Tag: HIV prevention

Categories : HIVTags :

HIV Funding Still Falls Short of Targets After Pledges: What’s at Stake

On By ModernMedia
Photo by Miguel Á. Padriñán

Melanie Bisnauth, University of the Witwatersrand

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.

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.

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.

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.

Melanie Bisnauth, Doctoral Researcher, School of Public Health and Public Health Technical Advisor, Anova Health Institute, University of the Witwatersrand

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Categories : Expert Opinion HIVTags :

Salim Abdool Karim | Transforming Adversity Into Opportunity for the AIDS Response

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Epidemiologist Professor Salim Abdool Karim is internationally recognised for his significant contributions to research on HIV treatment and prevention. (Photo: Supplied)

By Salim Abdool Karim

As World AIDS Day 2025 swings by, CAPRISA Director Professor Salim Abdool Karim reflects on the frantic days following this year’s unprecedented cuts to health aid and research funding from the US, arguing that the deliberate disruptiveness was designed to be cruel. Nonetheless, he argues, our HIV response must now forge ahead on a path that is more affordable, sustainable and independent.

STOP WORK!

A “STOP WORK” order is immediate.

The Centre for the AIDS Programme of Research in South Africa (CAPRISA) received its first US government “STOP WORK” order from the US Agency for International Development (USAID) on 27 January 2025, imposing a 90-day suspension on a major HIV prevention research project.

A week earlier, on 20 January 2025, incoming US President Donald Trump signed an Executive Order imposing a 90-day freeze on USAID funding. Shortly thereafter, Elon Musk and his Department of Government Efficiency arrived at the USAID headquarters to systematically dismantle it and terminate most of its projects. Within 7 days, the full effect of Trump’s decision was reverberating across the world. The acute US funding cuts disrupted its foreign aid programmes that had for years worked to improve the lives of the most vulnerable communities across the globe.

The impact was instantaneous. Several US-funded projects ground to a halt. Feeding programmes for the hungry, shelter projects for those displaced by war and conflict, daycare for abandoned children and many other programmes in dozens of countries around the world were stopped. The swiftness of the implementation of the USAID dismantling caught the world off-guard.

On 3 February, Secretary of State, Marco Rubio, declared himself to be the new head of USAID, giving Musk carte blanche to destroy it. That day, I was contacted by journalists from The New York Times and from the prestigious magazine Science for information on the impact of US funding cuts on our HIV research.

On 7 February, the New York Times front page headline, “Clinical Trials Left in Lurch By Aid Freeze” informed the world of the impact of the US funding cuts on AIDS research in Africa. It described in graphic detail the impact of the funding cuts on research Dr Leila Mansoor and Dr Disebo Potloane of CAPRISA were undertaking in partnership with world-leading US scientist Dr Sharon Hillier, in developing new HIV prevention technologies for women.

Exactly a month after the initial 90-day “STOP WORK” order, we were notified that this US government funded project had been officially terminated for good. Several other large US-funded projects in South Africa, such as an HIV-vaccine development project led by Professor Glenda Gray, also received termination notices.

While the US government is perfectly entitled – as it sees fit – to stop funding for any of its projects, the deliberate disruptiveness of its implementation was sadly designed to be cruel. Musk relished his destruction of USAID with a chainsaw performance on stage at the Conservative Political Action Conference on 21 February. Ironically, the chainsaw, which he had just received as a gift from Argentine President Javier Milei, was engraved with the phrase “Viva la libertad, carajo”, which is Spanish for “Long live liberty, damn it.”

‘Disownment of science’

The Trump administration effectively dislocated the highly effective partnerships forged by the US and South African scientific communities over the past three decades. It was not simply a withdrawal of funding, but the disownment of science that rocked these research collaborations. A devaluing of science and an era of disinformation set in.

False information from the Trump administration is now rife, from debunked theories regarding autism from vaccines to the supposed dangers of paracetamol during pregnancy to the fictitious “white genocide” in South Africa or “Christian genocide” in Nigeria. This is a threat to democracy and to the decades of progress made in the AIDS pandemic.

