Foreign aid has been the backbone of Africa’s HIV/Aids response but now the continent must take control of its health future.
Dear African Union leadership and African governments,
I am writing not just as a young person from Namibia living with HIV, but as one of the 26 million Africans who depend on lifesaving medication to survive. Over the years, international aid has played a critical role in funding treatment, prevention and awareness programmes, saving millions of lives, including my own.
But the recent decision by international donors, including USAid and Pepfar, to reduce funding for HIV/Aids programmes, among others, fills me with deep fear and uncertainty. Beyond this fear, I am left with an even greater question: where are we headed, and are we doing enough for ourselves as a continent?
For decades, Africa has been at the centre of the global HIV/Aids crisis, carrying the highest burden of infections and deaths. In 2023, an estimated 65.2% (26 million) of the 39.9 million people living with HIV globally were from sub-Saharan Africa. Out of the 630,000 people who died from the disease in 2023, 390,000 were from sub-Saharan Africa.
Young women and adolescent girls are disproportionately affected, with infection rates significantly higher than their male counterparts. In 2023, women and girls (all ages) accounted for 62% of all new HIV infections in the region. Every week, 4,000 adolescent girls and young women aged 15 to 24 become infected with HIV globally. 3,100 of these infections occurred in sub-Saharan Africa.
Structural barriers, including gender inequalities, discrimination, stigma, and poverty, continue to drive new infections in Africa. Many countries still struggle with healthcare infrastructure issues, social stigma and mental health that prevents people from seeking support and healthcare.
For years, foreign aid has been the backbone of Africa’s HIV/Aids response, and the progress Africa has made in tackling HIV/Aids is undeniable. Progress has been made in eliminating mother-to-child transmission, expanding access to antiretroviral treatment, addressing HIV stigma and discrimination, and a reduction in annual new HIV infections. There is a lot to celebrate and be proud of.
The recent decision to shift HIV/Aids funding has led to the closure of 32 drop-in centres and affected 49% of PrEP services in Zambia. In Mozambique, 66% of its HIV response funding comes from Pepfar, the transportation of antiretroviral (ARV) treatment to health facilities is no longer funded, and more than 19,000 community workers are affected, limiting testing and enrollment of people living with HIV into treatment programmes.
Ethiopia is on track to reach the global 95-95-95 targets, with 90% of people living with HIV knowing their status, 94% receiving antiretroviral treatment, and 96% achieving viral suppression. This pause means that 2,385 people will not be able to continue ARV, tuberculosis and sexually transmitted infections treatment.
And 18,075 people will no longer receive support for health and care services because of job loss. We are at risk of a major setback on all the progress we have made against HIV/Aids in Africa
If we do not take control of our healthcare response, who will fund our hospitals, clinics and community outreach programmes? How many lives will be lost before we realise that Africa must take responsibility for its health crisis?
We must take full ownership of our HIV/Aids response. Africa must look inward and implement bold frameworks and policies that prioritise domestic resource mobilisation and allocate greater resources to healthcare, in line with the Abuja Declaration, which calls for at least 15% of total spending to go toward health.
We need to invest in local pharmaceutical manufacturing to expand local drug production, ensure affordability, and reduce dependency on imports. Africa must build strategic, localised, global and public-private partnerships to strengthen healthcare independence.
Strengthening health sector governance across African countries is essential to support the Africa Centres for Disease Control and Prevention’s push for universal health coverage. Achieving this goal will require harmonised systems across the continent, along with targeted support for countries that need it, particularly in areas such as procurement, administration and budgeting to ensure effective and equitable implementation.
Our continent is home to brilliant and innovative minds. Let us invest in research and development, lead vaccine innovation and advance treatment and prevention strategies tailored to Africa’s needs.
Additionally, addressing poverty and inequality, investing in education and scaling up prevention programmes are now more critical than ever. This roadmap will not only reinforce African ownership of the Aids response but will also accelerate the goal of ending HIV as a public health threat by 2035 and contribute to broader economic growth.
Tuwilika Elias is a public policy analyst and an advocate of advancing health equity.