Africa: Climate Change is Now an Immediate Threat to HIV Control

Rio de Janeiro, Brazil — Evidence is growing that the people most affected by HIV are also the most vulnerable to the effects of climate change.

Climate change is reshaping health systems and lives across the globe, but its impact on the HIV response has received far less attention than it deserves. Floods, droughts and displacement are fragmenting testing, counselling and prevention programmes, and damaging the infrastructure that keeps people in care. In regions such as sub-Saharan Africa, where poverty and structural inequality already drive a disproportionate share of the global HIV burden, these shocks risk pushing the most vulnerable further behind.

Although climate change does not alter how HIV behaves in the body, it is increasingly influencing who becomes infected with HIV, who remains in care and, ultimately, who survives. As extreme weather events become more frequent and severe, health experts warn that decades of progress against HIV could be undermined unless climate resilience becomes central to HIV programming.

For Abireham Misganaw, the Global Climate and Health Technical Lead at Pathfinder International, the convergence of the climate crisis and the HIV epidemic is no longer a future concern; it is already unfolding across many of the world’s most vulnerable communities.

“Climate change is increasingly disrupting the HIV response by damaging health systems, displacing communities, worsening food insecurity, and making it harder for people to reach services,” he said. “Evidence shows that extreme weather events can affect the full HIV care continuum, including testing, linkage to treatment, viral suppression and prevention services.

Misganaw said that climate-related disasters damage health facilities, disrupt transport networks, displace communities and worsen food insecurity, making it increasingly difficult for people living with HIV to access essential services. Missed clinic appointments, interrupted treatment and reduced access to prevention programmes can quickly reverse hard-won gains in HIV control.

Pathfinder has observed these risks firsthand in Mozambique, said Misganaw, where a succession of cyclones – Idai and Kenneth in 2019, Gombe in 2022, and Freddy in 2023 – damaged health facilities and disrupted community outreach and HIV service delivery in several provinces. The organisation worked alongside local health authorities to restore services by strengthening community health worker networks, integrating HIV care into primary healthcare and improving follow-up for vulnerable populations.

He said these experiences demonstrate why climate resilience should no longer be viewed as a separate environmental issue but must now be built into HIV programs.

Broken treatment

Extreme weather is also exposing long-standing weaknesses in health systems, particularly medicine supply chains. Floods, droughts and other extreme weather events don’t just close clinics. They interrupt antiretroviral therapy by damaging facilities, blocking transport routes, displacing patients and staff, and disrupting the supply chains that keep medicines flowing.

“The consequences include treatment interruption, poor adherence, disengagement from care, increased viral load, and a higher risk of AIDS-related illness and death,” said Dr Joram Sunguti Luke, a medical doctor and public health professional who works in HIV and AIDS & Sexual and Reproductive Health and Rights (SRHR), and is Senior Technical Advisor at Pathfinder International.

“These shocks also make it harder to reach people with prevention, counselling, and follow-up services at the very moment they may need them most,” he said.

According to Dr Sunguti, Pathfinder offers a strategic mix of behavioural, biomedical, and structural HIV prevention interventions tailored to local contexts and the needs of different populations. These populations include adolescent girls and young women, high-risk boys and young men, key populations, people in HIV serodiscordant relationships, and those within prison settings. Community-based approaches, including mobile clinics, peer navigators, community ART groups and home delivery of medicines, can significantly reduce treatment interruptions during climate emergencies.

Climate change is also exposing the fragility of medicine supply chains that millions of people living with HIV depend on.

Dr Sunguti said that climate change highlights the importance of climate-smart supply chains capable of maintaining medicine availability during floods, extreme heat and infrastructure failures. “The biggest supply chain weaknesses are weak forecasting and quantification, limited buffer stocks, fragmented procurement systems, poor last-mile delivery, inadequate storage, and low resilience to transport and power disruptions that affect the cold chain,” he said.

Climate shocks expose these vulnerabilities almost instantly, particularly where warehouses, roads and digital systems were never designed to withstand floods, storms or heat. The fixes are equally well understood: stronger logistics data systems, decentralised distribution, multi-month dispensing, emergency stock buffers, climate-resilient storage, and contingency plans tested well before a crisis hits.