Science, in its search for the truth, is under attack, as disinformation-based policies become official.

No time to wallow

Following the initial shock, we realised that we had zero time to wallow in this grief of sorts. CAPRISA went to work mobilising our own resources, reaching out to participants in terminated studies to offer them medical and emotional support. In March and April, our scientists routinely worked late into the night on new grant applications to research funders besides the US government. That hard work is now beginning to bear fruit as new grants begin to fill the gaps in our research funding.

These unprecedented disruptive funding cuts have been a stark reminder to never take donor funding for granted. And certainly, never to be as heavily reliant on a single donor again. While overseas development aid is intended to be altruistic, it has often come with strings attached. Those strings were a rude awakening in 2025 and has left several governments and non-governmental organisations, who were dependent on US foreign aid, in the lurch.

Scientific breakthroughs in HIV, including those by South Africa’s many highly accomplished AIDS researchers, have had widespread global impact benefitting vulnerable groups from all walks of life. Ironically, the funding cuts comes at a time when even greater resources are needed for research to successfully navigate the “last mile” on the way to the Sustainable Development Goal of ending AIDS by 2030.

As this year’s World AIDS Day theme, “Overcoming disruption, transforming the AIDS response” reminds us, this is the time to forge ahead on a path that transforms the response to one that is more affordable, sustainable and independent. As African scientists, we have already begun to take bold steps on the path to greater independence, thereby shifting our focus away from the disruption towards charting a determined path to a world without AIDS.

*Abdool Karim is the Director of CAPRISA and Pro Vice-Chancellor (Research) at the University of KwaZulu-Natal in Durban.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

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Categories : Healthcare Politics and RegulationsTags :

Global Fund to Cut R1.4-Billion to SA for HIV, TB and Malaria

On By ModernMedia
Photo by Reynaldo #brigworkz Brigantty

By Liezl Human

The Global Fund to Fight AIDS, TB and malaria (Global Fund) has notified Health Minister Aaron Motsoaledi that it will reduce funding to South Africa by R1.4-billion.

Global Fund said it would be reducing allocations for the seventh grant cycle from R8.5-billion to about R7.1-billion, a 16% reduction. Of this, 55% would be allocated to the National Department of Health and the rest to non-profit organisations such as the Networking HIV & AIDS Community of Southern Africa, Beyond Zero, and the AIDS Foundation of South Africa.

The fund informed recipient countries in May that it would be revising over 200 grants amidst funding shortfalls.

Global Fund was established in 2002 and provides funding for HIV, TB and malaria programmes in over 100 countries. According to its 2024 results report, 72% of its funding from 2021 to 2024 went to sub-Saharan Africa.

Other African countries also received notification of funding cuts. Mozambique’s allocation decreased by 12%, Malawi’s by 8% and Zimbabwe by 11%.

The shortfall in funding is due to Global Fund not having received money pledged by national governments. Over US$4 billion of the shortfall is due to the United States not fulfilling its pledge.

We reported last month how Mozambique’s health system has crumbled amidst USAID funding cuts.

In South Africa, funding cuts from PEPFAR earlier this year have led to clinics closing down, health staff getting retrenched, and people struggling to access HIV medication.

“As you know, the external financing landscape for global health programs is going through significant changes, with substantial impact on lifesaving services for the fight against the three diseases and health and community systems,” the Global Fund said in its letter to South African representatives.

The letter continued that while the Global Fund has “received some significant donor payments in recent days”, prospects to give the full grant cycle 7 (GC7) pledges “remain highly uncertain” and still face a risk of funding shortfalls.

“This is a difficult and unavoidable decision, which may require your country to reconsider how best to use the remaining GC7 grant amounts together with domestic resources and other sources of funds to keep saving lives,” the Global Fund said.

Foster Mohale, Department of Health spokesperson, said that the funding cut did not come as a surprise. Mohale said the department is “working with the provinces” to ensure that “service delivery” is not disrupted, and to apply measures to ensure “efficient use of limited resources”.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : Ageing HIVTags :

Older Adults are Getting Infected with HIV, but Prevention Focuses on Young People

On By ModernMedia

Prevention and treatment campaigns are not adequately targeting the particular needs of the 50+ years age group.

