Africa has to make a critical shift towards self-sufficiency in addressing its HIV challenges, emphasising the need for ownership, sustainable financing and strengthened health infrastructure for lasting impact.
The recent Second Global Edition of the African Public Square (APS) open debate, convened during King’s Africa Week at Bush House, King’s College London, on 2 March 2026, posed a question that cuts to the heart of Africa’s contemporary development predicament: “How should the resourcing of African agency be negotiated?”
Nowhere is this tension between ownership and administration more urgent than in Africa’s HIV response. The debate did not emerge in a vacuum. A cascade of structural shocks preceded it. In January 2025, the Trump administration ordered a comprehensive review that temporarily halted nearly all US foreign aid, leading to an immediate suspension of Pepfar and the rapid dismantling of USAid’s development programmes.
Combined with significant cuts in development assistance for health from other major donors, including in Europe, these actions exposed the fragility of health systems that had come to rely on continued external funding. Africa CDC estimates that Official Development Assistance for Africa’s health sector fell by around 70% between 2021 and 2025, even as multiple public health emergencies across the continent placed increasing strain on already vulnerable systems.
For the HIV response, which had been designed over two decades around sustained external financing, the consequences…
