Africa now has some of the most effective tools to prevent and treat HIV, but millions of people risk losing access because the money that paid for those medicines is disappearing.
Development Diaries reports that discussions at the International AIDS Conference have highlighted a growing funding crisis threatening HIV services across Africa, even as researchers unveiled major advances in HIV prevention and treatment.
The concern comes as African governments respond to declining international support by increasing domestic investment and expanding local pharmaceutical manufacturing.
Scientific progress is moving faster than the systems responsible for delivering it, leaving many African countries with better HIV medicines but shrinking resources to place them in the hands of the people who need them.
Services for young people, community outreach programmes and HIV prevention for vulnerable populations have been among the first to disappear as donor funding declines.
UNAIDS reports that international HIV assistance fell by 23 percent between 2024 and 2025, condom funding dropped by 93 percent and the use of pre-exposure prophylaxis (PrEP) declined by 38 percent.
Twenty-two African countries are developing transition plans, while 11 have increased their HIV budgets for 2026. Kenya is among those pursuing greater health independence through domestic pharmaceutical manufacturing to reduce reliance on imported medicines and external financing.
The crisis is exposing the weakness of a health system that depended heavily on foreign funding for more than two decades. Programmes financed largely through the United States President’s Emergency Plan for AIDS Relief (PEPFAR) expanded access to treatment across Africa, but the rapid withdrawal of that support has revealed how vulnerable those gains remained when domestic financing failed to keep pace.
African governments now face the task of financing services they previously depended on donors to sustain. Health and finance ministries must strengthen domestic investment, while UNAIDS and other international partners continue coordinating the transition and monitoring its impact.
Access to HIV prevention and treatment is closely linked to the rights to health and life recognised under regional and international commitments that African governments have endorsed. Losing access to treatment because funding disappears is therefore more than a financial problem.
Young people, sex workers and other vulnerable populations have been among the first to lose services because many of the programmes supporting them depended heavily on donor funding, with women and adolescent girls, who account for a significant share of HIV infections across eastern and southern Africa, losing access to testing, treatment and services that prevent mother-to-child transmission.
Similarly, rural and low-income communities face longer journeys to fewer functioning clinics and increasing medicine shortages.
The funding crisis is unfolding across the continent rather than within individual countries, making isolated national responses increasingly difficult. Kenya, South Africa, Ghana, Mozambique and several other countries are confronting the same challenge, strengthening the case for coordinated African financing and regional pharmaceutical manufacturing instead of temporary emergency measures.
Citizens can help to protect those gains by monitoring national HIV budget allocations, demanding increased domestic investment and documenting clinic closures or medicine shortages through health-rights organisations so that governments cannot overlook the scale of the problem.
African governments should establish protected domestic funding for HIV programmes with publicly reported disbursements, invest jointly in regional manufacturing of medicines and diagnostic equipment, and publish detailed transition plans showing how prevention, treatment and community services will continue as donor funding declines.
The African Union should coordinate a continental financing and manufacturing strategy because Africa already has the science needed to end AIDS. The challenge now is ensuring that the resources to use it remain available.
