Africa: U.S. Defends New HIV Funding Model As Activists Challenge PEPFAR Reforms

What the report says

AllAfrica reported that HIV activists challenged U.S. officials in Rio de Janeiro ahead of the AIDS 2026 conference, arguing that changes to Washington’s global HIV funding approach and cuts under the Trump administration have created a public health crisis. U.S. officials defended the shift, saying the new model is intended to make HIV responses more sustainable and led by partner countries rather than weakening support.

The dispute centers on the America First Global Health Strategy, which is moving U.S. HIV assistance toward five-year bilateral memoranda of understanding. AllAfrica reported that 34 countries have signed agreements covering 2026 to 2030, with governments expected to increase domestic health spending as U.S. support gradually declines. Acting U.S. Global AIDS Coordinator Jeff Graham said Washington remains committed to ending HIV and described the reforms as a change in delivery model, not mission. He said the U.S. has committed nearly $15 billion in health assistance over five years, while partner governments have pledged more than $10 billion.

PEPFAR official Dr. Rebecca Bunnell said implementation plans are based on efficiency, shared decision-making, domestic co-investment and accountability. She pointed to integration of HIV services into broader health systems, including examples in Mozambique, and said civil society would remain important in monitoring disruptions and reaching vulnerable groups.

Officials from partner countries also backed the transition. Kenya’s Director-General for Health, Dr. Patrick Amoth, said Kenya was the first to sign both the new Health Cooperation Framework and Strategic Objective Agreement, with a combined U.S.-Kenyan investment of about $2.8 billion. The debate matters because PEPFAR has long been central to HIV treatment and prevention in Africa, and changes to its financing model could affect service delivery during the transition.