The United Nations Office at Geneva
Multimedia Newsroom
UNAIDS Press conference 25 November 2025
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1:11:46
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MP4
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4.5 GB
Geneva, Switzerland (shot 25 November 2025)
Courtesy: UNTV Geneva
- Exterior UNOG
- Interior press room, two principals and moderator on panel
- Room shot, two photographers while Winnie is speaking
- Reuters camerawoman wide shot from press conference room
- CU of camera woman
- Panel shot from above
- Winnie Byanyima holding up cover of UNAIDS World AIDS Day report
SOUNDBITES (all in English)
SOUNDBITE (English) – Winnie Byanyima, UNAIDS Executive Director: “The global response to HIV has suffered its most significant setback in decades that is what we are clearly saying in our World AIDS Day report.”
SOUNDBITE (English) – Winnie Byanyima, UNAIDS Executive Director: “Across 13 countries, the number of people newly initiated on HIV treatment has declined compared to last year. Stockouts of HIV test kits and medicines have been reported in countries including Ethiopia and the Democratic Republic of Congo. Prevention services—already under strain before the crisis—were the hardest hit. 450,000 women in sub-Saharan Africa lost access to what we call mother mentors these are women who connect them to services ; 24% of providers reported interruptions in early infant diagnosis. Nigeria saw a 55% drop in condom distribution. Community-led organizations—the backbone of the HIV response—reported widespread closures, with more than 60% of women-led organizations suspending essential programmes. In other words: the funding crisis exposed the fragility of the progress we fought so hard to achieve.”
SOUNDBITE (English) – Winnie Byanyima, UNAIDS Executive Director: “Today, this is our call to action, 40.8 million- almost 41 million- people are living with HIV worldwide, 1.3 million new infections occurred last year, and 9.2 million people are still not receiving treatment, AIDS is not over.”
SOUNDBITE (English) – Dr Byrone Chingombe, Technical Director at the Centre for Sexual Health and HIV/AIDS Research CeSHHAR , Zimbabwe: “Let me start by saying that 2025 has been a very hard year personally, and professionally, just to give you some context – in Zimbabwe the bulk of the funding for HIV programs comes from external donors.”
SOUNDBITE (English) – Dr Byrone Chingombe, Technical Director at the Centre for Sexual Health and HIV/AIDS Research CeSHHAR “That caused panic, confusion, misinformation across all strata of society in our programming. when the cuts happened. The trouble is within facilities, the tablets wre on the shelves (HIV treatment) but the service providers meant to distribute them had been laid off, that caused treatment disruption and adherence for treatment and prevention and importantly that disrupted trust among our communities.”
END
World AIDS Day update
25 November 2025 – The global response to HIV has suffered its most significant setback in decades, warns a new UNAIDS report released today ahead of World AIDS Day 2025. ‘Overcoming disruption, transforming the AIDS response’ details the far-reaching consequences of international funding reductions and lack of global solidarity which sent shockwaves through low- and middle-income countries heavily affected by HIV.
Abrupt reductions in international HIV assistance in 2025 have deepened existing funding shortfalls. The OECD estimates that external health assistance is projected to drop by 30–40% in 2025 compared with 2023, causing immediate and even more severe disruption to health services in low- and middle-income countries.
“The funding crisis has exposed the fragility of the progress we fought so hard to achieve,” said Winnie Byanyima, Executive Director of UNAIDS. “Behind every data point in this report are people—babies and children missed for HIV screening or early HIV diagnosis, young women cut off from prevention support, and communities suddenly left without services and care. We cannot abandon them. We must overcome this disruption and transform the AIDS response.”
A failure to reach the 2030 global HIV targets of the next Global AIDS Strategy could result in an additional 3.3 million new HIV infections between 2025 and 2030.
Today, 40.8 million people are living with HIV worldwide, 1.3 million new infections occurred in 2024, and 9.2 million people are still not accessing treatment.
This World AIDS Day, UNAIDS is calling on global leaders to:
- Reaffirm global solidarity, multilateralism and the collective commitment to fight and end AIDS together.
- Maintain funding for the response
- Invest in innovation, including affordable long-acting prevention and treatment options.
- Uphold human rights. Empower communities.
“This is our moment to choose,” Ms. Byanyima urged. “We can allow these shocks to undo decades of hard-won gains, or we can unite behind the shared vision of ending AIDS. Millions of lives depend on the choices we make today.”
NOTE TO EDITORS/PRODUCERS:
No embargo. Please use the images in the context described. Unless indicated, the HIV status, sexual orientation, or any other characteristic of people in the images are unknown and should not be described inappropriately. If in doubt, contact UNAIDS: Sectorc@unaids.org
Teleprompter
[Other language spoken]
[Other language spoken]
We are the 25th of November on the advanced St November of a Commerce LA conference.
The press.
This is the UN AIDS Pre World AIDS Day press conference.
Thank you for joining online and in the room.
I'm joined here with Winnie Bianima who is the Executive Director of UN AIDS and Anjali Ashraker who is the UN AIDS Deputy Executive Director.
[Other language spoken]
Byron Doctor Byron Chingumbe over to you.
