What will HIV funding look like in 2026?

Health organisations that merge, more investment from the private sector, larger contributions from local governments and a much bigger focus on preventing new HIV infections. That’s how the international health advocate, Mitchell Warren, sees HIV programmes surviving this year after the US government’s massive funding cuts in 2025. Warren heads the New York organisation, Avac, which also works in East and Southern Africa.

Ten countries, eight of them African,will receive donations of a six-monthly HIV prevention jab, lenacapavir, from the US government’s Aids programme, Pepfar, this year. South Africa, on the other hand, willget donations only from the Global Fund. Warren explains: “It’s bad for the HIV response in South Africa and around the world but it’s also just the most remarkably dumb economic policy because South Africa is the strongest economy on the continent [and the goal of Pepfar’s investment is tobuild a market for lenacapavir as fast as possible].” By December, the fund had received only 63% in pledges for its $18 billion goal of contributions.

The UK’slatest contributionis 15% less than itsprevious contributionin 2022 andGermany’s 2022 contributionwas 23% higher than its2025 contribution(the fund works in three-year cycles). We talked toWarrenabout what we can expect in the Aids world this year, what we can do differently and how he thinks we should rebuild. Following is an edited version of Mia Malan’s conversation with Warren,which was broadcast on ourBhekisisapodcast.

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Mia Malan (MM):Let’s start with your work. How has your organisation changed in the past year? Mitchell Warren (MW):We received one of those[Pepfar] stop-work ordersa year ago and ended up laying off about a third of our staff.

Even more difficult were decisions about sub-grants to partners all over East and Southern Africa — those grants were terminated, meaning a lot of them had to downsize and lay off staff as well. We’re about 40% smaller budget-wise and working hard to make sure we are fit for the future. MM:What does “fit for the future” mean when you have less money?

How do you become smarter? Can you give practical examples?

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