By Lehlohonolo Lehana.
The Joint United Nations Programme on HIV/Aids (UNAIDS) released a report that highlights a significant funding crisis threatening years of progress in the fight against HIV/Aids.
UNAIDS and the SA National Aids Council launched the Global AIDS Update Report 2025 titled “AIDS Crisis and the Power to Transform” in Ekurhuleni
New HIV infections have been reduced by 40% since 2010, and 4.4 million children have been protected from acquiring HIV since 2000. More than 26 million lives have been saved. The response to HIV is one of the most successful public health interventions in history.
However, this phenomenal progress risks being reversed. Sudden, drastic cuts from a number of donors have sent shockwaves through global health. UNAIDS’ new report, AIDS, Crisis and the Power to Transform, shows the impact the cuts are having globally. UNAIDS estimates that if the world does not act, there could be an additional 6 million new HIV infections and 4 million AIDS-related deaths by 2029.
The report highlights the measures some countries are taking to fill the gaps and sustain the response into the future. However, for many, that future remains uncertain.
The report highlights the impact that the sudden, large-scale funding cuts from international donors are having on countries most affected by HIV. Yet, it also showcases some inspiring examples of resilience, with countries and communities stepping up in the face of adversity to protect the gains made and drive the HIV response forward.
Some 25 of the 60 low and middle-income countries included in the report have indicated increases in domestic budgets for their HIV responses in 2026.
The estimated collective rise among the 25 countries amounts to 8% over current levels, translating to approximately US$180 million in additional domestic resources.
“This is promising, but not sufficient to replace the scale of international funding in countries that are heavily reliant,: the report says.
Although there was significant progress in the HIV response in 2024, UNAIDS reported that a weakening consensus on aid and substantial, sudden funding shortfalls in 2025 caused widespread disruptions in health systems.
These challenges led to cuts in frontline health workers, halted HIV prevention programmes, and jeopardised HIV treatment services.
According to data, in Mozambique alone, over 30 000 health personnel were affected. In Nigeria, pre-exposure prophylaxis (PrEP) initiation has plummeted from 40 000 to 6 000 people per month.
If United States-supported HIV treatment and prevention services collapse entirely, UNAIDS estimates that an additional six million new HIV infections and four million additional Aids-related deaths could occur between 2025 and 2029.
“This is not just a funding gap – it’s a ticking time bomb.
“We have seen services vanish overnight. Health workers have been sent home, and people, especially children and key populations, are being pushed out of care,” said UNAIDS Executive Director Winnie Byanyima.
Even before the large-scale service disruptions, the reported data for 2024 shows that 9.2 million people living with HIV were still not accessing life-saving treatment services last year.
Among those were 620 000 children aged zero to 14 years living with HIV but not on treatment, which contributed to 75 000 AIDS-related deaths among children in 2024.
In 2024, 630 000 people died from Aids-related causes, 61% of them in sub-Saharan Africa. Over 210 000 adolescent girls and young women, aged 15 to 24, acquired HIV in 2024 – an average of 570 new infections every day.
UNAIDS said HIV prevention services are severely disrupted, while community-led services, which are vital to reaching marginalised populations, are being defunded at alarming rates.
In early 2025, the organisation said over 60% of women-led HIV organisations surveyed had lost funding or were forced to suspend services.
The United States President’s Emergency Plan for AIDS Relief (PEPFAR) reached 2.3 million adolescent girls and young women with comprehensive HIV prevention services in 2024 and enabled 2.5 million people to use HIV PrEP – many of these programmes have now stopped completely.
UNAIDS said South Africa currently funds 77% of its AIDS response, and its 2025 budget review includes a 5.9% annual increase in health expenditure over the next three years, including a 3.3% annual increase for HIV and tuberculosis programmes.
The South African government intends to finance the development of a patient information system, a centralised chronic medicine dispensing and distribution system, and a facility medicine stock surveillance system.
Meanwhile, as of December 2024, seven countries – Botswana, Eswatini, Lesotho, Namibia, Rwanda, Zambia, and Zimbabwe – had achieved the 95-95-95 targets: 95% of people living with HIV know their status, 95% of those are on treatment, and 95% of those on treatment are virally suppressed.
The report also highlights the emergence of unprecedented, highly effective new prevention tools like long-acting injectable PrEP, including lenacapavir, which has shown near-complete efficacy in clinical trials, though affordability and access remain key challenges.
Meanwhile (ARVs) have been detected in South Africa’s water sources, particularly downstream of wastewater treatment plants, new research has found.
The drugs most frequently detected were lopinavir and efavirenz, with concentrations at some sites far exceeding global norms. This is attributed to South Africa’s HIV treatment programme, the most extensive of its kind in the world.
The research, by North-West University’s unit for environmental sciences and management and its Africa unit for transdisciplinary health research, included professors Suranie Horn, Rialet Pieters, Henk Bouwman and Petra Bester.
The study found that aquatic ecosystems and wastewater management systems were affected. Freshwater snails exposed to ARVs exhibited altered embryonic development, while bacteriophages — viruses critical to controlling bacteria in wastewater treatment — were significantly affected. Such disruptions could lead to bacterial blooms and reduced water quality, the authors said.
The consumption of any type of exogenous drug by any organism in sufficient quantities may intervene with the regulation of metabolic systems and bring about adverse effects,” said the study, warning that the presence of antiretrovirals in water “can be considered a hidden or latent risk”.
The potential risks for human health were also red-flagged.
“Humans are also exposed to these compounds via drinking water, and at concentrations exceeding calculated hazard quotients,” the authors said. “Although not found in this study, humans and other organisms may potentially ingest antiretrovirals and their breakdown products via aquatic organisms such as fish.”
Concentrations of ARVs in some water sources exceeded acceptable thresholds, posing potential long-term health risks to humans. Current wastewater treatment processes are inadequate for removing these bioactive compounds, underlining the need for technological advancements.
Nearly all antiretrovirals were found in natural systems and some in drinking water, although none were found in the fish tissue samples, nor were antiretroviral metabolites found.