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The debt crisis is jeopardising Eastern and Southern Africa’s efforts to meet the 2030 goal of ending acquired immunodeficiency syndrome (AIDS) as a public health threat, a recent United Nations report has warned.
The report highlighted the financial strain threatening the region’s human immunodeficiency virus (HIV) response. Titled Domestic revenues, debt relief and development aid: Transformative pathways for ending AIDS by 2030, the paper was released by the Joint UN Programme on HIV/AIDS on September 19, 2024 ahead of the 79th session of the UN General Assembly in New York, United States.
As public debt payments rise and spending cuts are implemented under International Monetary Fund agreements, countries across Eastern and Southern Africa are facing significant challenges in financing HIV prevention and treatment programmes. If these issues remain unresolved, the report cautioned, governments could be left dangerously underfunded to support their HIV responses over the next three to five years.
The region, comprising countries such as Angola, Kenya, South Africa and Zimbabwe, remains the epicentre of the HIV epidemic, accounting for 52 per cent of all people living with HIV globally. In 2023, 20.8 million people in the region were living with HIV, including 12.9 million women and 800,000 children.
However, a growing financing gap is threatening progress. In 2022, an estimated $10.5 billion was needed to support the HIV response, but only $9.8 billion was available, 61 per cent of which came from international donors. Despite commitments to increase domestic funding, the region continues to rely heavily on international aid, with countries like Ethiopia, Malawi and Uganda depending on external assistance for nearly all of their HIV-related interventions.
Moreover, financial support for the HIV response has been declining in recent years, with funding in 2022 falling 1 per cent from the previous year and 12 per cent since 2017. Tax revenues have also dropped across the region, with Ethiopia, Kenya and South Africa still struggling to return to pre-pandemic levels of revenue collection.
The report further highlights the growing public debt crisis, with five countries, including Malawi and Zambia, classified as being in “debt distress,” while others, such as Kenya and South Sudan, are at “high risk.” As debt relief efforts prove insufficient, there is concern that governments may be forced to cut back on essential health services, including HIV programmes.
To fully fund the HIV response in 2024, the region will need to mobilise nearly $12 billion, a figure expected to rise to $17 billion by 2030 unless new infections are significantly reduced.
“World leaders cannot let a resource crunch derail global progress to end AIDS as a public health threat by 2030,” said UNAIDS Executive Director Winnie Byanyima, urging international cooperation and increased funding to prevent a reversal of hard-won gains in the fight against AIDS.