[Other language spoken]
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The global response to HIV has suffered it's most significant set back in decades.
That's why we are clearly saying in our World AIDS Day report for this year called Overcoming Disruption, Transforming the AIDS Response.
The report, here it is, details the devastating consequences of abrupt international funding cuts from many international donors, which sent shock waves through low and middle income countries heavily affected by HIV.
Since the abrupt pose by the United States in February, the complex ecosystem that sustains HIV services in dozens of low and middle income countries was shaken to its core.
Clinics closed without warning, thousands of health workers faced job losses or lost salaries, and life saving testing, treatment and prevention services experienced widespread and continuing disruption.
To give you an example of the disruptions, across 13 countries the number of people newly newly initiated on treatment has declined compared to last year.
Stock outs of HIV test kits and medicines have been reported in countries including Ethiopia and the DR Congo.
Prevention services already under strain before the crisis where the hardest hit preventive HIV medicine it was the distribution of preventive HIV medicines plummeted.
In Uganda it went down by 31%, in Vietnam 21% and in Burundi down by 64 percent.
450,000 women in sub-Saharan Africa lost access to what we call mother mentors.
These are women who connect them to services.
24% of providers reported interruptions in early infant diagnosis.
[Other language spoken]
Community LED organisations, the backbone of the HIV response, reported widespread closures with more than 60% of women LED organisations suspending essential programmes.
In other words, the funding crisis exposed the fragility of the progress we fought so hard to achieve.
Byron, who has joined online will give you additional real life examples from Zimbabwe in just a moment.
UN AIDS High Viron UN AIDS warns that the collapse of HIV prevention services could result in 3.3 million additional new infections if we do not by by 20-30.
The positive news is that access to HIV treatment services has somewhat stabilised.
The funding crisis has unfolded against a deteriorating human rights environment globally, with severe consequences for the marginalised groups.
So funding cuts accompanied by reversals of human rights gains.
Currently IN2025168 countries criminalise some aspect of sex work, 152 impose criminal penalties for the possession of small amounts of drugs and 64 criminalise sex same sex relations and 14 criminalise transgender people.
Cases of criminal prosecution of people living with HIV are on the rise and 4048 new HIV related criminal cases were reported across 23 countries between January and June of this year.
For the first time since UN AIDS started reporting on punitive laws, the numbers of countries criminalising same sex, sexual activity and gender expression have increased.
They've been declining, but for the first time we see an increase.
In the past year alone, Mali and Trinidad and Tobago have introduced criminalisation of same sex relations.
Uganda's Anti Homosexuality Act has intensified the proscription of same sex relations.
The prosecution and Ghana has moved in a similar direction with the parliament reintroducing the Human Sexual Rights and Family Values Bill this year.
Mali has also criminalised transgender people and Liberia is advancing an Anti Homosexuality Bill which could include criminalisation of HIV, non disclosure exposure and transmission.
We see regression on rights, burdens on civil society including onerous registration procedures, restrictions on organisations receiving international assistance, Prohibitions of some civil society activities are increasing worldwide.
CIVICAS, an international NGO focused on civil rights and citizen action, reported in last year that civil society was under severe attack in 116 / 119 countries and territories under severe attack.
These restrictions on civil society, particularly those working with the marginalised groups at risk of HIV, are further undermining HIV service access and weakening accountability.
The sexual reproductive rights and bodily autonomy of women and girls are under attack.
The Gambia was one of the highest rates has one of the highest rates of female genital mutilation FGM in the world.
Although the practise was criminalised through legal reform in 2015, nearly a decade passed without enforcement.
The first convictions under the law in 20-30 sparked a nationwide backlash linked to the protection of religion, tradition and culture.
This set off a chain of events that brought the country to the brink of repealing it's FGM ban, which would have made the The Gambia the first country ever to do so.
Today is also the first day of the 16 days of activism to end gender based violence.
GBV, including digital violence, pushes girls out of school.
Out of school girls are more vulnerable to violence, to HIV, to exploitation and to early pregnancy.
Nearly one in three women, estimated 840 million globally, have experienced partner or sexual violence during their lifetime.
This figure has barely changed since 2000.
[Other language spoken]
Sexual violence in the last 12 months alone 3300 and 16,000,000 women 11% of those aged 15 or older were subjected to physical or sexual violence by an intimate partner in Kenya.
UN AIDS modelling Our modelling shows girls who have experienced sexual and gender based violence face a 63% higher risk of HIV infection.
We see a close correlation there.
Education is one of the strongest Shields against sexual and gender based violence.
Girls with secondary education are up to 30% less likely to experience intimate partner violence.
Recent UNS modelling shows that girls completing secondary school could prevent more than 44,000 cases of GBV in 10 countries.
In 2024, $18.7 billion was available.
I'm talking now about funding for HIV.
Last year, $18.7 billion was available for the global AIDS response.
That was 17% below what was needed annually.
Sub-Saharan Africa faces one of the largest funding gaps globally, making sustained and increased investment critical to prevent service disruptions and maintain momentum towards ending AIDS.
