – an average of 570 new infections every day.
UNAIDS said HIV prevention services are severely disrupted, while community-led services, which are vital to reaching marginalised populations, are being defunded at alarming rates.
In early 2025, the organisation said over 60% of women-led HIV organisations surveyed had lost funding or were forced to suspend services.
The United States President's Emergency Plan for AIDS Relief (Pepfar) reached 2.3 million adolescent girls and young women with comprehensive HIV prevention services in 2024 and enabled 2.5 million people to use HIV PrEP – many of these programmes have now stopped completely.
'Meanwhile, the rise in punitive laws criminalising same-sex relationships, gender identity, and drug use is amplifying the crisis, making HIV services inaccessible,' UNAIDS said.
Beacon of hope
UNAIDS said South Africa currently funds 77% of its AIDS response, and its 2025 budget review includes a 5.9% annual increase in health expenditure over the next three years, including a 3.3% annual increase for HIV and tuberculosis programmes.
The South African government intends to finance the development of a patient information system, a centralised chronic medicine dispensing and distribution system, and a facility medicine stock surveillance system.
Meanwhile, as of December 2024, seven countries – Botswana, Eswatini, Lesotho, Namibia, Rwanda, Zambia, and Zimbabwe – had achieved the 95-95-95 targets: 95% of people living with HIV know their status, 95% of those are on treatment, and 95% of those on treatment are virally suppressed.
The report also highlights the emergence of unprecedented, highly effective new prevention tools like long-acting injectable PrEP, including lenacapavir, which has shown near-complete efficacy in clinical trials, though affordability and access remain key challenges.
Byanyima believes there is still time to transform this crisis into an opportunity.
'Countries are stepping up with domestic funding. Communities are showing what works. We now need global solidarity to match their courage and resilience.'
A call for solidarity
The 2025 Global AIDS Update ends with a call for the international community to unite in addressing the financing gap.
It urges support for countries to close the remaining gaps in HIV prevention and treatment services, eliminate legal and social barriers, and empower communities to take the lead moving forward.
UNAIDS emphasised that every dollar invested in the HIV response not only saves lives but also strengthens health systems and promotes broader development goals.
Since the start of the epidemic, 26.9 million deaths have been averted through treatment, and 4.4 million children have been protected from HIV infection through vertical transmission prevention.
'In a time of crisis, the world must choose transformation over retreat. Together, we can still end Aids as a public health threat by 2030 – if we act with urgency, unity, and unwavering commitment,' Byanyima said. – SAnews.gov.za
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