Amid funding disruptions, leaders from 11 African Countries release policy
recommendations to advance HIV response—backed by more than 60 experts from around
the world
May 9, 2025 — As disruptions in U.S. Government funding for global health destabilize
healthcare services for millions of people and threaten a major resurgence of the global
HIV pandemic, leaders of the HIV response from 11 African countries came together at a
landmark convening to discuss the evolving situation and to build on existing strategies to
advance the effectiveness and long-term sustainability of the HIV response. The
convening—hosted by the Government of Malawi and co-chaired by Dr. Beatrice Matanje,
Chief Executive Officer (CEO) of Malawi’s National AIDS Commission (NAC); Dr. Lilian
Chunda, Chief of Health Services at Malawi’s Ministry of Health; and Dr. Charles B.
Holmes, Prof. and Director of Georgetown University’s Center for Innovation in Global
Health (CIGH)—culminated in a series of recommendations for policymakers across the
Africa region and beyond.
These recommendations were published today in a joint Lancet HIV Viewpoint and a
related policy brief endorsed by more than 60 leaders and experts who attended the
convening.
“The recommendations of this group reflect the grounded views of many leaders of HIV
programs across the continent of Africa and are intended to be helpful as political leaders
and finance ministers make critical decisions in the months and years ahead,” said Prof.
Kenneth Ngure, Immediate Former Dean of the School of Public Health of the Jomo
Kenyatta University of Agriculture and Technology in Kenya and the President Elect
International AIDS Society, who co-authored the Lancet HIV Viewpoint and endorsed the
policy recommendations.
The multi-country convening was held February 18–19, 2025, in Lilongwe, Malawi, under
the auspices of the broader Sustainable Prevention Initiative (SPI), a group that emerged
from discussions begun at the 2023 ICASA meeting in Harare, Zimbabwe. Senior leaders of
National AIDS Coordinating Authorities and HIV Directorates from 11 African countries
(Eswatini, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa, Tanzania, Uganda,
Zambia, and Zimbabwe) attended the convening, along with development partners,
donors, civil society representatives, and technical experts.
The meeting dialogue deepened the group’s collective understanding of the seismic shifts
in the external funding environment for HIV programs, and accelerated discussions on core
health system functions and capabilities essential for sustaining and strengthening HIV
programming. Participants highlighted emerging examples of nationally-led policies and
programs, with a focus on integrated HIV prevention approaches, the vital importance of
emerging long-acting HIV prevention technologies and alignment of the needs of
communities and impacted populations.
Following the convening, SPI leaders wrote a Viewpoint article titled “The Global HIV
Response at a Crossroads: Protecting Gains and Advancing Sustainability Amid Funding
Disruptions,” published today in the Lancet HIV, and 60 participants endorsed a policy
brief titled “Strengthening National Leadership for Sustainable HIV Programs: A Policy Brief
for Government Leaders.”
The Viewpoint provides specific country-level inputs on how funding disruptions threaten
to reverse gains in the HIV response, includes a series of recommendations for national
leaders, and calls on funders to support service delivery integration, fund high-priority
under-funded areas, invest in health system resilience, and ensure access to long-acting
pre-exposure prophylaxis (PrEP).
The policy brief, developed for national political leaders, outlines key strategic priorities for
governments to sustain their HIV response: increasing domestic financing, integrating HIV
prevention and treatment within primary healthcare services, prioritizing prevention—
including highly effective long-acting formulations—within national HIV agendas, and
ensuring inclusive access to HIV services for vulnerable populations.
As noted by Malawi’s Chief of Health Services responsible for Reforms in the Ministry of
Health, Dr. Marthias Joshua, in remarks delivered at the opening of the Lilongwe
convening, “The key question before us is not only what must be sustained, but how we
ensure its sustainability in the face of evolving challenges. Malawi’s experience with the
Blantyre Prevention Strategy has demonstrated that sustainability cannot be achieved
through short-term interventions alone. A health systems approach is essential—one that
coordinates resources and strengthens long-term capacity across the entire continuum of
the HIV response. Sustaining progress requires structural solutions, ensuring that HIV
prevention, diagnosis, treatment, and care are embedded within a resilient, adaptive, and
nationally owned health system.”
“Through this work and these policy recommendations, we’re moving towards a better
understanding of how we can protect gains made in the HIV response,” noted NAC CEO, Dr.
Matanje. “This starts with national leadership on key reforms including integration of HIV
interventions within broader national health systems, while ensuring that vulnerable
groups continue to be reached effectively with the most effective interventions. We are
calling upon all national leaderships, policy makers, program implementers and
development partners to consider the recommendations made through the publications
launched today.”
Dr. Yogan Pillay, Director of TB and HIV Delivery at the Gates Foundation noted that “the
Gates Foundation is pleased to support these important dialogues aimed at advancing
more sustainable and effective responses to HIV. It is encouraging to see national leaders
taking greater ownership of their HIV programs to maintain the greatest possible impact as
we approach the 2030 deadline to meet the Sustainable Development Goals.”
Dr. Holmes, CIGH Director and former PEPFAR Chief Medical Officer and Deputy U.S.
global AIDS coordinator, commented that “while the precipitous decline in U.S. support is
undermining key elements of the global HIV response, Governments and Civil Society are
coming together to identify strategic actions they can take to maintain momentum against
the HIV pandemic. I’m confident that these discussions and recommendations will
ultimately enable stronger national responses to HIV and will give donors greater
confidence in continued investments towards ending AIDS.”
A convening at IAS 2025, the 13th IAS Conference on HIV Science, in Kigali, Rwanda will
focus on these topics and provide for further dialogue around the functions, capabilities
and national leadership needed in the next phase of the global HIV response.
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