‘Donor countries are choosing to walk away while many high-burden countries remain shackled by debt they cannot escape,’ says Beatriz Grinsztejn, IAS president and AIDS 2026 international co-chair
.AIDS 2026 | Rio de Janeiro.
A steep decline in government support has put HIV prevention and services under more strain than at any point in nearly a quarter century and threatens to stall or even reverse decades of progress, according to analysis released by UNAIDS at AIDS 2026, the 26th International AIDS Conference in Rio de Janeiro, Brazil. The first report, conducted by UNAIDS and KFF, concluded that a 25% decline in U.S. donations marks the largest single-year drop since international funding began scaling up in 2002. A companion report by UNAIDS found that many countries, including resource-poor nations, have tried to offset that funding shortfall, with more than 55 countries declaring that they would boost domestic HIV investments in 2026.
The analysis determined that, while HIV cases and AIDS-related deaths have steadily declined over three decades, funding and service cuts have exacerbated inequalities worldwide and threaten the 2030 goal of ending AIDS as a public health threat.
The analysis found that global HIV targets are not being met. In 2025, there were 1.2 million new HIV acquisitions and more than half a million people (570,000) died from AIDS-related illnesses; new HIV acquisitions have been rising in 21 countries, including Pakistan, the Philippines, Madagascar and—paradoxically—the conference’s host country, Brazil. Other countries, including Kenya, Lesotho, Rwanda, Zimbabwe and Eswatini, are making progress toward the 2030 target despite international funding shortfalls, researchers found. Around nine million of the 41 million people living with HIV were not on treatment and only half of all children living with HIV worldwide had access to antiretroviral therapy in 2025.
Government contributions to the global fight against HIV declined by $1.5 billion, or 18%, from 2024 to 2025, from 1.5 billion, and is now at the lowest level in nearly two decades. In some countries, funding for condoms has been nearly eliminated. A swath of countries were dealt deep cuts in community-led services, including prevention services for men who have sex with men, for sex workers and for survivors of gender-based violence.
It’s not only the reduction in funding from the U.S., although the restrictions on PEPFAR have taken a toll, development assistance (ODA) from multiple countries fell by nearly a quarter in 2025, hitting global health and HIV programs hard, especially in lower-income countries in Africa, which are more than 90% dependent on ODA for HIV services.
At a press briefing ahead of the opening session of AIDS 2026, global health leaders called on donor governments to re-commit to funding HIV response, while encouraging low- and middle-income countries to continue filling in the gaps whenever possible.
“We come to Rio de Janeiro at a moment of real danger for the HIV response,” Beatriz Grinsztejn, IAS president and AIDS 2026 international co-chair, said, at a press event prior to the opening of the conference. “Never has donor funding fallen so far, so fast, and those most vulnerable are already paying the price. Donor countries are choosing to walk away while many high-burden countries remain shackled by debt they cannot escape. We must rethink outdated models, rebuild what has been broken and rise to ensure the response gets the resources it needs.”
“Ending new infections is no longer simply an aspiration—it's scientifically achievable,” said Winnie Byanyima, executive director of UNAIDS.
“But scientific breakthroughs alone will not end AIDS,” she continued. “Innovation without access… is injustice. Today, medicines remain out of reach for most of the people who need them. UNAIDS estimates that approximately 20 million people will need access to long-acting prevention if these breakthroughs are to change the course of the epidemic. That means affordable prices, rapid voluntary licensing, generic competition, regional manufacturing, technology transfer, fast introduction into national health programs. The innovation is no longer limited by science. The scientists have done their part. It's limited by inequality. Science has done its job. Now politics must do its job.”
The report, she added, “tells two stories … one of extraordinary scientific progress,” and the other a warning. “Funding cuts, rising inequality, attacks on human rights, shrinking civic space. Together, they are putting decades of progress at risk.”
Erika Castellanos, executive director of Global Action for Trans Equality (GATE), slammed the Trump administration for cutting funding, saying those hurt most would be trans people and other marginalized communities. “The United States made a political decision to withdraw,” she said. “Other wealthy donor governments made political decisions not to step forward. These decisions have consequences: a clinic closing, an outreach worker losing their job and life-saving medicine become unavailable. By telling communities to be resilient, what is really being asked is that we survive abandonment when funding disappears.Services for trans people, for sex workers, gay and bisexual men, people who use drugs, migrants and other criminalized communities, and women and young girls, are treated as expendable.”
“Survival is determined by a healthcare system recognizing our humanity, a government considering our lives worth protecting and a world that is willing to pay the cost of keeping us alive,” she said. “I know what it means to enter systems that were never designed for people like me in mind. Will my name be respected? Will my body be judged? Will I be humiliated? Will I be safe? Will I receive care at all?”
