Global HIV leaders have urged African countries to fully own their HIV responses and called on governments to urgently invest in community-led systems to protect two decades of progress.
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Speaking on July 13 during the opening of the 13th International AIDS Society Conference on HIV Science (IAS 2025) in Kigali, they warned that without sustained and smarter investments, millions of lives are at risk.
Dr. Yogan Pillay, the Director of HIV and TB Delivery at the Gates Foundation, explained the need to build national programmes from the ground up. He gave an example of the success of the Blantyre model in Malawi, where the district medical officer took ownership of the HIV response and developed localized interventions.
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“Taking a detailed, ground-up approach is essential as it means co-developing, co-publishing, and building programmes alongside local leaders from the very start,” Pillay said.
He spoke against the disconnect that can arise between global funding strategies and national situation, noting that nothing is more harmful than having multiple donors running competing programmes.
“Funders like the Gates Foundation must be clear about what we’re doing, what outcomes we seek, and what success looks like. Efficiency matters more than ever now, especially with shrinking resources.”
Representing the President’s Emergency Plan for AIDS Relief (PEPFAR), Dr. Ingrid Katz, said that PEPFAR’s 20-year history has built strong national systems, adding that the current focus is supporting countries to take full control of their HIV programmes.
“This is about sustainability, Ministries of Health should lead. Our job is to invest in what works and support countries as they shape their own HIV responses within broader health systems.”
Katz pointed to sustainability roadmaps developed since 2023 as important tools to guide countries through this transition.
She acknowledged that many countries are facing disruptions, noting the importance of keeping long-term planning and national priorities at the center of the response.
UNAIDS Deputy Executive Director, Christine Stegling, noted the risks of excluding communities from the HIV response.
“Where we’ve seen the worst impact of the current funding crisis is in community systems and prevention, that is where it hits first,” she stated.
Stegling added that community networks have driven the HIV response since the start, demanding treatment, holding governments accountable, and reaching those left out by mainstream health systems.
She also mentioned the need to institutionalize funding for communities, not just because it’s the right thing to do, but because it’s more efficient and effective.
Stegling explained that while 80% of countries allow networks of people living with HIV to operate, only half support networks of key populations such as sex workers, LGBTQ+ people, and drug users, with legal protections and funding mechanisms.
“We need enabling policy and legal frameworks, there should be models like social contracting and community-run enterprises to become standard parts of national responses,” she added.
She added that the challenge is ensuring community systems can survive in difficult political environments, noting the need for innovative financing that works even where human rights are under attack.
Dr. Pillay noted that self-care and artificial intelligence are key drivers in HIV strategies, adding that self-care is central to both prevention and sustainability and AI can help reach people more efficiently.