By Africa.com | Created at 2026-08-06 07:37:00 | Updated at 2026-08-06 09:02:55
1 hour ago
By Kilford Zimondi, Country Director, Humana People to People South Africa
For over a year now, governments, donors, and health organisations across Africa have been adapting to a changing global health landscape. Continued cuts to development assistance for health, shifting donor priorities, and geopolitical pressures are forcing countries to confront hard questions about HIV financing and the need to prioritise programmes amid competing primary health care needs.
In South Africa, annual new HIV infections fell from roughly 340,000 in 2010 to 170,000 in 2024, while AIDS-related deaths dropped from about 150,000 to 50,000 a year. Progress was achieved as treatment access expanded to millions. During this period, new infections fell faster than the virus could spread through the population: this is successful epidemic control in action. It was built, in large part, by communities, and the question now is how to fund and sustain this progress over the long term.
As longstanding donors and contributors to the Global Fund reassess their commitments and many low- and middle-income countries face their own fiscal constraints, this crucial progress risks stalling. Latest UNAIDS data (2024-2025) already shows HIV testing programmes falling by 22% in high-burden settings.
The challenge is no longer simply about mobilising more money but about determining how to build on what communities have achieved so far and how to survive as external funding continues to contract. That conversation often centres on domestic resource mobilisation: more public spending, expanded health insurance, and new revenue sources. While these are, of course, important, sustainability isn’t only about how much money is available. It is also about where the money goes.
The global HIV response has always depended on communities. Long before HIV services were recognised as international priorities, community organisations were reaching populations that formal institutions could not. Today, community health workers, peer educators, youth networks, women’s organisations, and civil society groups remain central to prevention, testing, treatment adherence, and retention in care.
Their role is even more desperately needed as funding and support for at-risk groups decline. Women and adolescent girls still account for a disproportionate share of new infections, while treatment interruptions and loss to follow-up persist, reflecting gaps not just in service delivery but in trust, access, and equity. Clinic-based services alone cannot close them. Community-led models are often best positioned to reach people facing social, geographic, or economic barriers because they operate where formal systems struggle to maintain a presence, offering the trust and local knowledge needed to sustain engagement over time.
Despite decades of evidence proving their value, community systems remain chronically underfunded, too often treated as temporary project costs rather than core health infrastructure.
Investment in community systems pays dividends beyond HIV. Community health workers also support tuberculosis control, sexual and reproductive health, maternal and child health, disease surveillance, and health promotion, making them especially valuable as governments pursue integrated primary health care and universal coverage. Rather than being viewed as parallel systems, community-led models are well-suited to be integrated to strengthen the link between facilities and the people they serve.
The policy implication is straightforward: countries should treat community systems as part of the health workforce and finance them accordingly. That means integrating community health workers into national human resources strategies, building sustainable financing mechanisms for community-based delivery, and including civil society in long-term implementation and accountability frameworks, while protecting funding for community-led monitoring to help identify and resolve service gaps.
Governments across Africa are increasingly reforming healthcare and taking ownership of epidemic control and prevention. This is good news for the continent’s future sustainability. Yet external donors still have an important role to play. External funding is essential to support transitions and help countries future-proof their health care systems by strengthening supply chains, clinical services, and staff training, without overlooking the community infrastructure that underpins already successful HIV programmes.
There are plenty of examples already in action. Humana People to People’s peer-led, community-based models work hand-in-hand with governments and local authorities to advance both HIV outcomes and broader health goals. Our flagship Total Control of the Epidemic model is one such example. It mobilizes people and communities to act — building knowledge, fighting stigma and discrimination, and driving local action on HIV and TB prevention, care and treatment. Working in close partnership with governments at all levels. Since 2000, over 29 million people have been engaged, helping change the course of the epidemic from within their own communities.
TCE is one proof of concept among many. Yet despite decades of evidence proving their value, community systems remain chronically underfunded, too often treated as temporary project costs rather than core health infrastructure. The lesson is not that one programme should be replicated wholesale, but that community infrastructure itself is a strategic asset worth financing, and community-led expertise a vital resource to learn from.
Following the discussions at AIDS 2026, the global community fighting HIV has a chance to redefine what a sustainable approach to this virus looks like. This is not a question of who fills the funding gaps, but how the systems already built by communities will be recognised, resourced, and supported to grow.
Kilford Zimondi writes on community-led health systems and HIV programme sustainability, and will bring his perspectives to the 2026 International AIDS Conference in Rio de Janeiro, Brazil (26-31 July 2026).
