I was diagnosed with HIV in 2000. Back then, Aids was a death sentence for most Africans. There were no antiretrovirals in the public health system. There was shame, silence and a government that refused to acknowledge the epidemic killing its own people. I watched friends die. I watched women — always women — carry the weight of a disease they had little power to prevent.
Twenty-five years later, I am still here. And so is the fight.
On 22 and 23 June, world leaders will gather at the UN headquarters in New York for the High-Level Meeting on HIV/Aids, held under the theme "United to End Aids". It happens every five years. It produces a Political Declaration — a document that sets the global commitments and targets that will define how the world responds to HIV for the next five years and beyond. This one is arguably the most consequential since the declaration that kick-started the global Aids response in 2001.
I need you to understand what is at stake and why what happens in that room matters to every woman, every girl and every marginalised community on the continent.
The numbers that should keep us awake
In 2024, sub-Saharan Africa accounted for 63% of all new HIV infections among women and girls globally. Every week, more than 3 300 adolescent girls and young women in our region became infected with HIV. Every week. That is not a statistic — that is a classroom, a church congregation, a neighbourhood, disappearing into the epidemic.
Despite carrying more than 77% of weekly global new HIV infections among young women and girls, sub-Saharan Africa receives just 1% of annual global health expenditure. Let that sink in. The burden is ours. The money is not.
Progress that took decades to build is being dismantled in real time. When the US froze Pepfar funding in January 2025, the impact was immediate and brutal. Clinics closed overnight. Health workers were sent home without pay — more than 30 000 in Mozambique alone. The DREAMS programme, which had been reaching two million adolescent girls and young women across 10 countries in our region with HIV prevention, sexual and reproductive health services and economic empowerment — shut down. PrEP services, which had been protecting hundreds of thousands of people, stopped. Modelling studies predict that the cuts could result in up to 74 000 excess HIV deaths in Africa by 2030 and six million new infections globally if services continue to collapse.
This is not an abstraction. These are lives. These are girls who had no say in the decision made in Washington.
The human rights crisis hiding in plain sight
HIV does not spread in a vacuum. It spreads along the fault lines of inequality; of gender, poverty, stigma and criminalisation. In too many of our countries, the communities most vulnerable to HIV are also the most criminalised. Sex workers. Gay and bisexual men. People who inject drugs. Trans women. Their exclusion from health systems is not an accident. It is a policy choice. And it is killing people.
For women and girls, the vulnerability is structural. We cannot negotiate condom use with partners who hold economic power over us. We cannot access PrEP from clinics that shame us for our sexuality. We cannot report sexual violence in systems that do not believe us. HIV prevention that ignores gender inequality is not prevention, it is theatre.
A new Political Declaration that does not explicitly commit to the decriminalisation of key populations, to the dismantling of gender-based barriers to healthcare and to the full inclusion of community-led organisations in the HIV response, will be a hollow document. We have had enough hollow documents.
Why community-led responses are not optional
I have spent more than two decades working at the frontline of the epidemic. I have seen what works. It is not top-down. It is not donor-driven programmes designed in Washington or Geneva by people who have never sat across from a young woman afraid to tell her boyfriend she wants to use a condom.
What works is communities. It is peer educators who share languages and lived experiences. It is women's organisations that hold health systems accountable. It is activists who make noise when governments try to quietly roll back commitments. The UNAids Global Aids Strategy 2026–2031 recognises this. The new Political Declaration must not only echo it — it must fund it.
The 2026 HLM is an opportunity to redirect political will and financial commitments toward the community-led infrastructure that has proven, again and again, to be the backbone of an effective HIV response. Governments must commit to increasing domestic funding so that the Aids response is not held hostage to the shifting foreign policy priorities of any single donor country. Africa cannot keep outsourcing its survival.
A decisive moment: not a diplomatic formality
The UN Secretary-General António Guterres said it plainly earlier this month: the world has made historic gains against HIV but the gains are increasingly at risk. He is right. And the people most at risk of losing everything are not in New York. They are in Alexandra, in Kampala, in Harare, in Maputo.
The 2026 High-Level Meeting will produce a new Political Declaration with global targets for 2030. The targets must be ambitious, funded and enforceable. They must centre African women and girls. They must protect key populations. They must demand accountability from governments, not just in rhetoric but in budgets.
I did not survive 25 years with HIV and co-found an organisation fighting for prevention and rights, to watch the global Aids response quietly unravel while diplomats applaud themselves in air-conditioned conference rooms.
The world must go to New York this June with more than good intentions. It must go with commitments we can hold it to. It must go prepared to name what is failing and to fund what works.
Because the alternative — of six million more infections, of hundreds of thousands of preventable deaths, of an entire generation of African girls robbed of their futures — is not something history will forgive.
We must remember no human should be criminalised .
We have come too far. We cannot stop now.
Yvette Raphael is the co-founder and executive director of the Advocacy for Prevention of HIV and Aids in South Africa, an AVAC Fellow and one of Africa's leading voices on HIV prevention, human rights and community-led responses.
This is the second of a five-part series on the High-Level Meeting on HIV (HLM)