I have sat in enough rooms where governments make promises about HIV to know the difference between a declaration that will change lives and one that will gather dust. The 2026 UN High-Level Meeting on HIV/Aids is an opportunity for the former. Whether it delivers will depend on whether governments treat civil society as partners in the response or as window dressing for the cameras.
Let me be plain about what civil society means in the context of the South African HIV response. It is not a collection of NGOs in air-conditioned offices. It is the 18 sectors of the South African National Aids Council (Sanac) Civil Society Forum: the women’s sector, youth networks, people living with HIV, sex workers, traditional health practitioners, traditional leaders, faith communities and others, including key and vulnerable populations. It is the community health workers who walk into villages, shacks and informal settlements to find the people that health systems miss. It is the traditional health practitioners, like those I represent, who are often the first and sometimes only trusted health advisers for millions of people across Southern Africa.
For too long, traditional health practitioners have been treated as obstacles to the HIV response rather than assets in it. The reality is the opposite. When we were brought into the fold — trained, resourced and respected as part of the response — we became game-changers. We were able to provide condoms from our indumbas. We referred patients to clinics. We challenged stigma from in the communities where it breeds. We helped people understand that HIV treatment is not in conflict with African healing traditions but compatible with them. That partnership needs to be recognised and funded in the new Political Declaration.
The broader point is this: the HLM must commit governments to financing community-led responses not as a nice-to-have but as a structural imperative. For too long, community organisations have operated on shoestring budgets, dependent on donor funding that can disappear overnight — as Pepfar demonstrated so brutally in 2025. The collapse of educational after-school programmes, of PrEP (pre-exposure prophylaxis) services and of peer outreach programmes — all happened in countries where communities had done everything right and governments had done nothing to build the domestic infrastructure that would make the services resilient.
South Africa’s Sanac model represents something important: a formal mechanism for civil society to hold government accountable on HIV. But accountability requires resources. The new Political Declaration must push governments, especially African governments, to dramatically increase their domestic investment in the HIV response. External donors will not always be there. Political winds change. The epidemic does not.
Civil society in South Africa is watching New York closely. We will be holding a mirror to whatever comes out of that meeting. If the Political Declaration is ambitious, funded and rights-based, we will champion it. If it is vague and uncommitted, we will say so loudly. That is not obstruction. That is accountability. And accountability is precisely what the global Aids response needs right now.
Solly Nduku is the chairperson of the South African National Aids Council Civil Society Forum and general secretary of the National Unitary Professional Association for African Traditional Health Practitioners in South Africa.
This is the fourth of a five-part series on the High-Level Meeting on HIV (HLM)