Africa’s Defining Moment: Leading the HIV Response

For decades, Africa’s HIV response has been heavily influenced by external donors and international health organisations. While these efforts have saved millions of lives, they have also created a reliance on foreign aid, leaving the continent vulnerable to shifting global priorities. Now, as HIV funding declines and global crises compete for resources, Africa faces a critical moment: the need to take ownership of its HIV response.

A newly published article in The Lancet Global Health (available here) argues that Africa must step up and lead the fight against HIV with urgency, boldness, and vision. With 65% of the world’s 39.9 million people living with HIV residing in Africa, the stakes couldn’t be higher. Countries such as Botswana and Rwanda have demonstrated that progress is possible by reaching UNAIDS' 95-95-95 targets - showing that local leadership and commitment can drive meaningful change.

Challenges and the Call to Action

Despite significant strides, major challenges remain. Key populations—including adolescent girls, young women, and marginalized communities—continue to face disproportionately high infection rates due to stigma, punitive laws, and systemic exclusion. Furthermore, recent U.S. policy shifts, including a withdrawal from the World Health Organization (WHO) and potential cuts to PEPFAR, threaten to destabilize Africa’s healthcare systems, leading to disruptions in treatment, increased infections, and loss of critical healthcare personnel.

The article highlights six pillars that African governments and stakeholders must embrace to take control of the HIV response:

1. Strengthening Political Commitment – Fully implementing the Abuja Declaration and integrating HIV responses into broader health systems.

2. Increasing Domestic Financing – Exploring innovative funding mechanisms such as public-private partnerships.

3. Empowering Communities – Addressing stigma and ensuring equitable access to care through community-led accountability.

4. Reforming Legal Barriers – Eliminating laws that marginalize key populations and fuel HIV transmission.

5. Investing in Research and Data Sovereignty – Generating locally driven solutions tailored to Africa’s specific needs.

6. Leveraging Global Partnerships on Africa’s Terms – Ensuring that external support aligns with African priorities and strengthens local systems.