Last World Aids Day, I wrote about a young woman who exchanged sex for a single tomato. This October, I met a 15-year-old, already a mother of two, her eldest just three, who had to survive in the same way. These are not stories from the distant past. They are unfolding now, in 2025, across our region. They remind us that too many lives remain on the edge and that our work to ensure no one is left behind in the HIV/Aids response is far from over. And yet, we find ourselves at a turning point. The hard-won gains of the past decade are at risk of slipping away, even as so much still remains to be done.
For four decades our region has carried the heaviest weight of the global HIV epidemic. But it is here that we have also seen some of the most extraordinary progress: millions of lives saved, millions protected from acquiring HIV and health systems built from the ground up through the courage and leadership of communities. This is progress earned through struggle and solidarity. But today those gains are under threat.
This year’s World Aids Day theme – Overcoming disruption, transforming the Aids response – captures the urgency of this moment. The disruption we face is real and immediate, and the foundations of our progress are being shaken.
In 2025, abrupt reductions in international HIV/Aids funding hit our region with devastating force. Countries moved quickly to protect access to treatment, but HIV/Aids prevention and community-led services, services that reduce risk, empower women and girls and support key populations, were greatly affected.
Young women, like the ones I described at the start, were hit hardest. In a recent Athena Network survey, nearly half of the 440 young women interviewed said they could no longer access sexual and reproductive healthcare, HIV/Aids prevention or even treatment. Clinics had closed, health workers were unavailable and vital programmes had been scaled back or shut down.
Across the continent, the consequences of the disruptions have been stark:
- Uptake of pre-exposure prophylaxis fell sharply between late 2024 and mid-2025, by 38% in Uganda and 64% in Burundi;
- Prevention programmes for adolescent girls and young women, who still account for 1 in 4 new HIV infections in sub-Saharan Africa, were cut abruptly;
- 2.5 million adolescent girls and young women across 15 high-burden countries have been greatly affected by the closure of the Pepfar-supported Dreams initiative, which had provided information, sexual and reproductive health support and livelihood skills; and
- Services for key populations (including sex workers, gay men and other men who have sex with men, transgender people and people who inject drugs) were disrupted or shuttered.
UNAids warns that the collapse of HIV/Aids prevention services could result in 3.3 million additional new infections, globally, between 2025 and 2030. Many of these would be here, in our region.
And yet, despite all of this, I remain optimistic.
Refusing to back down on HIV/Aids
I have seen countries rally in extraordinary ways. Many countries moved swiftly to close the funding gaps and keep their citizens on HIV/Aids treatment, some increased their health budgets to cushion the shock. For example, Tanzania is introducing new levies for health and HIV/Aids to offset the funding cuts. South Africa has stepped up domestic financing for their HIV/Aids response. The Africa Union’s Roadmap to 2030 and Beyond, which was endorsed by our own leaders, anchors a vision of sustainable, diversified financing for HIV/Aids and health.
And our communities, as always, refuse to give up.
In Zimbabwe, LGBTQI+ groups are building partnerships with the government to protect access to lifesaving services. The National Empowerment Network of People Living with HIV/Aids in Kenya (Nephak) is pushing for HIV/Aids care to be fully integrated into national health insurance so that no one is left behind. These are acts of leadership and commitment to the HIV/Aids response.
But we cannot overcome disruption through resilience alone. We must protect the foundations of our progress with sustained financial investment, renewed commitment to HIV/Aids prevention and the leadership of the communities that have carried us this far. And we must not forget the two young women I mentioned earlier, left behind and facing the harsh consequences of our inaction.
We can allow this moment of disruption to undo a generation of progress and see millions more young women and girls exchanging sex, and acquiring HIV, for survival; or we can transform this moment into one of renewal that brings us closer to ending HIV/Aids as a public health threat.
Eastern and southern Africa have come too far to turn back now. DM