Sub-Saharan Africa has a huge funding gap and depends very much on international assistance to meet to to respond to HIV with 20-30 resource.
So with this huge funding gap, we need to sustain international assistance and support developing countries to raise more domestic resources and allocate to the HIV response.
Despite these challenges, I've mentioned, several countries are demonstrating resilience.
So we have in our report a message of hope.
For example, Nigeria, Uganda, Cote d'Ivoire, South Africa and Tanzania have all committed to increasing domestic resources in HIV services.
They are reallocating their budgets to close a gap.
UN AIDS is working with more than 30 countries to develop and implement what we call national sustainability plans, HIV plans.
Again, these are efforts to move away from dependence because of the cuts in international assistance to domestic financing.
All these are positive, but we have to say that the gap can't be closed with domestic resources immediately.
There are severe challenges.
There are huge challenges to in raising domestic resources.
We can talk about them if you want in the Q&A session.
The roll out of the HIV prevention twice yearly injection called lenacapavir is moving.
I talked about it here a couple of months ago.
That is a a hope, a message of hope here.
On Friday, the Medicines Control Authority of Zimbabwe announced that it has fast tracked approval of Lenacapaville, clear clearing the injectable medicine in just 23 days.
Zimbabwe's approval comes as a global fund.
PEPFAR and Gilead began rolling out Lenacapaville in African countries, with the first shipments delivered last week to Eswatini and Zambia.
Each country received about 500 starter doses.
Regulatory submissions are currently underway in Rwanda, Tanzania, Botswana and several other high burden countries.
This initiative aims to reach 2 million people, which UN AIDS estimates could avert 50,000 new infections over three years.
However, however, this is still a drop in the ocean because UN AIDS estimates that 20 million people will need to be reached with this prevention, with this prevention, Lenacapavir and others in order to achieve the 2030 Global HIV prevention target, that target of reducing new infections by 90% from 2010.
So we're not close to the target, but hope because it's start, we've started rolling out this very effective prevention medicine.
In addition to this, Unit AID has signed an agreement with generic producer Dr Reddies to make Lenacapaville available at $40 per person per year in 120 low and middle income countries.
Starting in 2027.
Unitaid announced an initiative to start rolling out in a number of countries, and it is working together with a number of partners, I believe.
I believe this is also starting quite soon.
The Gates Foundation has signed a deal with Indian manufacturer Hetero for a similar deal, again starting in 2027.
All this is good news and gives hope, but it needs to be accelerated and scaled up.
Gilead has signed royalty free agreements with just six generic manufacturers.
We need more generic producers to be included in these agreements, notably on the African continent, to reach more people and drive prices down even further, and also in Latin America and the Caribbean where new infections are rising and where no company has been licenced to produce generics.
There are also regional initiatives giving us hope such as the Akra Reset and the African Union Road Map to 2030 and beyond.
These are initiative to carve out pathways towards health sovereignty of Africa.
President Mohammed of Ghana describes the ACRA Reset as a new vision of multilateralism marking marking a transition from global cooperation based on aid and promises to 1.
Built on mutual accountability, innovation and joint investment, the Reset demonstrates how countries can transition from aid dependence to self financed resilient health systems.
It positions health not merely as a cost, but as a driver of national prosperity and human security.
In February this year, heads of State and Government of Africa adopted the AU Road map to 2030 and beyond.
This stresses the importance of national ownership, community engagement and the transition self-reliance health systems that are sustainable.
All these regional initiatives give us hope too.
I'm just returning from the G20 Leaders Summit in Johannesburg, South Africa that ended on Sunday.
In the declaration adopted by the G20 leaders, they recognise that investments in health can be a fundamental driver of stability, growth and resistance and resilience.
They underline the importance of sustainable investment in resilient health system and pandemic preparedness and response.
The G20 leaders recognised that the developing countries face challenges in accessing finance to funds to finance their development agenda, including health.
One of the big challenges that they addressed was that of debt, that the majority of sub-saharan African countries are in a category of close to debt distress or in debt distress.
And that many of them the interest payments they make, the interest, the repayments of debt are several times more than the total investment they make in the in their health systems.
So the G20 leaders committed to support developing countries with a stronger, more effective debt restructuring process that can release fiscal space for these countries to be able to invest in the health of their people, including HIV, in the HIV response, the US.
Has released has released its new America First Global Health strategy that's also a a message of hope in our report.
This strategy signals continued significant investment in the global HIV response.
The US government aims to finalise bilateral agreements with around 70 countries to support Co investment in global health and stable transitions.
Of these, there are about 20 countries which are where these agreements are HIV focused.
These are mostly in Africa.
The Global Fund's recent A replenishment conference happened on Friday on the margins of the G20 meeting leaders meeting.
This replenishment Co hosted by South Africa and the UK, also generated renewed commitments with secured pledges of more than $11.3 billion.
We thank these governments for their commitment and additional pledges are expected from some more countries.
However, we have fallen short of the target of $18 billion because of cuts from some of the major donors.
For example, the US dropped from 6 billion to 4.6 billion and others too.
But what is hopeful is that there are countries that have increased their contributions to the Global Fund.
