By MONICA KAYOMBO in Rio de Janeiro, Brazil
A PEACEFUL protest by HIV activists set the tone for a pre-conference session ahead of the 26th International AIDS Conference on Sunday, as demonstrators challenged the United States (US) over changes to its global HIV funding strategy under the President’s Emergency Plan for AIDS Relief (PEPFAR).
The protest briefly disrupted remarks by Acting U.S. Global AIDS Coordinator Jeff Graham, with activists accusing the U.S. administration of undermining decades of progress in the global HIV response through funding restrictions, the closure of HIV programmes serving key populations and reduced transparency in the management of PEPFAR-supported programmes.
In a statement issued after the demonstration, campaigners from organisations including South Africa’s Treatment Action Campaign and Health GAP said communities affected by HIV were already experiencing disruptions to treatment and prevention services.
“The U.S. government must be held accountable for the ongoing global public health emergency they are causing,” said Anele Yawa of South Africa’s Treatment Action Campaign.
Health GAP Executive Director Asia Russell said the world could not ignore what she described as the erosion of decades of progress in HIV programming.
The protest came just before a U.S. government-hosted session dubbed “Operationalizing the America First Global Health Strategy: ( MoUs), Implementation Plans and Governance,” where senior officials sought to reassure partner countries that the US remains committed to ending HIV while reforming how its global health assistance is delivered.
Opening the session, Chris Akolo, Senior Technical Director for HIV at FHI 360, said the meeting had been organised to foster dialogue among ministries of health, local implementing partners and U.S. government agencies as bilateral Memoranda of Understanding (MOUs) become central to future HIV programming.
He said the discussions would focus on translating the agreements into practical implementation plans that promote sustainability and country ownership while maintaining essential HIV services.
Addressing delegates, Mr Graham acknowledged widespread concerns over the reforms but insisted the United States was “changing the model, not the mission.”
“The United States remains the most generous country in the world. Our commitment to ending HIV is undiminished. We are here. We are still in the leadership seat for global health. We are here leading the HIV response. We’re changing the model, but not the mission,” he said.
Mr Graham said the reforms are intended to help countries gradually take ownership of their HIV responses instead of remaining dependent on external donors.
“We are helping countries build the capacity to solve their own challenges instead of perpetuating dependency,” he said.
He argued that under the previous model, only about 40 cents of every U.S. health assistance dollar reached frontline healthcare workers and essential commodities, while the remaining 60 cents was spent on overheads, technical assistance and programme management.
“Success was often measured by how many dollars went out the door and into partners’ hands, not necessarily by how much actual care was being delivered,” Graham told delegates.
He dismissed claims that the US was withdrawing from global HIV programmes, saying Congress had appropriated $9.4 billion for global health programmes in 2026 and that the U.S. intended to utilize the full allocation, including continued investments in HIV, tuberculosis, malaria, maternal and child health and global health security.
Mr Graham revealed that 34 countries have already signed bilateral MOUs with the US, while others are finalising implementation plans tailored to their disease burden, financial capacity and national priorities.
He stressed that the agreements were designed to create shared investment between the US and partner governments rather than abruptly ending donor support.
“Transition to country ownership has been written into PEPFAR legislation since 2008. We are simply making it real,” Mr Graham said.
He added that partner countries have committed more than $10 billion in domestic health financing over the next five years as part of the new agreements.
PEPFAR Deputy Assistant Secretary Dr. Rebecca Hulett said implementation plans are designed to ensure countries increasingly lead and finance their own HIV programmes without compromising progress toward ending AIDS as a public health threat.
“At this time of seismic change, but also of seismic opportunity, all of us have a role in ensuring success going forward,” she said.
She explained that countries are integrating HIV services into broader national health systems through stronger laboratory networks, digital health platforms, community health worker programmes and disease surveillance while maintaining a strong focus on HIV prevention and treatment.
The session also heard from government representatives from Cambodia, the Dominican Republic, Kenya and Nigeria, who shared their experiences in negotiating bilateral agreements with the US.
Her Excellency Dr Youk Sambath, Secretary of State at the Ministry of Health in Cambodia said its new five-year MOU provides funding for HIV, tuberculosis, malaria and global health security while supporting increased domestic investment and national ownership of HIV services.
The Dominican Republic Vice Minister for Collective Health in at the Ministry of Public Health Dr Eladio Perez said it now finances 100 percent of its HIV and tuberculosis medicines and aims to achieve full national ownership of its HIV response by 2028.
Kenya Director General of Health Dr Patrick, the first country to sign the new health cooperation framework, described the agreement as a shift from donor assistance to genuine partnership. Officials said the country aims to fully manage HIV programme financing, commodity procurement, health workforce management and digital health systems by 2030.
Nigeria, represented by Dr Temitope Ilori, Director General for National Agency for the Control of AIDS also reaffirmed its commitment to a government-led HIV response, saying it is finalising implementation plans and governance structures to strengthen national ownership while maintaining collaboration with the US.
While the U.S. delegation presented the reforms as a pathway towards sustainable, country-led health systems, activists remained unconvinced, arguing that communities are already feeling the impact of programme changes.
The debate highlighted the central question hanging over AIDS 2026: Can countries successfully transition to greater ownership of HIV programmes without reversing decades of hard-won gains in the fight against AIDS?
