Executive Director of UNAIDS, Winnie Byanyima's Statement at the opening of ICASA

Excellencies, Ministers, fellow Africans, dear sisters and brothers,

I stand before you not simply to talk about AIDS.

I stand before you to talk about Africa’s future.

And the choices, the courage, and the convictions that will determine whether our children inherit a continent of dignity and health, or one of inequality, preventable illness and unfulfilled promise.

Ours is the continent with the highest HIV burden.

Here in Africa, we are 19% of the world’s population but make up 65% (26.5 million) of the 40.8 million people living with HIV globally.

More than half of the people waiting for treatment (4.7 M) live on our continent.

More than half of all new HIV infections (670 K) were here in Africa.

Yet we have the science, tools, and knowledge needed to end AIDS.

This is no longer a medical challenge.

Ending AIDS is a political choice.

Here are the three choices you as African leaders can make to get us there: 

1. Choosing to resource the HIV response.
2. Choosing to protect the rights of our people, so they can safely access HIV services; and
3. Choosing to seize new innovations and secure health sovereignty.

First, resourcing the response.

 International development assistance- aid is collapsing.

Amid donor fatigue, global economic shocks, competing crises, and shifting priorities, external health aid is projected to drop by 30% to 40% this year from 2023 levels (WHO).

The sudden impact has been devastating for people living with and at risk of HIV. But, in the hardest of circumstances, communities and governments have been resilient.

Africa is not being beaten down by cuts – our continent is transforming, laying the foundations for a more sustainable, inclusive, and nationally-owned HIV response.

I welcome the African Union Roadmap to 2030, which focuses on sustaining the HIV response and strengthening health systems, and the Accra Reset led by President Mahama, which places health financing and sovereignty at the heart of a transformed development ecosystem. These are crucial plans that must move to implementation. 

Within constrained envelopes, governments are reprioritising to protect public health and the HIV response. 

Nigeria has approved increases to its health budgets and HIV spending. Uganda has taken steps to double domestic health spending. Cote d’Ivoire has committed to increase domestic HIV investment by $60-65 million this year – and $80-85 million in 2026 and beyond. South Africa has increased its domestic HIV investments by $33 million. Tanzania is dedicating certain tax increases to mitigate the impact of aid cuts on HIV services.

President Mahama has uncapped financing for Ghana’s national health insurance fund- freeing up 3.5 billion cedi (300 M USD) to support broader and deeper health coverage.

Turning those commitments to action is an essential step to securing a sustainable future for the HIV response.

But we face a serious challenge. For years, revenue collection in Africa has hovered at around 16% of GDP – far lower than the rest of the world – and that limits what we can achieve and the investments we can make into health, education, social protection, infrastructure. 

What little is collected is being sucked away to pay for debt servicing.  Even before this year’s cuts, 2 in 3 African countries spent more on debt than health.

Health taxes and other innovative measures can be helpful in the short term. But for serious domestic HIV investment, we need action to spur economic growth, curb tax dodging, and progressively tax income, wealth, and corporate profits. 

This year’s Financing for Development Conference and G20 Summit brought new commitments to relieve the burden through debt restructuring, and provide financing in fair and affordable terms for the future. 

That is Africa’s opportunity – remove the crushing burden of debt, enable our countries to use affordable financing to build a better future so we can breathe new life into our economies, our health systems, and the wellbeing of our people.

Second, human rights.

Amid the shock to financing, inequality is widening, civic space is shrinking, and we are seeing a determined, organized and well-funded backlash against human rights and gender equality.  Pushing people further away from life-saving services. 

UNAIDS data shows that adolescent girls and young women continue to carry the heaviest burden of new HIV infections, especially in sub-Saharan Africa. 

62% of new HIV infections in this region are among women and girls. Around 4,000 young women globally acquire HIV every week, and 3,300 in sub-Saharan Africa. 

That is because they have less power, less protection under the law or culture. They are denied opportunities – 46% of upper secondary school girls in sub-Saharan Africa are not in school. This leaves them vulnerable to sexual and gender-based violence.

And women in sub-Saharan Africa who have experienced intimate partner violence in the past year are over 3 times more likely to acquire HIV.

Laws protecting the bodily autonomy and sexual and reproductive rights of adolescent girls and women are under threat. Some countries have come close to repealing laws banning female genital mutilation.

LGBTQ+ people, sex workers, and people who use drugs –the communities at the heart of the HIV response – are being pushed away from services by criminalization, stigma and discrimination. 

HIV prevalence among men who have sex with men is five times higher in countries that criminalise homosexuality. 

Yet, this year, even more countries are criminalising same-sex relationships.

Niger’s new Constitution specifically criminalises the sexual practices of LGBTQ+ people.

Burkina Faso, has –for the first time- criminalized same-sex relations and the so-called promotion of homosexual practices

Mali’s new penal code makes homosexuality and the “promotion” of homosexuality a criminal offence. 

Let us be clear. These laws are not African in origin. They are colonial-era imports, reinforced by global ideological movements. 

Geopolitical tensions between big powers are playing out across borders – bringing culture wars that damage our human rights to favour certain strategic and ideological interests.

We have to say no. We will not allow our continent – our human rights – to be used as a battlefield in your proxy wars.

We cannot end AIDS by silencing people, by denying their existence, by pushing them away from services.

To protect people’s health, we must protect their rights. 

That is at the heart of African values - Ubuntu, I am because we are.

Third, the opportunity of new innovations.

HIV prevention is our weakest link, but now it is also a huge opportunity.

A whole new suite of long-acting HIV prevention tools are becoming available, with the potential to revolutionize the HIV response.

Generic cabotegravir, administered by injection 6 times a year, is available in many countries. So are dapivirine vaginal rings which prevent infection for three months at a time.  And once-a-month oral PrEP is entering late-stage trials

We now have lenacapavir, which prevents HIV infection with injections just twice a year

The Global Fund, PEPFAR and Gilead have already begun rolling it out in Africa, with the first injections happening on World AIDS Day in eSwatini and Zambia.

In 2027, generic versions will be available in many African countries for just $40 per person per year.

We have an incredible opportunity to end AIDS as a public health threat. But that can only happen if these innovations actually reach people.

Just 2 million people will receive lenacapavir before generics become available. We need to reach 20 million. Expanding generic production, pooling procurement, and – yes – protecting rights, so people can safely access services are crucial steps. 

This is an American innovation, but African scientists and research institutions were critical to its development and testing. We should be proud of that – and make sure our people benefit now.

In the longer term, we need to invest in our own local and regional manufacturing and innovation. Africa carries 25% of the world’s global burden of disease yet contributes just 3% of the worldwide medicine manufacturing. (AUDA-NEPAD). 

We have enormous potential. In May, the Global Fund procured a first-line HIV treatment (TLD: tenofovir, lamivudine, dolutegravir) - produced in Kenya, and now saving lives in Mozambique. Brazil’s G20 Presidency established a Coalition for Local and Regional Production, Innovation, and Equitable Access. 

We have immense talent; an emerging generation desperate to make a difference; and some of the greatest research institutions in the world. This is our opportunity – we must seize it.

So today, I ask you to make the choices needed to end AIDS:

• Invest in health sovereignty. Not with promises, but with budgets.
• Use the law, not to discriminate, criminalize, or shame vulnerable people, but to equalize and protect rights.
• Let communities not just inform your HIV responses, but lead them.
• And invest in the innovation needed to revolutionize HIV prevention and end AIDS as a public health threat.

 These are the choices that will overcome disruption and transform the response – that will put us on the path to ending AIDS. I urge you to make them today.

Thank you.