CROI 2026: Funding Cuts Threaten Global HIV Progress

Denver, Colorado – The 33rd Conference on Retroviruses and Opportunistic Infections (CROI) highlighted a concerning trend: potential setbacks in the global fight against HIV due to funding cuts from the United States and other key donors. Experts at the conference, held February 23-27, 2026, presented strategies to mitigate the impact of these cuts, particularly in resource-limited countries.

US Funding Cuts and Global Impact

The conference opened with a stark reminder of the progress made in combating HIV, but also the fragility of those gains. Illesh Jani, from the Mozambique National Institute of Health, noted that despite significant global investments, the 2025 goal of reducing new HIV infections to less than 370,000 annually was not achieved, and the world is currently off track to meet the 2030 Sustainable Development Goal of ending the HIV epidemic.

A key concern raised at CROI 2026 was the conditional nature of PEPFAR (The President’s Emergency Plan for AIDS Relief) funding, differentiating between authorized and unauthorized programs. Programs facing potential cuts include medical circumcision (Voluntary Medical Male Circumcision – VMMC), Pre-Exposure Prophylaxis (PrEP), community aid, and support for orphans and vulnerable children.

Strategies for Resilience: The Four “I’s”

In response to the funding crisis, Illesh Jani proposed a framework based on four key strategies, all starting with the letter “i”:

• Invest in HIV prevention to sustain program viability through innovative financing methods, such as national health insurance (like in Rwanda), product-specific taxes (like the AIDS levy in Zimbabwe), and debt-to-health swaps.
• Innovate with financing methods.
• Institutionalize evidence-based approaches, prioritizing interventions for key populations and integrating community support. Currently, only 2.6% of sub-Saharan African grants support programs for these key populations (2022 data).
• Integrate community supports.

Disruptions in HIV Service Delivery

A survey conducted by Ellen Brazier between June and July 2025, encompassing 92 HIV clinics and 11 programs across 32 countries, revealed the extent of potential disruptions. The survey indicated that nearly a third of respondents reported disruptions in HIV counseling and testing. 18-27% reported disruptions in PrEP provision, HIV treatment services, pediatric HIV services, prevention of mother-to-child transmission, early infant diagnosis, and access to antiretroviral treatments.

Looking Ahead

CROI 2026 served as a critical platform for discussing the challenges facing the global HIV response. The conference underscored the need for innovative financing strategies, evidence-based interventions, and a continued commitment to reaching key populations to prevent a reversal of the progress made in the fight against HIV/AIDS. The symbol of an apple core was used to represent the need for strategic and resilient responses to the funding crisis across Africa.