HIV Funding Still Falls Short Of Targets After Pledges: What's At Stake

(MENAFN- The Conversation) The US government paused all foreign assistance in January 2025. This abrupt decision affected the delivery of life-saving HIV medicines and the provision of HIV prevention services to millions of people. A UNAIDS report estimates there could be an additional 6 million new HIV infections and 4 million Aids-related deaths by 2029 if the world does not act.

In November 2025, a global health initiative, The Global Fund, raised US$11.34 billion for HIV/Aids, tuberculosis and malaria. Melanie Bisnauth, a public health professional in healthcare systems strengthening and HIV/Aids leadership, discusses how far this latest funding could go and how African nations can tackle the dwindling funding for HIV/Aids control.

What is the funding status for HIV/Aids?

Raising US$11.34 billion is significant but it falls short of the US$18 billion target. The Global Fund is trying to raise US$18 billion for its work from 2027 to 2029. The Global Fund is a worldwide partnership to end the epidemic of HIV/Aids, tuberculosis and malaria and ensure a healthier, safer and more equitable future for all.

It is only a partial response to the global funding gaps.

The US pledged US$4.6 billion to the Global Fund during the fund's summit in November 2025, on the side of the G20 meeting in South Africa. It was a reduction from its previous pledge of US$6 billion to support prevention, treatment, care and related services for the three diseases. But it is also an indication that the US has not abandoned all multilateral global health efforts. It remains the largest single contribution to the Global Fund 2027 to 2029 cycle.

The shortfall may strain existing programmes and delay expansion of life-saving interventions for HIV/Aids, tuberculosis and malaria.

HIV remains a major global public health issue, having claimed an estimated 44.1 million lives to date. An estimated 40.8 million people were living with HIV at the end of 2024, 65% of whom are in the WHO African region.

Job losses could create inefficiencies or service reductions. Building a sustainable HIV response and meeting key goals was already challenging before the sharp funding decline in 2025. Over 11 million people had unsuppressed viral loads in 2024.

Overall, while the funds raised demonstrate continued global solidarity, they are insufficient to fully compensate for the US withdrawal and broader declines in donor support.

There are potentially long-term consequences. Reduced funding and service disruptions threaten to reverse years of progress. Infections could rise, especially in communities where viral suppression was already low. Lack of service delivery and supply of treatment will weaken trust in health systems and can lead to treatment interruptions, drug resistance and poorer health outcomes.

As the Global Fund's executive director said at the Replenishment Summit,“the old model” of development funding is over. This model is the heavy reliance on international funding like USAID and other donor organisations.

It's essential for countries to become more self-reliant. But the statement warned that too abrupt a transition could be dangerous.

I fear that the COVID-19 pandemic has already taken a toll on the quality of care provided. Healthcare systems are already overburdened.

National governments have to step up and locally support their healthcare systems, collaborate and build together, and strengthen their health funding structures.

Read more: US funding cuts have crippled our HIV work – what's being lost

What should the response be for better HIV funding in Africa?

Africa's HIV response should be multi-pronged.

After attending the Africa Summit in Geneva in May 2025, stakeholders, country representatives, donor agencies and NGOs expressed a key message: those involved in the sector should not reinvent the entire wheel. There is value in the knowledge gained from programming, technical expertise, data insights, partnerships, communities and global health networks should be used to strengthen, adapt and scale what already works.

This will ensure that Africa's HIV response remains community-centred, evidence-driven, and resilient in the face of emerging challenges.

The global health climate has changed and communities have lost trust because of severely disrupted or even completely cut programmes. African governments must allocate their own resources for HIV programmes, through budget prioritisation, health insurance schemes, and innovative financing such as public-private partnerships. Improvements, such as integrating HIV services into primary care, using data-driven targeting, and negotiating lower drug costs can maximise impact.

Strengthening regional collaborations and pooled procurement through organisations like the African Union or regional health bodies can improve bargaining power and reduce dependency on external aid. A balanced mix of donor support, domestic financing and operational efficiency is essential to maintain gains and expand access to treatment for all in need.

It is important not to rely solely on international support or one funding body. Diversifying funding portfolios is critical.

Read more: Pepfar funding to fight HIV/Aids has saved 26 million lives since 2003: how cutting it will hurt Africa

What effects has the withdrawal of US funds had?

Reduced US contributions led to immediate financial shortfalls, threatening ongoing HIV prevention and treatment programmes.

For example, some clinic supply and services faced disruption in delivery and supply of antiretroviral therapy, and stock-outs of treatment and malaria nets.

The world is still likely to feel the impact in the coming months. For example:

• Progress towards epidemic control could slow, potentially increasing illness and death.

• Programmes that relied heavily on US support have already scaled back services or will do so.

• Funding uncertainty remains a major concern. Governments will have to reallocate limited domestic resources or seek alternative donors.

• Global health co-ordination, technical assistance and advocacy efforts may be weakened. In the past these supported robust HIV responses in Africa in progress toward the UNAIDS targets.

• Reliance on fragmented funding streams will increase.

Read more: HIV is on the rise among older Africans, but care and research overlook this group – lessons from Kenya and South Africa

How can African countries better fund their HIV programmes?

They can take steps that involve a mix of domestic revenue generation, efficiency gains and strategic partnerships:

• diversify funding through raising domestic revenue, such as earmarked taxes

• expand the reach of social health insurance coverage

• leverage corporate investment and innovation through public-private partnerships

• negotiate pooled procurement of drugs and diagnostics regionally to reduce costs

• involve communities in decision making, which will help strengthen sustainability

• integrate HIV programmes into broader health systems – it improves efficiency, reducing duplication and operational costs.

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