For example, South Africa doubled its contribution and pledged 36.6 million.
Ireland, India and Spain also increased their pledges.
And there are also some encouraging examples outside this multilateral initiative of Global Fund.
There are also examples of South S Corporation.
I was in South Africa last week, as I said, and was present at the launch of a new initiative where China is supporting South Africa with a grant of $3.4 million focused on HIV prevention for young people and people who inject drugs.
This is a new collaboration of South S collaboration channelled through US of the the United Nations.
Similar agreements are being processed by China for more countries including Iran, Lesotho and a number of countries in Africa and that Latin America and the Caribbean.
Today, here is our call to action and I'm finishing what this long presentation to you and looking forward to your questions today.
This is our call to action 40.8.
Almost 41 million people are living with HIV worldwide, almost 41 million, 1.3 million new infections occurred last year and 9.2 million people are still not receiving treatment.
So we have 40.8 million living with HIV.
Out of these, about 31 millionaire on treatment.
That's good news, that's success.
But about 9.2 are still not on treatment.
AIDS is not over.
We have new infections and we have millions of people still not on treatment, not to mention those who are on treatment but who are not virally suppressed because they are not taking it regularly enough.
So the work is still there to be done.
This World AIDS Day, UN AIDS is calling on global leaders first.
Reaffirm global solidarity and your faith in multilateralism.
Reaffirm your commitment to fight and end AIDS together as a world community.
Our progress to date has been because the world came together.
This weekend's G20 Leaders Summit and the Global Fund replenishment on the margins of this summit reinforces our faith in multilateralism.
It is alive.
It may be weakened, but it is alive and there, and countries can rise and strengthen multilateralism.
2 Maintain funding for the HIV response.
Here I'm talking about international assistance for countries that need it most.
High burdened low income countries in particular, but also highly burdened middle income countries, they need continued support in order to maintain their progress and also gradually transition to domestic financing.
Still on the funding, domestic financing cannot grow fast enough to feel.
I've said that already, domestic financing is growing but not fast enough.
So we need international assistance to remain so that countries can grow their domestic resources.
And on the question of domestic resources, we are calling on the G20 leaders, as they mentioned in their declaration to move quickly to strengthen their debt restructuring mechanism, which is called the Common framework, so that it can address the serious debt burden of developing countries who are choking on debt and are unable to invest in their health systems, including in their HIV responses.
To 3rd we call on countries, we we call on Gilead, the company that owns the technology of Lena Copperville to move to licence more companies to produce the scale and so that the cost can come down further.
Licenced companies in Latin America and Caribbean, licenced companies in sub-Saharan Africa.
Let every region be able to produce learn a cup of veer and so that we can move fast to drive down new infections.
We call upon the governments and the funders, donor governments and multilateral funds like the Global Fund to put more resources in prevention and particularly in rolling out this new medicine in a couple of view that could be could help to drive down new infections very fast and bring us closer to ending AIDS as a public health threat.
So we need action on the part of the company in terms of in time, in terms of register of licencing, more companies driving down cost and we need more resources to support developing countries to roll out to all the people who need it.
3rd uphold human rights and empower communities.
We call on all governments to defend the right to health as a fundamental human rights.
This means standing family for bodily autonomy and sexual reproductive health, and rights of women and girls, ensuring that every person has the freedom and dignity to make decisions about their own body and health.
We must push hard against a backlash on rights, rights of sexual minorities, LGBTQ people, rights of girls and women to make choices on over their own bodies, and rights to information and education about sexuality.
These are at the heart of the success of the HIV response and we must strengthen community LED action because communities are the heart of every successful response.
We have been able to reach 31 million people because communities were there to reach the people because they know the person who needs the services.
So the space for civic civil society too has been shrinking.
We call on governments to step up and continue to expand civic space and to enable communities to lead services for their people, their voices, their leadership, their lived experience, drive progress and accountability.
This is our moment to choose.
We can allow these shocks to undo decades of hard won gains, or we can unite behind the shared vision of ending AIDS.
Millions of lives depend on the choices we make now.
This has always been about justice, about equality, about human rights and of course, about global solidarity, the world coming together to fight and in this disease.
[Other language spoken]
I'm sorry to be long.
I didn't have just got off a plane from South Africa.
Didn't have enough time to edit.
My Lords, thank you.
[Other language spoken]
[Other language spoken]
We are now going to get a first hand perspective from Doctor Byron Chingombe, who is joining us online from Harare.
He's the technical director at the Centre for Sexual Health and HIV AIDS Research.
He's got more than 15 years of experience in the field of HIV programming for high risk populations.
Thank you, Byron, for joining us.
Over to you.
Thank you very much Charlotte and thank you for the opportunity confirm you can hear me clearly.
[Other language spoken]
[Other language spoken]
[Other language spoken]
So let me start by saying 2025 has been quite a difficult and hard here for us professionally and even personally.
Just to give you context, the bulk of funding for HIV programmes in Zimbabwe, it comes from external donors and it says that Zimbabwe where I I, I work, we focus on HIV services for populations at high risk, that sex workers, men who have sex with men and people who inject drugs.