To strengthen resilience, Dr Sunguti said countries need better logistics data systems, decentralised medicine distribution, multi-month dispensing of antiretroviral medicines, emergency stock buffers, climate-resilient storage facilities and contingency plans that are tested before disasters strike.

He said the organisation has implemented HIV prevention, care and treatment programmes across 10 countries using evidence-based, rights-based and gender-responsive approaches. Its current work focuses on integrating HIV services into primary healthcare while strengthening community and health systems. That has included supporting ministries of health in strengthening supply chain management through improved forecasting, logistics management information systems (LMIS), data use for decision-making, and decentralized distribution systems integrated within primary healthcare.

Who gets left behind

Climate change is not affecting everyone equally. Dr Sunguti said the most at-risk groups are people living in poverty, women and girls, adolescents and young people, rural communities, migrants and displaced people, people with disabilities, and key populations who already face stigma and barriers to care.

Adolescent girls and young women are particularly exposed, because climate-related poverty can drive up school dropout, transactional sex, child marriage and gender-based violence, all recognised drivers of HIV infection. These groups typically have the fewest resources to absorb the shock of transport disruption, income loss, food insecurity or service closures. This means that climate shocks, therefore, deepen existing inequalities unless responses are deliberately designed to reach those most likely to be missed.

Displacement compounds the problem further, severing the link between people and the services they depend on. “When communities are displaced, or roads and clinics are damaged, HIV testing, counselling, condom distribution, PrEP delivery, and peer-led outreach are often the first services to be interrupted,” he said.

“Climate shocks expose weaknesses in health systems and medicine supply chains.”

Following Cyclone Idai in Mozambique, for example, large-scale displacement complicated HIV testing, treatment continuity and patient tracking because many individuals lost access to their usual health facilities and medical records, he said. People also lost medical records, miss appointments, or avoid services because of stigma, insecurity, or uncertainty about where to go.

“That is why emergency responses should include HIV continuity planning, not only short-term relief,” said Dr Sunguti.

Sub-Saharan Africa’s disproportionate share of the global HIV burden cannot be separated from poverty, and that has direct implications for how prevention is designed. Poverty reduction should be treated as a core part of HIV prevention, especially in high-burden regions where climate shocks, food insecurity and economic stress interact with HIV risk.

“When households face hunger, lost income or unstable livelihoods, people are more likely to face barriers to prevention and treatment, and in some contexts may be pushed toward higher-risk coping strategies,” he said.

Social protection, livelihoods support, food assistance and cash transfers are therefore not peripheral add-ons. They function as prevention-enabling interventions in their own right. They should be seen as investments in HIV prevention because they reduce the economic pressures that can increase vulnerability.

Despite the growing challenges posed by climate change, scientific advances are also creating new opportunities.

Scientific advances are opening a new front in this fight. Dr Sunguti said that the long-acting HIV tools have the potential to make care more resilient by reducing how often people need to visit clinics and by improving continuity during periods of disruption. The PURPOSE 1 and PURPOSE 2 clinical trials found that twice-yearly lenacapavir provides near-complete protection against HIV acquisition among women and other at-risk populations, one of the most significant advances in HIV prevention in decades.

“Long-acting prevention products could be particularly valuable in climate-vulnerable settings because fewer clinic visits reduce dependence on transport infrastructure that may be disrupted by floods or extreme weather,” he said.

For prevention specifically, longer-acting options can help protect people who struggle with daily or frequent service access, especially during climate shocks or displacement. They are not a complete solution on their own, he said, but paired with equitable delivery systems, community-based access and reliable supply chains, they could meaningfully reduce vulnerability to interruptions.

The access gap

The barrier to scaling tools like lenacapavir is no longer scientific; it’s economic and logistical. Scientific breakthroughs only improve public health when countries can actually afford to procure and deliver them. High prices, licensing restrictions, limited manufacturing capacity, regulatory delays, and insufficient financing continue to prevent many low- and middle-income countries from accessing new HIV medicines.

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