HIV Gains Are At Risk as Countries Face New Pressure to Fund Response

The global HIV response is entering a decisive phase as the United Nations prepares for renewed commitments on ending AIDS as a public health threat by 2030. While treatment expansion has sharply reduced AIDS-related deaths and new infections since 2010, widening financing gaps, unequal access, prevention shortfalls and human rights setbacks now threaten to slow or reverse gains.

The United Nations has laid out a renewed global agenda for ending AIDS as a public health threat by 2030. According to the United Nations Secretary-General's latest report on HIV/AIDS, the world has made measurable progress against the Human Immunodeficiency Virus (HIV), with 31.6 million of the 40.8 million people living with HIV receiving antiretroviral therapy in 2024. The expansion helped reduce AIDS-related deaths to their lowest level since the early 1990s. New HIV infections fell by 40% between 2010 and 2024, while AIDS-related deaths declined by 54%.

However, the data show that the response remains far from the 2025 targets. At the end of 2024, 9.2 million people still could not access HIV treatment. There were 630,000 AIDS-related deaths, about twice the 2025 target, and 1.3 million people acquired HIV, around 3.5 times the target. The 2030 goal remains possible, but the margin for delay is narrowing.

The financing model is under pressure

The report cites projections that international aid for health from several major donors could fall by up to 40% in 2025 compared with 2023. This is concerning because many HIV programmes, especially prevention and community-led services, depend heavily on external support. In parts of Africa, the Caribbean and the Middle East and North Africa, prevention services are heavily reliant on international financing. If funding falls faster than domestic systems can absorb the cost, treatment continuity, testing, prevention and community outreach could suffer.

The new strategy estimates that low- and middle-income countries will need $21.9 billion annually for HIV investments by 2030. It calls for a larger domestic share, with low-income countries funding about a third of their HIV responses, lower-middle-income countries about two thirds, and upper-middle-income countries almost all of theirs. The approach may strengthen national ownership, but it could strain countries already facing debt burdens, conflict pressures and competing health priorities.

Global progress masks regional and social gaps

Sub-Saharan Africa (SSA) recorded a 56% fall in new HIV infections between 2010 and 2024, showing what sustained treatment, prevention and political commitment can achieve. However, infections surged by 94% in MENA, 13% in Latin America, and 7% in Eastern Europe and Central Asia.

The gaps are also visible across populations. More than 620,000 children living with HIV were not receiving antiretroviral therapy in 2024. Children accounted for only 3% of people living with HIV but about 12% of AIDS-related deaths. Adolescent girls and young women also remain highly exposed. In 2024, 4,000 girls and young women aged 15 to 24 acquired HIV every week, including 3,300 in SSA.

Key populations and their sexual partners remain crucial to prevention challenges. They accounted for an estimated 74% of new infections outside SSA and about 26% in SSA. The report links these risks to stigma, discrimination, punitive laws, gender inequality and violence, all of which can limit access to testing, prevention and treatment.

Governments, donors and communities carry the next burden

Member states must decide whether to adopt the proposed 2030 targets, increase domestic financing, integrate HIV services into broader health systems, and reform laws or policies that restrict access to care. UNAIDS remains important for target-setting, data, accountability and country support. But its own future is under review. The report notes that the Secretary-General has proposed, under the UN80 Initiative, a sunset process for UNAIDS in 2026 and the mainstreaming of its capacities into the wider UN development system. A working group is expected to provide an interim report by June 2026 and a finalized plan by October 2026.

International donors, including the Global Fund and the United States, remain critical because many countries still rely on external financing. National health and finance ministries will have to turn political pledges into budgets, procurement systems, insurance coverage and service delivery.

Community-led organizations are also key stakeholders. They often reach people whom formal health systems miss, including key populations, migrants, refugees and people facing stigma. The strategy's success will depend partly on whether these groups are funded and protected during the transition to more domestic financing.

The hardest choices sit at the intersection of money and rights

Ending AIDS as a public health threat requires sustained investment at a time when aid is uncertain and national budgets are under pressure. Countries may benefit from stronger domestic systems and better integration of HIV into primary healthcare, but poorly managed integration could weaken specialized services or reduce trust among groups already facing discrimination.

Politically, the strategy tests whether governments will treat HIV as a long-term public health priority rather than a fading crisis. Socially, it highlights how gender inequality, stigma and violence continue to shape infection risks and treatment access. Legally, it raises difficult questions about punitive laws affecting sex workers, gay men and other men who have sex with men, people who inject drugs, transgender people, people in prisons and people living with HIV.

The report notes that four countries introduced criminalization of same-sex relationships in 2025. Such laws can discourage people from seeking services and make prevention harder to deliver.

Innovation offers promise, but not a shortcut

Scientific advances could help accelerate prevention. Long-acting injectable PrEP, including lenacapavir, has created new momentum. The United States announced support for efforts by the Global Fund to provide long-acting PrEP to up to 2 million people in high-HIV-burden countries. Partnerships involving generic manufacturers also aim to reduce costs.

However, innovation alone will not close the gap. New tools must be affordable, available and delivered through trusted systems. If communities most at risk cannot access them, the public health impact will be limited.

The main uncertainty is whether financing, rights protections and service delivery can move fast enough together. Countries may increase domestic budgets, but it wouldn't fully compensate for international funding reductions.

What's next?

The first test will be the 2026 high-level meeting on HIV/AIDS and whether member states adopt strong, measurable 2030 commitments. Next will be financing: donor pledges, Global Fund resources, bilateral aid decisions and national budget allocations. Treatment continuity, prevention scale-up, access to long-acting PrEP and funding for community-led organizations are also key areas to watch.

The UNAIDS transition process will be another key signal, particularly the June 2026 interim report and October 2026 finalized plan. The next phase will show whether governments can preserve the gains of the past two decades while adapting to a tougher financing and political environment.