So 60% of our programme was funded by USID and 40% from the Global Fund in 2024.
That enabled us to achieve videographic coverage of 42 out of the 64 districts in the country and with 183 service delivery points that cuts across static sites, mobile sites and outreach services.
This has enabled us a lot of work.
We were able to reach more than 40,000 individuals with HIV and necessary services in 2024 across prevention, testing and treatment support.
So when the disruptions came in general 2025, we lost the funding and the resources and the the the subsequent services that caused a lot of panic, confusion, misinformation across all strata for society and our programming.
The tablets within facilities and these tablets also on shelves, but the service providers meant to then make these available.
[Other language spoken]
That caused the disruption, adherence for treatment and prevention.
Importantly, that disrupted trusts among our communities.
Most of the people that we work with and we say don't routinely use public sector facilities for fear of experiences around stigma, discrimination and to reach them we then need to go out into the community and throughout its services or community services.
And this is there will be made extra difficult if not impossible with the reduced funding landscape.
We also know over the years the number of people that we've been able to reach with our services and this has been cumulatively increasing over the years and we have noted a significant drop in people accessing services from us.
For instance, our case finding is plummeted by more than 50% within 2020.
First, this does not mean that people have suddenly stopped being at risk or services are longer needed.
It only means that people have lost success.
So as such as Zimbabwe have tried to be resilient mainly by trying to diversify our funding sources so that we start reimagining our programme so that we maintain the level of service delivery.
The big one of our resilience has been the communities that we serve and at the centre of our programme is the leadership of the community itself and these communities continue to mobilise people for services and link them to services.
These are going to be the backdrop of losing 2/3 of this community footprint.
So they are now much more stretched and this very much echoes with the Executive Director sentiments that community LED programmes are much more resilient and this continues even in the face of shocks and disruptions.
The other pillar to our resilience has been funders, funders that remain committed, funders that step in to mitigate.
In some funders that also supports our transition to sustainability.
So we did lose an annual budget of more than 5 million from PEPFAR for KB programming.
But the stability of the Global Fund, which was also the component of our programme, is seen through the GC 7 grant that is going through to December 2026 and this has enabled us to continue offering services across the country up to this date and beyond.
We were one of the organisers that we're pioneering the introduction of Cambridge Gravy A2 monthly injectable to prevent HIV in Zimbabwe.
We are happy to say that Vivian Care was able to step in with the resources that we're able to maintain service delivery, focusing on the engagement, restarting and offering these services to people previously on family and they've been disrupted.
Also importantly, the resources are supporting capacity building of service providers so that the Cabela and other HIV prevention services are offered in a sustainable manner to those at risk who need these services.
So the question goes, what do we then have in the future?
What does the future hold for us?
I think the first thing that's coming and we should recognise is the game changer, the long acting injectable in a couple of any effective 6 monthly dosing.
Also happy to say that Zimbabwe has made significant strides in preparation for its introduction.
So it's already acknowledged.
We did get regulatory approvals earlier this week and we have also managed to update the prevention and treatment guidelines to recognise the long acting injectable.
We've also been started the capacity building of service providers in selected districts so that once we get the injectable we're good to go in a couple of years expected in within the first quarter of 2026 in Zimbabwe.
And we're hoping that with high impact implementation of programming around in a couple of years scale, we'll be able to restore HIV prevention services to those who need the most.
I think the other driver within the future for emphasis is AI powered health applications.
So these are a crucial link that will enable us to widen reach among those at risk, particularly those who don't routinely walk into service, service facilities.
So these visual platforms are increasingly becoming important because we now have a shrunken funding landscape which might not be able to support the traditional access platforms that we had previous.
I'm also happy to say that as SECHA, we were able to get support from GAS Foundation and if they explored and piloted a digital health companion called Mumbai.
We're working on this in one district in Zimbabwe and we're planning to quickly learn from it and scale it up for national use with support from the Ministry of Health and Childcare so that there is wider reach and people are able to easier says HIV services.
Thank you very much for the opportunity for us to share our experiences.
And Sasha, I thank you.
And back to you Charlotte, I hope you got all that presentation.
[Other language spoken]
Thank you, Byron, That was very nice that that was very complete and very hands on as as we had said, first hand perspective.
I'm now going to turn it over to the questions to questions in the room.
I see that Olivia has a question from Reuters.
[Other language spoken]
Hello everyone, thank you very much for organising this briefing today.
Some really interesting themes that have come up from both speakers.
I just wanted to get a sense of what you are projecting for 2026 in terms of the likely impact you're expecting from the collapse of HIV prevention and both in terms of services and in terms of access to preventative medicines, condoms, etcetera.
And secondly, you're mentioning about domestic funding, certainly, yeah.
I would be keen to have your projection please for next year in terms of what what you're expecting in terms of likely impact from the collapse of HIV prevention services as well as medicines, condoms, etcetera.
And also you're mentioning about the challenges of accelerating domestic funding.
Perhaps you can outline what some of those challenges are in terms of closing the gap between domestic funding and international funding?
And just finally, just a broader comment if possible.
I mean, given the way things are in the kind of global financing situation and other issues that you outlined today.