Photo by Sergey Mikheev on Unsplash

Indeed, between 2000 and 2016, the number of adults aged 50 years and older living with HIV in sub-Saharan Africa doubled. At present, their HIV prevalence is exceeding that of younger adults.

By 2040, one-quarter of people living with HIV in Africa will be aged 50 years and older; tailored awareness and treatment campaigns are pressing.

Dr Luicer Olubayo, a researcher at the Sydney Brenner Institute for Molecular Bioscience (SBIMB) at Wits University and the first author of a study published in The Lancet Healthy Longevity journal, which investigated HIV in older people in Kenya and South Africa, noted that perceptions on who acquires HIV are limited. “We often think of HIV as a disease of younger people. It doesn’t help that intervention campaigns are mainly targeted at the youth.”

Moreover, older adults are less likely to believe that they can get HIV. This misconception is pervasive and has consequences for reaching global targets to achieve UNAIDS’ 95-95-95 targets by 2030 (95% of people living with HIV know their status, 95% of people who know their status are on treatment, and 95% have a suppressed viral load).

“While HIV prevalence among individuals over 50 years of age is similar to or even exceeds that of younger adults, HIV surveys focus on younger individuals, leaving considerable gaps in understanding HIV prevalence, incidence and treatment outcomes in older populations,” says Associate Professor F. Xavier Gómez-Olivé, at the MRC/Wits-Agincourt Research Unit.

Stigma remains a barrier to treatment

The uptake of HIV testing among older adults is poor, which delays diagnosis and limits access to care. This is, indeed, one of the signifiers of the pervasiveness of stigma surrounding the disease.

“We know that there is significant social stigma related to HIV infection. This is why understanding HIV-related stigma in older adults remains crucial as a way to inform interventions to support older people’s mental health and overall well-being,” says Olubayo.

Interventions could focus on repeated testing, the use of pre-exposure prophylaxis (PrEP), and campaigns to increase awareness and reduce infections among the elderly.  

“HIV can be managed alongside other chronic conditions, too, since HIV is managed as a long-term illness,” says Gómez-Olivé.

Non-communicable diseases, such as hypertension, diabetes, and obesity, have dramatically increased in sub-Saharan Africa, particularly among older people. HIV treatment and intervention can be included in the healthcare ecosystem of long-term illnesses.

Apart from stigma, a complex interplay of factors shapes HIV risk

The study shows that age, education, gender, and where people live all affect their risk of HIV. Even though more people now have access to HIV treatment, older adults—especially in rural areas—still face significant challenges in preventing HIV, such as low education levels and gender inequality.

Widowed women had the highest HIV rate (30.8%). This may be due to losing a partner to HIV, stigma, and a greater risk of unsafe behaviours like transactional sex and limited power to negotiate condom use. People without formal education and those with low income also had higher rates of HIV infection.

The benefit of longitudinal data to make decisions

 An important added value of this study is the provision of longitudinal insights into the HIV epidemic among older adults in sub-Saharan Africa. “Our study is beneficial in that older populations are under-represented, and not much is known about them over time. What changes are occurring? We have to answer these kinds of questions. With longitudinal data, we can look at the effectiveness of antiretroviral therapy coverage in older people,” says Gómez-Olivé.

The study used data collected in urban Kenya and in urban and rural sites across South Africa during two data collection waves: 2013-2016 and 2019-2022.  

Throughout a decade of research, the team has been gaining a deeper understanding of this ageing HIV epidemic. Numerous important insights about HIV in older populations have been achieved, and research gaps are being covered.

Data for the study were drawn from the Africa Wits-INDEPTH Partnership for Genomic Research (AWI-Gen) from adults aged 40 years and older. AWI-Gen is a multicentre, longitudinal cohort study conducted at six research centres in four sub-Saharan African countries (South Africa, Kenya, Burkina Faso, and Ghana) to investigate various health determinants.

Source: University of the Witwatersrand