Lloyd Mulenga, M.B.Ch.B., Ph.D., on Zambia's HIV funding risk | IAS 2026

Zambia has cut its annual new HIV infections from a peak of roughly 58,000 in the late 1990s to about 28,000 today, surpassing UNAIDS's 98-98-97 testing, treatment and viral suppression targets, according to Lloyd Mulenga, Ph.D., M.Med., M.B.Ch.B., M.Sc., director of infectious diseases at the Zambia Ministry of Health. Mulenga is scheduled to speak today at preconference sessions on AIDS prevention, held ahead of the official Monday start of the International AIDS Society's AIDS 2026, 26th International AIDS Conference in Rio de Janeiro, Brazil.

Before 2002, Zambia funded its HIV response almost entirely with domestic resources, Mulenga said, with patients paying about 40 kwacha a month — then roughly $1 — for treatment that government support only partially covered. Support from the Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) changed that trajectory.

For antiretroviral drugs and laboratory “commodities,” PEPFAR now funds close to 50% of costs, the Zambian government about 30%, and the Global Fund about 20%, Mulenga said. For the HIV response as a whole in the country, PEPFAR has been the largest funder, Mulenga said, accounting for approximately 78% of the financial support, followed by the Global Fund at approximately 13% to 15% and the Zambian government at 9%.

Mulenga attributed Zambia's progress to a combination of factors: political stability across changes in government, sustained donor support, and community organizations that generated demand for services and helped shape policy. "Those factors enabled us to reach and control the HIV infections," he said.

In this interview with Managed Healthcare Executive, Mulenga discusses why he is concerned that recent cuts to U.S. funding threaten to undo those gains, particularly among adolescent girls and young women.

Adolescent girls and young women ages 15 to 24 account for nearly half of Zambia's new HIV infections, and young women make up nearly 80% of infections within that age group, Mulenga said. Programs aimed at reducing their vulnerability were largely funded by PEPFAR and the Global Fund, and many of those interventions are no longer in place due to funding cuts and a broader U.S. realignment, he said.

"Our greatest fear right now is a surge in the number of new HIV infections because of lack of the community interventions, which the USG [United States government] was really supporting and were key," he said.