I mean, would you say we are now heading in the wrong direction after so many years of work by your agency and also many other partners on the ground towards actually, you know, seeing more of a resurgence of AIDS rather than a reduction?
[Other language spoken]
Should we do one at a time?
[Other language spoken]
OK, I will answer it together with my colleague Angelina Shrekar, our UN AIDS Deputy Executive Director.
[Other language spoken]
Your on your last question, are we moving in the wrong direction?
I wouldn't say in the wrong direction.
[Other language spoken]
That's how I would put it, because, as I said earlier, if we do not step up on prevention, given that there are even such new innovations that could help us move faster on prevention.
But if we don't, because countries are unable to put money in their own responses and development assistance is declining so rapidly, if that continues, we could.
And also the push back on rights that makes people afraid to come to get what they need even when it is there, then we're going to have new infections rising.
And we have some estimates that Angelique can can talk about.
So we're not in the wrong direction, not at this moment, but we are slowing.
We are seeing that the disruptions have slowed us and are pushing us back from the direction we've been on.
On the question of domestic, domestic financing, the high burden countries, HIV, high burden countries are concentrated in sub-Saharan Africa.
This is also the region where the countries are low income countries and they face particular challenges.
One of them is no domestic revenue mobilisation.
They've been trying for years to increase the taxes they collect, but there are constraints there.
One of the big constraints is that they are unable to rein in all the taxes that they should collect from the production in their countries.
And this lies one in the way they tax.
They do not tax progressively.
They are pressured by big multinational companies to go down low on taxes.
So there is an unhealthy race to the bottom on taxation, but also because there are tax loopholes that these companies can exploit and avoid paying their their fair share on the profits they make.
So there is an important convention being negotiated at the United Nations on tax collaboration, corporate tax collaboration that needs to be agreed as soon as possible in order to plug those loopholes that stop them collecting all the revenues that they could collect.
But they must also tax a reach tax progressively.
That is also a challenge that across the world rich people and big companies are very close to governments and they are able to write themselves out of tax brackets so that the burial of taxation is mostly on poor people through indirect taxes, consumer taxes rather than income taxes and wealth taxes on the rich.
So this is another problem.
But the biggest challenge, immediate challenge low income countries of Africa face today is this inequitable access to finance.
They've borrowed, often borrowed at very high rates.
They go to market and are charged double, triple what rich countries pay for, for capital.
[Other language spoken]
Because they are risk is assessed unfairly.
They are seen to be more at more risky than they really are.
So the way the financial system is is, is is working works against them.
They borrow at high cost.
And more recently there's been a perfect storm with COVID, with the war in Ukraine, interest rates short up and suddenly they find that what they borrowed at now has multiplied several times over.
And they are now paying some of them five times more towards the repayment of debt, the interest on debt than on health of their people.
So there is a strong call for restructuring this debt.
This is not about debt forgiveness really.
It's about reorganising the debt so that the the payments they make are much lower and there is more money now to put in health and education and and even in the infrastructure that can promote growth, which will bring more taxes and so on.
So those are the issues about the inability to raise taxes.
There's a need for urgent debt relief that frees the space for countries to invest in the immediate challenges of health and particularly of health, but also of education and social protection.
And there is also a need for a reform in the global financial architecture so that these cycles of debt don't continue happening and that there's equitable access to capital for all countries.
So G20 made some, there was some effort at severe in the financing for development conference.
There was some momentum towards addressing the debt issue and there is now a willingness of G20 also to move faster.
So let's see what happens.
And we are calling on them to really move this as an issue of as an urgent issue to free fiscal space to save lives.
Those are the answers and I want to let Anjali come in quickly prevent projections on prevention.
Sure, thank you.
[Other language spoken]
Thanks, Winnie and thank you for the questions.
Just a few things to complement what what Winnie has shared.
First on the collapse of HIV prevention, as we've noted and as Winnie has has shared, we were concerned before the disruption of services and the collapse of funding.
You know, still this stagnant 1.3 million new infections around the globe with adolescent girls and young women most impacted on the continent of Africa and key populations around the globe.
We're very concerned about new infections on the rise and as you rightly note with a a real collapse in prevention services and attention being placed on on treatment.
We are very concerned about combination prevention including condom use, including Prep, oral and injectable, including many of the other combination prevention interventions as well as treatment as prevention.
I think the one thing I would just two other things I would just add to compliment what Winnie has shared is on the domestic resource question.
I think the only other thing to add would be that it's also very important in in ensuring that we collectively work on not just what is being allocated toward the HIV response from domestic resources or funders, but how we are spending resources.
So really making sure that every every dollar, every euro, every Kwatcha is spent well on impactful interventions and finding efficiencies.
And the final thing on, are we headed in the wrong direction?
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And just to emphasise the points that look, we are at a point where we can either stand still, we can go backwards or we can go forward.
And that really is as Winnie had said, this is really the moment of the call to action to make sure we move forward together in solidarity.
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So we, we understand that considering the situation, the number of new cases hasn't raised yet.
But what are the risks, the risk, do you have any figure on that apart from the 3.3 million of new infections that will risk between 2025 and 2030, What what are the concrete risk in terms of figure?
