Declining Donor Funding for HIV Programmes in Sub-Saharan Africa: Implications for HIV Incidence, Mortality, and Domestic Financing

Abstract

The Human Immunodeficiency Virus (HIV) has severely affected the Sub-Saharan Africa (SSA) region over the past twenty years, with over two-thirds of the global population of people living with HIV found in the region. Bilateral initiatives from the United States, such as the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), played key role in financing HIV programmes across sub-Saharan Africa. A 2025 UNAIDS report showed significant decline in new HIV infections across SSA by 62% and AIDS-related deaths by 76% from 2010 to 2024. However, recent decline in donor funding has created uncertainty regarding the sustainability of HIV programmes in low- and middle-income countries, particularly in sub-Saharan Africa. This narrative review synthesized evidence from major databases such as PubMed/Medline, Web of Science, Google Scholar and other grey literature published between January 2010 and May 2026, to examine the implications of declining donor funding on epidemiological outcomes, and explores the role of domestic financing in HIV response sustainability. A total of 46 studies met the inclusion criteria, comprising peer-reviewed articles, modelling studies, policy analyses, and grey literature reports. Empirical evidence indicates disruptions to HIV services in several countries, especially those heavily reliant on donor funding. Modelling studies also revealed there could be notable increase in HIV incidence and AIDS-related mortality if alternative financing models are not put in place. Strengthening domestic financing, executing phased donor transitions, and integrating HIV services into national health financing systems, are critical to sustaining progress toward HIV epidemic control and ensuring the long-term resilience of HIV programmes in the region.