HIV funding cuts risk 'unravelling decades of progress', global health experts warn

At the Aids 2026 conference, Brazilian advocates highlighted that their health system operates independently from foreign funding, and they had predicted a significant reduction in donor funding for HIV. Juliana Cesar, the political liaison coordinator at the Brazilian HIV NGO Gestos, stated that this "dissolution of USAID might 'feel like a rupture', it’s something advocates at the Brazilian HIV NGO Gestos have seen coming for a long time."

Brazil's HIV prevention and treatment programs are fully funded by the country's Unified Health System, which has enabled the country to achieve milestones like the elimination of HIV transmission to newborns in 2025. However, negotiations with pharmaceutical companies still restrict Brazil's access to the latest HIV preventions and treatments. Additionally, NIH funding cuts could also impact HIV-related research in Brazil.

Cesar explained that Brazil is in a unique position due to the right to healthcare being enshrined in its constitution since 1988. Members of civil society had advocated for HIV prevention and treatment to be part of the Unified Health System, which was subsequently earmarked into its budgets. Gestos has also advocated for other countries to implement measures similar to Brazil's Financial Transaction Tax, which would have funneled money from every transaction towards the public health system.

However, the tax was abolished in 2007 as Brazil shifted towards the right. Cesar also noted that the tax was not implemented effectively, as the same percentage was imposed on every citizen, regardless of income. She has long encouraged other countries to consider such measures, as they would provide them with greater financial independence from foreign policy decisions and allow for more autonomy in tailoring HIV programs to their citizens.

Cesar first suspected a reduction in foreign aid more than a decade ago, after tracking UN negotiations since the 2000s and noticing increasingly restrictive language and conditions around funding for sexual and reproductive health and rights, as well as LGBTQ+ communities. After 2012, Cesar observed funding "conditions that would exclude the very communities that we should serve." Different nations attempted to find "common ground" in funding, but the "common ground would become stricter and stricter."

Ailish Brennan, a policy analyst at Harm Reduction International, pointed out that foreign aid agreements often require countries to purchase HIV medications from donor countries, such as the US, effectively pumping money back into the donor country economy. Domestic production of HIV medications could contribute to the broader shift towards "health sovereignty" and genuine country ownership over health systems.

Additionally, redirecting foreign aid away from "narcotics control" could preserve HIV prevention and treatment programs, as nearly $1bn worth of foreign aid went towards policing and criminalization of narcotics-related offenses between 2012 and 2021.