As World AIDS Day is marked around the globe, rapid scientific progress is being overshadowed by funding shortfalls and weakened health systems that are putting the global fight against HIV at risk.
The global fight against HIV/Aids has found itself at a troubling crossroads. On one hand, scientific progress is picking up pace; on the other, the latest UNAIDS report paints a stark picture of a world struggling to keep its momentum.
International response is weakening, held back by falling funding and disrupted health services.
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Worldwide, an estimated 41 million people are now living with HIV. Last year saw 1.3 million new infections, and 9.2 million people still lack access to life-saving antiretroviral (ARV) treatment.
According to UNAIDS Executive Director Winnie Byanyima: “the global response to HIV has suffered its biggest setback in decades.”
But she insists that “HIV is not over,” and has called for renewed global mobilisation.
Her plea follows especially disappointing news: the Global Fund to Fight AIDS, Tuberculosis and Malaria raised just over €9 billion for the next three years – far short of the €15 billion it says is needed.
This is even lower than the last replenishment round in 2022, threatening the future of crucial programmes around the world.
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Positive developments in the lab
But it’s not all bleak. In research centres worldwide, scientists are making remarkable advances.
Yazdan Yazdanpanah, director of the French National Agency for Research on AIDS and Emerging Diseases (ANRS-MIE), describes the situation as a paradox: impressive scientific advances on one side, declining capacity to roll them out on the other – a sort of “double dynamic”.
One encouraging development is the arrival of long-acting antiretroviral treatments. Instead of taking a pill every day, people can now receive treatment once every two months.
This, Yazdanpanah explains, boosts adherence and generally feels more manageable for many. Some 43 percent of people living with HIV say these long-acting treatments are their first choice – even before considering side effects or tablet size.
Prevention tools are also evolving. A major breakthrough is injectable PrEP, which offers long-term protection against HIV.
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Lenacapavir – recently recommended by the World Health Organization – provides six months of protection with a single shot.
“It’s one injection every six months to prevent HIV,” says Yazdanpanah. Thanks to an international pricing agreement, the cost could be around €35 per year in 120 low-resource countries, compared with roughly €25,300 per year previously charged in the United States.
South Africa, Eswatini and Zambia on Monday began administering the groundbreaking injection in the drug’s first public rollouts in Africa.
Eastern and southern Africa account for about 52 percent of the 40.8 million people living with HIV worldwide, according to 2024 UNAIDS data.
Under the programme, manufacturer Gilead Sciences has agreed to provide lenacapavir at no profit to two million people in countries with a high HIV burden over three years.
Critics say this is far below the actual requirement and that the market price is out of reach for most people.
Progress needs power, power needs funding
These advances, impressive as they are, risk remaining theoretical unless health systems can keep up.
In 2025, global development aid for health fell by 22 percent, driven largely by reductions or withdrawals from major US programmes.
The consequences are already being felt, says Françoise Vanni, external relations director at the Global Fund.
“There has been a crisis in international financing for the fight against HIV/Aids and for global health more broadly, with drastic cuts from a number of donor countries that have really caused major interruptions in the delivery of essential services,” she explained to RFI.
With infections rising again in several countries, she is blunt about the reality for frontline programmes: “Very concretely, it means it is much more difficult to fight these diseases effectively.”
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Nowhere is this fragility clearer than in sub-Saharan Africa, which bears a disproportionate share of the epidemic. The region accounts for a large share of new HIV infections and is home to 60 percent of all people living with the virus.
In 13 countries, fewer people started treatment last year. Supply shortages have been felt, too, with disruptions in Ethiopia and the Democratic Republic of Congo affecting both HIV testing and access to antiretroviral (ARV) therapy.
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The funding crisis, compounded by the lasting effects of the Covid-19 pandemic, is undermining the progress made since the early 2000s.
In Nigeria, condom distribution has dropped by 55 percent.
Community organisations – traditionally the backbone of HIV work – are also under heavy strain, with more than 60 percent of those led by women forced to suspend essential programmes.
UNAIDS makes its position clear: science alone cannot end the epidemic. The agency is urging the global community to rethink the funding model so that heavily affected countries invest more of their own resources. Without this shift, the world will almost certainly fall short of its goal to end the HIV/Aids epidemic by 2030.
At best, current trends would allow the international community merely to hold the epidemic steady. At worst, if the decline in funding continues, UNAIDS warns of a resurgence of HIV/Aids by 2030.
This has been adapted from the original article in French and lightly edited for clarity.