Global Health Watch: New Political Declaration on HIV/AIDS, End of US PEPFAR Support for South Africa + Treatment Declines

Issue 74

June 26, 2026

UN member states adopted a new Political Declaration on HIV/AIDS reaffirming global commitments to end AIDS by 2030, but for the first time since 2001, the declaration was not adopted by consensus – and with the US notably voting against it. At the same time, last week’s news that the US Department of State is assuming greater control over PEPFAR is followed this week by the phase-out of US PEPFAR support for South Africa and new analyses showing PEPFAR-supported HIV treatment declined in 2025, following the US Administration’s foreign aid freeze. Also, for organizations in the US, please consider signing Partners in Health’s Letter to Protect CDC PEPFAR Programs.

UN HIV Declaration Adopted Amid Deep Political Divisions

The UN General Assembly adopted a new Political Declaration on HIV/AIDS this week reaffirming global commitments to end AIDS as a public health threat by 2030. However, for the first time since political declarations on HIV began in 2001, the declaration was not adopted by consensus. And importantly, the US delegation voted against the declaration. Deputy US Representative to the UN, Tammy Bruce, said in a comment rejecting the declaration that it strayed too far from the targets for ending AIDS “by including divisive topics”. The declaration acknowledges that progress toward the 2030 goal is off track, highlighting widening funding gaps, disruptions to HIV services, and persistent barriers faced by populations at high risk of HIV. Advocates and civil society played an important role in ensuring the declaration included commitments to evidence-based, rights-based HIV responses and renewed calls for sustained investment in prevention, treatment and community-led services.

IMPLICATIONS: The divided vote underscores how geopolitical tensions and domestic politics in the US are shaping global health policy at a moment when the HIV response faces its greatest financing crisis. While the declaration provides an important political framework for countries and advocates, it carries no binding obligations and offers few concrete answers to address the growing funding shortfall as nationalism rises and development assistance falls. The US government’s opposition marks an insular, ideologically driven retreat from longstanding consensus for rights-based HIV programming, particularly for key populations who continue to bear a disproportionate burden of HIV. This is consistent with the harmful policies and positions the US Administration has taken against communities vulnerable to HIV including the Promoting Human Flourishing in Foreign Assistance (PHFFA) and the invisibility of vulnerable populations in the most recent PEPFAR data.

In response, global civil society groups led by Health GAP have elevated the People’s Declaration on HIV/AIDS as a counter to the resulting Political Declaration. Over 400 organizations signed onto the People’s Declaration, illustrating a major show of power and call for action by governments to reaffirm commitments, rights, and investments to end HIV for everyone, everywhere.

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US Ending PEPFAR in South Africa

The US Administration abruptly announced its intention to end PEPFAR support in South Africa, with funding expected to terminate by early 2027. The decision is part of the Administration’s broader retrenchment from foreign assistance and is related to political disagreements with the South African government. South Africa receives more than $400 million annually through PEPFAR, which supports health workers, prevention programs and service delivery. This decision marks one of the most consequential changes to PEPFAR since its creation in 2003, with significant implications in envisioning an end to the HIV epidemic – in South Africa and globally. This news follows the Administration’s Executive Order in February 2025, which made baseless claims about South Africa, and the March 2025 decision to “hold all research awards” for South Africa after designating it a “country of concern”. At the time, AVAC told Bhekisisa, “It is very clear that the President is using budgets and terminations of previously agreed to programmes to redefine agendas… that defy science and are clearly political and ideological.”

IMPLICATIONS: The PEPFAR withdrawal from South Africa reinforces the shift away from evidence to ideology, moving from long-term global health partnerships toward a more transactional foreign policy model. These short-sighted decisions come despite the historical South Africa-USA partnership that has catalyzed scientific research and program impact for HIV prevention and treatment, where the country plays a vital role in clinical research, development of cutting-edge prevention technologies, and implementing models for treatment, care and prevention. Although South Africa finances its own antiretroviral medicines, PEPFAR supports important aspects of the health workforce, community-based prevention and services for key populations. A rapid withdrawal will disrupt testing, prevention and services, placing additional strain on the country battling the largest HIV epidemic. Furthermore, the end to PEPFAR funding along with the severance of National Institutes of Health (NIH) research partnerships, cuts off a country that is central to ending the global epidemic and one that continues to inform the science of HIV and tuberculosis treatment and prevention.

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New Analysis Shows Decline in PEPFAR-Supported HIV Treatment

A new analysis published in Nature Health finds that PEPFAR-supported HIV treatment declined in 2025 following the US Administration’s foreign aid freeze, with approximately 2 million fewer people reported as receiving PEPFAR-supported antiretroviral therapy than in 2024 (a 10% decrease). Of the 26 countries examined, treatment support fell across all, though some of the decline reflects changes in how PEPFAR classifies and reports treatment support rather than patients losing access to care. South Africa was called out in the analyses, accounting for most of the treatment declines—individuals previously counted as receiving direct PEPFAR support were reclassified as benefiting from broader health system investments, resulting in a net treatment decline of about 95,000 people (1.8%). The authors conclude a “decline of ∼1.73 million individuals on direct PEPFAR-supported treatment and an increase of ∼1.64 million individuals on treatment benefitting solely from the programme’s broader support to health systems, yielding a net treatment loss of 94,881 (−1.8%)”.

IMPLICATIONS: As the authors conclude, “while the analysis cannot determine whether and to what extent declines will translate into reduced individual- or population-level treatment outcomes, a reduction in PEPFAR-supported treatment of this scale within a single fiscal year raises concerns.” The data underscore the significant disruptions caused by funding uncertainty and restructuring across the program.

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Add Your Voice to Stop OMB’s Attack on American Science

Proposed new regulations by the White House Office of Management and Budget (OMB) would use budgetary and regulatory tools to bypass longstanding scientific peer-review and congressional processes, including withholding appropriated funds, restructuring federal agencies, and proposing rules that would give political appointees greater influence over research funding decisions. Public comments are due by July 13th – please consider taking action and visit Stand Up for Science’s STOP OMB portal now.


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