Do you have estimations?
What you have just said is an estimate.
We're asking for estimates.
We've given you an estimate of new infections by percentage compared to the previous years because we we see that that figure between 2025 and 2030, but we don't see the comparison with the previous years.
Well, last year new infections were 1.3 million, last year 1.3 million and it was the same as a year before 2022.
So we were not the decline was actually stalling, we were declining but the decline was reducing, stuck, reaching stagnation point and that was worrisome that we were not reducing new infections as sharply as we wanted.
But now we are saying that if this situation is not reversed, if the investment in prevention services doesn't pick up again, we're going to see new infections now rising not from 1.3 to an additional 3.3.
I think it is because think about it, I'm just coming.
I will give you the example of South Africa.
South Africa is the most well off country in the sub-saharan region.
It was shouldering 83% of its own response, paying with its own resources.
Only 17% was foreign assistance.
But when this was cut off, what was closed immediately Where the services that were being provided by community, civil society?
These were about, I think they said, 12 clinics that were funded externally, run by NGOs and communities and that were servicing primarily the key populations, the LGBTQ people, the sex workers, people who interact and as well women and girls, particularly girls were programmes that were targeting young women and girls because of also their own special needs.
Now, when these were closed, they were focusing on prevention but also testing, treatment, care.
But the treatment side is what was hit hardest because these same people, the government moved quickly to try to bring them back to services, right, to bring them back to mainstream services.
So in fact, they were picking out those who are HIV positive to come to get treatment at mainstream clinics and to try to give them privacy to overcome stigma and discrimination.
But the prevention was not there.
So you see that prevention has been hit more than than treatment and prevention has been LED very much by communities.
So that is why you're going to see new infections rising, even though actually governments are struggling hard to keep people on treatment.
But even there you're probably going to see, we are seeing already the a drop in tests, testing it's not as high in some countries as it was before the drop suggests that perhaps it's these people who fear the mainstream services who are not coming because of fear of of stigma, mercy that was sorry.
Christoph Cobwell from AFP, Yes, yeah, sorry to insist, but about this figure of 3.3, would it be so 3.3 million annually or total by 2030?
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Thanks for the question.
Hopefully, I could provide a little more detail to answer your question and maybe compliment a couple of things that Winnie mentioned as well.
First, it is three additional 3.3 million cumulatively by 20-30.
I want to emphasise that in the new global aid strategy for 20/26/2031 and the targets that have been set, those targets are very ambitious to make sure that we are the globe is striving toward a 90% reduction in new, in new cases.
So that accelerated push is going to be really important as when he was noting in her remarks earlier that we, we as a globe have to work on.
The other thing I'd like to note is that I think it's, I think it's very important to connect the funding landscape at a granular level with what we're seeing in the prevention response.
So for example, we show in the report that we show in the report how external donor funding by category.
So for example, by prevention category is arrayed across different regions and where you see high external funding it especially in cases for prevention like in West and Central Africa for instance, where it's 91% externally funded for prevention.
This is where we become very, very concerned because we know that in in situations like this where regions or countries in particular are highly dependent on external funding and we see declines in external funding for prevention, then we have an issue on our hands where new infections will continue to rise.
So just continuing to bridge the gaps between funding and implementation.
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I'm going to take the next question from Carmen Pond from Politico.
This will be the second to last question.
Then we will take the question from Jenny Lee from Devex over to you, Carmen.
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So I have two questions if I may.
The first one is about the funding cuts.
Obviously, the US has been the biggest one, but the report does refer to funding cuts from several donors.
So I was wondering if there have been other countries or other major donors in the HIV space that have cut funding this year and if that was done suddenly like in the US or it was a more gradual cut.
And the second one is the report mentions that people have died as a result of the sudden funding cuts, I assume mostly those coming from from the US side.
And, you know, the State Department disputes that claim every time it comes up.
So I was wondering if UNAIDS has any sort of like accounting, although I know it's a very grim accounting of, you know, potential deaths as a result of the sudden US funding cuts on HIV.
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You were speaking very fast.
I missed the last question you you asked.
Can you repeat it?
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So I was wondering about people dying as a result of the US funding cuts.
The report mentions that people have died.
The State Department disputes that.
It says that is not true.
So I was wondering if the UN8 has any any sort of like concrete data on the number of people who died as a result of the cuts, particularly the suddenness of the US funding cuts.
Regarding cuts, the cuts are happening across the board.
Of course, the cut, the pause of the US funding was dramatic because it was immediate and and unexpected.
But there was also a restoration we are happy about that of funding and the US being the major funder of the HIV response, their return means that there is some stability of the response.
We are also happy that the US has offered multi year funding that gives some predictability for those countries that receive that assistance.
But for the other donors we've we are also seeing dramatic cuts or cuts in ODA.
It is expected that by the end of this year, the total total funding ODF funding will have reduced by close between 30 and 40% from the from last year, a cut of between 30 to 40% from last year and that includes global health.
Yes, some countries like the UK have said they will ring fence, although they have also cut their domestic, their international assistance, their aid from 0.5% of their GDP to 0.3%.