Later, responding to a reporter’s question, Castellanos said her group spends most of its time fighting what she called the “anti-gender movement.” She added, “I don’t want anyone to go with the perception that the anti-rights and anti-gender movement is about trans people alone. It is not. It’s about sexual and reproductive health and rights of women, of children, of men, of everyone. It is a consistent, organized dismantling of the health infrastructure that we have had over the years.”
Mariângela Simão, secretary of health and environmental surveillance at Brazil’s Ministry of Health, also discussed the role of politics in funding cuts. “We’re living in an increasingly conservative world … and we are seeing that conservative waves tend to criminalize or tend to punish people that are different or to create problems for access to the treatment people deserve,” she said. Healthcare must be recognized as a human right, as it is in Brazil, she said.
Mathume Joseph Phaahla, South Africa’s deputy Mminister of health, shared the ways his country has responded to fill the gaps left by the withdrawal of international aid.
“Our government has been strengthening domestic investment, protecting the gains of the last two decades and prioritizing the interventions that do the most in terms of reducing new infections and mortality,” he said. “With the support of partners, the Global Fund, UNAIDS and the Children’s Investment Fund, we launched the rollout of the new Ghana Capital as an additional platform. That domestic financing now accounts [for] close to 60% of total funding across the response reflects a shift that African governments are actively driving, not just because of the fact that being caused by the current circumstances, but very consciously so.”
He emphasized, however, that the HIV/AIDS response must be a collaboration between domestic and international partners. “Financing can grow and must grow, but we have to be honest to say that no African finance ministry can fully replace overnight the scale, the predictability, and the technical [leadership] that international partnership has provided over two decades.”
“The question is no longer whether we know how to end HIV and a public health threat; we do,” said Jarbas Barbosa, director of the Pan American Health Organization (PAHO) and WHO regional director for the Americas. “The question is whether we commit to finish the job. We must ensure they reach everyone who needs help. This requires sustained political commitment, investment, partnership, stronger health system, and action to eliminate stigma and discrimination.”
Conference attendees noted that the host, Brazil, which played a key role in clinical trials that helped bring long-acting lenacapavir to market, was not included among the countries authorized to manufacture lower-cost generic versions of the medication through an agreement with lenacapavir’s maker, Gilead Sciences.
“For decades, Brazil has made bold political choices,” said Alexandre Padilha, Brazil’s minister of health.
“As one of the first countries to provide free HIV treatment to all who needed it, we have demonstrated that a public health response grounded in science, universal access and human rights can save lives,” he added. “Now, we must work together to ensure that innovation and equitable access reach every community. Innovation without access is not an innovation. It is an injustice.”
During the press conference, a reporter noted that Brazil has formed a committee to negotiate with various companies for lower drug prices, and asked if that means a loss of solidarity among countries. But Simão said that if Brazil succeeds, it will set a precedent for other countries.
UNAIDS estimates that 20 million people need access to antiretroviral-based prevention if the world is to significantly reduce new HIV acquisitions.
Justice is essential to the HIV/AIDS response
Not only has the drop in international funding imperiled the HIV response, reversals on human rights are also a threat, according to the report. For the first time since UNAIDS began tracking human rights trends, it found that criminalization of marginalized populations increased in 2025, including Burkina Faso and Niger, which made same-sex sexual activity illegal, and Senegal, which increased penalties for same-sex sexual activity. According to the report, as of 2025,168 countries criminalized sex work, 66 countries criminalized same sex sexual relations and 14 countries had laws discriminating against transgender people.
These punitive policies are not only unjust, but also bad public health, Byanyima said. “When people fear arrest, violence, discrimination or stigma, they avoid health services. HIV spreads when rights are denied. Human rights are not separate from the HIV response. Theyare essential to its success.”
Byanyima noted that, despite the backsliding on human rights in many places, 149 Member States recently adopted a progressive Political Declaration on HIV and AIDS aligned with the UNAIDS Global AIDS Strategy 2026–2031 and its 2030 targets, which include:
• 40 million people on treatment
• 20 million with access to antiretroviral-based prevention
• less than 10% of people living with or at risk of HIV experiencing stigma and discrimination
• less than 10% of women and girls and people living with or at risk of HIV
• less than 10% of countries having policies that deny or limit access to HIV services.
Byanyima said meeting these goals would prevent an additional 3.2 million new HIV acquisitions and 1.3 million AIDS-related deaths by 2030. She concluded by urging all partners and governments to continue mobilizing to achieve the ambitious targets in the Political Declaration. “This will require renewed solidarity, sustained financing and unwavering commitment to human rights,” she said.