Lloyd Mulenga, M.B.Ch.B., Ph.D., on funding cuts and risk to prevention efforts| AIDS 2026
Zambia's Lloyd Mulenga, M.B.Ch.B., Ph.D., says U.S. funding cuts pushed African governments toward domestic financing, but he fears for HIV prevention.
Lloyd Mulenga, M.B.Ch.B., Ph.D., director of infectious diseases at the Zambia Ministry of Health, said his biggest fear amid U.S. funding cuts to HIV programs isn't a return to the mortality rates the country saw in the late 1990s — it's a resurgence in new infections, particularly if community prevention work gets squeezed out.
"My main worry is over new HIV infections as opposed to those infections which we have, because I know governments will try and do whatever it takes to buy those ART [antiretrovirals] for treatment. But will they also prioritize the community interventions?" Mulenga said in an interview with Managed Healthcare Executive (MHE) recorded before the AIDS 2026, the 26th International AIDS Conference in Rio de Janeiro, Brazil, which concluded today
Mulenga said in the interview with MHE that it is difficult, within a single funding envelope, for governments to prioritize investments that pay off in future health benefits over threats they don't yet see as immediate, a dynamic he considers one of the biggest risks facing the HIV response going forward. Mulenga said he doesn't expect Zambia's mortality to climb back to 1998-2000 levels, crediting African governments’ accumulated experience managing the HIV response. But he warned that new infections could still rise, adding cost burdens to national health systems already stretched thin.
One outcome of the funding disruption, Mulenga said, has been a push toward domestic financing. "As long as we are relying on donors, we are not in control of our own situations," he said, pointing to new financial commitments from the Zambian government. He cautioned, though, that funding transitions need to happen gradually rather than through abrupt cuts, which he said would cause serious harm.
Donor government funding for the HIV response in low- and middle-income countries fell 25% from 2024 to 2025, to $6.2 billion, the largest single-year drop since donor funding scale-up began and the lowest level since 2007, according to a KFF/UNAIDS analysis that was presented at the AIDS 2026 meeting.
Separately, data from a report from amfAR, the Foundation for AIDS Research, which was also presented at the meeting, showed that disruptions in funding from U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) resulted in PEPFAR prevention spending falling 51% from fiscal year 2024 to fiscal year 2025, with condom and lubricant spending down 93%. Forty-three percent of implementing partners surveyed said they had permanently stopped at least one prevention activity, including PrEP and condom programs, according to the amfAR report, which is based on a survey of PEPFAR implementing partners.
The State Department, which administers PEPFAR, has said the amfAR analysis was methodologically flawed.