But they're saying within that cut they are ring fencing global health and not cutting global health.
But that's not the case with others.
With others, the cut is the cut and global health is is not ring fenced.
So the cuts are dramatic across the board and we saw that with the Global Fund replenishment that the gap between 18,000,000 and what was achieved, the pledges 11.3 that might go up to maybe 13 or close to 14 when the others also put in theirs.
There were some countries whose budget processes had not yet concluded, but we can see the gap will be more than or close or more than 4 billion for the Global Fund.
So yes, the cuts are deep and are fast and there is a need to support developing countries to find other resources to make up for it.
Or people dying, I think.
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Thanks, Winnie, and thank you for the question.
Maybe just a couple of a couple of points on that question around people dying.
First, just to emphasise again that in the report we we prioritised the display of both quantitative data and qualitative data because as you know UN AIDS monitors through the global AIDS monitoring over 160 countries and their responses where we're looking very closely at AIDS related deaths, new infections, new cases etcetera.
Funding for the HIV response.
Those data come out every summer.
And so next summer we will have a very holistic in depth analysis of specific deaths associated related to the funding disruptions etcetera that have occurred.
It takes that it takes us that long to be working with the countries to make sure we validate the numbers and share hard figures.
But that is also why we instituted the mini Global AIDS monitoring to look as quickly as we could across a number of countries to see what kinds of immediate impacts from the disruptions we could see.
And we did see, we did see drops in testing, we saw drops in seeking services, we saw drops in prevention services as Winnie had noted earlier.
So these are all important indicators for what we potentially will see in in the coming year.
We also provided qualitative data in the report, very, very rich and deep qualitative data from community organisations, from people living with HIV, from key population groups, women LED groups, youth groups, et cetera.
These qualitative data and from community LED monitoring data, these qualitative data are, are very important to provide further details on what we're seeing.
So the, the final thing I'll just note, as I've, as I've pointed to, we can't, we can't give you specifics in terms of have people died right now, but we will be able to have details to share in the coming, in the coming months.
But it but the final thing I'll say is that it's also important to look at AIDS related deaths or are they truly caused by are these deaths caused by AIDS?
Are they deaths caused by TB?
These are all the nuances that we will be looking at looking at as we move into the future.
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Perhaps it's also the wrong question to ask because HIV, it embeds itself in someone's body and takes time before it weakens the body and somebody dies.
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If people are suddenly off treatment, we also know that the virus that has been suppressed becomes live and that can happen in a few weeks.
But in those few weeks that patient will not die but will start to weaken because of the viral load.
So we really will see the evidence of this or the impact of these sudden cuts and the reversal in rights.
We will start to see it much later and that's why it is important that we put out this notice that we tell governments that the impact of their decisions today, we will see them later in a year, in two years.
So it's so important that governments are taking decisions well aware that they are not going to see the negative impact the debts now.
But by making decisions now, some people will die in some years to come, and that's not good.
So our notice is so important.
It's a warning about your decision now and that the real impact.
You will see it later.
Messi, that was very clear.
Thank you, Winnie and Anjali.
Last question from Jenny Lee Ravello from Devex.
She's the global health reporter.
Over to you, Jenny Lee.
Hi, thank you so much for for the opportunity.
Can you speak more about China's support for the HIV response and how significant this is during a period of funding cuts from traditional government donors?
We need mention agreements being discussed with several countries in Africa and Latin America and the Caribbean.
Will that funding be given directly to governments or also course through UN AIDS and, and, and can we expect China to also help provide lenacapavir to these countries, helping expand access to the HIV prevention drug?
My understanding with the funding in South Africa is it's focused on HIV prevention and I wonder if if that includes expanding lenacapavir access.
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China has been supporting the HIV response for a long time.
It has been contributing to our core budget.
This is additional to what they have been contributing.
This is very this is support SS collaboration between China and a number of developing countries.
We you can see our role as that of broker and technical supporter.
We encouraged and catalysed this funding for a number of countries as additional support by China to developing countries and we are providing Technical Support for the money to have it's highest impact.
Now in terms of where they're supporting, they selected a number of countries where they already have other programmes and have strong relationships.
These include countries like Zimbabwe.
I think there is also a country like I think Haiti might be one of them, Lesotho, Uganda, I think Tanzania.
But there are some Latin American countries, mostly African countries.
Cuba is one of the countries they are supporting.
So they will not spend their Chinese yuan buying Lena Kapavir.
Then a Kapavir is an American product and the Chinese government will spend its money on products from Chinese companies that that has to be expected.
So the prevention programmes will be rolling out some innovations that are Chinese and we can expect that learn a couple of you will be supported through Global Fund and others and China contributes to the Global Fund as well.
So it will be contributing to learn a couple of you but through the Global Fund, but it's it's direct, it's these projects will be more in in promotion of their own companies.
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That's the conclusion of the UNAIDS press conference.
And do not hesitate to go to our website unaids.org.
There are additional material, social media, etcetera.
Merci answer the next question.
Was there a Devix question that was it about China?
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I appreciate you coming and don't hesitate to reach out.
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