Global funding for the HIV response suffered its sharpest annual decline since international investments began more than two decades ago, raising fears that hard-won gains against the epidemic could unravel, according to new reports released Monday at the 26th International AIDS Conference.
The reports, published by UNAIDS and KFF at AIDS 2026 in Rio de Janeiro, found donor government funding fell by 25% in 2025, driven almost entirely by a steep reduction in U.S. support following changes to its global health programmes.
The conference, organised by the International AIDS Society (IAS), has brought together about 7,000 scientists, policymakers, healthcare workers, funders and people living with HIV to discuss the future of the global response.
Health leaders warned that the funding crisis comes at a critical time, with 1.2 million new HIV infections and 570,000 AIDS-related deaths recorded in 2025. While some countries continue to make progress, they said the financial shock threatens efforts to end AIDS as a public health threat by 2030.
“We come to Rio de Janeiro at a moment of real danger for the HIV response,” IAS President and AIDS 2026 Co-Chair Beatriz Grinsztejn told reporters before the conference opened.
“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.”
The KFF-UNAIDS analysis found the funding decline was the largest single-year drop since international HIV financing began expanding in 2002. It attributed the fall largely to funding delays and project cancellations linked to changes in U.S. global health assistance.
A separate UNAIDS report found governments in low- and middle-income countries increased domestic HIV spending by 4% in 2025, bringing domestic financing to nearly 60% of total HIV funding. More than 55 countries have pledged to increase their HIV budgets further in 2026.
Even so, UNAIDS Executive Director Winnie Byanyima said domestic resources alone cannot fill the gap left by declining donor support.
“The era of relying on international aid is over,” Byanyima said. “Countries cannot wait, and they cannot go backwards.”
She called for reforms to the global financial system, including faster debt restructuring, to allow governments to invest more in health and other public services.
The reports show a mixed picture of the epidemic. New HIV infections are increasing in countries including Brazil, Pakistan, the Philippines and Madagascar, while Kenya, Lesotho, Rwanda, Zimbabwe and Eswatini remain on track toward the 2030 global HIV targets despite mounting financial pressure.
South Africa’s Deputy Minister of Health, Joe Phaahla, said African governments must continue increasing domestic investment but warned that national budgets cannot fully replace decades of international support.
“African countries must continue to strengthen domestic investment and make HIV a national priority,” Phaahla said. “At the same time, no country can replace the scale of international partnership that has driven the global HIV response for decades.”
World Health Organization Director-General Tedros Adhanom Ghebreyesus said the world has made remarkable progress, with HIV infections and AIDS-related deaths at their lowest levels in more than three decades.
“Ending AIDS as a public health threat by 2030 remains within reach,” Tedros said. “But that progress is fragile.”He urged governments and donors to maintain investment in HIV prevention, testing and treatment to ensure the gains are not reversed.
Erika Castellanos, executive director of Global Action for Trans Equality, said funding decisions are already affecting communities living with HIV. “Fund this response like lives depend on it, because they do,” Castellanos said. “People living with HIV are not a line item in a budget.”
Brazilian Health Minister Alexandre Padilha, whose country is hosting the conference, said the global response must continue to prioritise universal access to treatment and innovation. “Innovation without access is not an innovation,” Padilha said. “It is an injustice.”
The conference comes as governments, donors and international agencies grapple with how to sustain the HIV response amid shrinking aid budgets. While countries are increasing domestic spending, global health leaders warned that without renewed international commitment and reforms to ease debt burdens, the world risks losing decades of progress against one of its deadliest epidemics.
