Sub-Saharan Africa Faces Funding Crisis in HIV Response Amid Rising Debt

Sub-Saharan Africa is home to over 25.9 million of the 39.9 million people living with HIV globally, yet the region’s significant progress in reducing new infections by 56% since 2010 is at risk. A recent report released ahead of the 79th session of the United Nations General Assembly highlights the urgent need for increased funding to sustain these gains.

The report warns that escalating public debt payments and spending cuts mandated by International Monetary Fund (IMF) agreements could leave countries dangerously under-resourced to tackle their HIV crises. “When countries cannot effectively look after the healthcare needs of their people because of debt payments, global health security is put at risk,” stated UNAIDS Executive Director Winnie Byanyima. She called for urgent debt reduction and enhanced domestic resource mobilization to create the fiscal space needed for a comprehensive global HIV response.

In countries like Angola, Kenya, Malawi, Rwanda, Uganda, and Zambia, debt servicing now consumes over 50% of government revenues. Even after debt relief measures, Zambia is projected to allocate two-thirds of its budget to debt servicing between 2024 and 2026.

HIV response spending has declined in Western and Central Africa, dropping from 0.3% of GDP in 2017 to just 0.12% in 2022. To fully fund the HIV response in 2024, Western and Central Africa will need to mobilize US$ 4.18 billion, a figure that could rise to US$ 7.9 billion by 2030 if new infections are not curtailed.

While US$ 20.8 billion was available for the HIV response in low and middle-income countries in 2022, this fell short, leaving Western and Central Africa with a funding shortfall of 32%. Eastern and Southern Africa faces similar challenges, requiring nearly US$ 12 billion in 2024, escalating to around US$ 17 billion by 2030.

To effectively respond to their health crises, sub-Saharan African nations must strengthen tax systems and address tax exemptions that cost an average of 2.6% of GDP in lost revenue. Additionally, international donors are urged to increase financial assistance for health initiatives, while creditors should consider debt relief for heavily indebted countries.

“World leaders cannot let a resource crunch derail global progress to end AIDS as a public health threat by 2030,” Byanyima emphasized.