Reports warn sharp fall in donor support leaves countries struggling to sustain prevention and treatment efforts despite rising domestic investment
By Bunmi Yekini
International funding for the global HIV response fell by 25% in 2025, marking the steepest annual decline since major donor financing began more than two decades ago, according to reports released by UNAIDS and KFF at the International AIDS Conference on Monday.
The reports attributed the drop entirely to a sharp reduction in U.S. support, warning that the funding shortfall is jeopardising decades of gains against the epidemic and placing millions of lives at risk.
The findings were released as about 7,000 scientists, policymakers, healthcare providers, donors and advocates gathered in Rio de Janeiro for AIDS 2026, the 26th International AIDS Conference.
“We come to Rio de Janeiro at a moment of real danger for the HIV response,” International AIDS Society President Beatriz Grinsztejn said.
“Never has donor funding fallen so far, so fast, and those most vulnerable are already paying the price.”
The joint KFF-UNAIDS analysis said the funding decline was driven by delays and project cancellations linked to changes in U.S. global health assistance, resulting in the largest single-year fall in international HIV financing since donor scale-up began in 2002.
A separate UNAIDS report found that domestic HIV financing rose by 4% in 2025, accounting for nearly 60% of total HIV spending as governments sought to offset declining international support. More than 55 countries have pledged to increase domestic HIV investments in 2026.
Despite those efforts, the report estimated there were 1.2 million new HIV infections and 570,000 AIDS-related deaths worldwide in 2025, with the global response falling short of internationally agreed AIDS targets.
New HIV infections are increasing in several countries, including Brazil, Pakistan, the Philippines and Madagascar, while Kenya, Lesotho, Rwanda, Zimbabwe and Eswatini continued to make progress towards ending AIDS as a public health threat by 2030.
“The era of relying on international aid is over,” UNAIDS Executive Director Winnie Byanyima said.
“Countries cannot wait, and they cannot go backwards. The world must urgently fix the broken global financial system and accelerate debt restructuring so governments can invest in what matters most.”
South Africa’s Deputy Minister of Health Joe Phaahla said African countries needed to expand domestic financing while maintaining international partnerships.
“No country can replace the scale of international partnership that has driven the global HIV response for decades,” he said.
World Health Organization Director-General Tedros Adhanom Ghebreyesus said the world had made remarkable progress in reducing HIV infections and AIDS-related deaths, with both at their lowest levels in more than three decades.
“But that progress is fragile,” Tedros said. “We have the tools, the knowledge and the evidence to save lives and prevent new infections. The challenge now is to sustain the commitment, investment and solidarity needed to finish the job.”
Brazilian Health Minister Alexandre Padilha said hosting the first International AIDS Conference in South America underscored the importance of equitable access to HIV prevention and treatment.
“Innovation without access is not an innovation. It is an injustice,” he said.