MUNICH – German Chancellor Olaf Scholz reaffirmed his government’s commitment to the global campaign against AIDS, including the Global Fund, at the opening of the international AIDS Conference – and appealed to other global powers to do the same.

The Ukraine war is draining Germany’s resources, and on the far right, the substantial and growing influence of the anti-immigrant, anti-global Alternative for Germany (AfD) party is also influencing German spending and policies.

The budget of the government’s development ministry (BMZ), largely responsible for overseas development aid, was cut by 7% earlier this year sparking fears that Germany may retreat from its leading role in global health.

“As one of the largest donors, Germany contributes €1.3 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria,” Scholz told the packed conference, which is being attended by over 10,000 delegates.

“And we will continue to support it because programmes sponsored by the Global Fund have saved 59 million lives,” he added to applause.

“We also support UNAIDS and the World Health Organization and will continue to be a reliable partner. Together with France and Norway, Germany supports the WHO Replenishment Round as a co-host for the European Union. Because the WHO needs more support. It is the chain that holds different threads of global health together.

“I would like to call on other donors for stronger support,” Scholz added. 

PEPFAR jitters

As Russia’s war on Ukraine drains European resources, the possibility of a victory by Donald Trump in the US presidential campaign is triggering fears that a drastic reduction in the US President’s Emergency Plan for AIDS Relief (PEPFAR) could then follow. Through PEPFAR, the US has been the world’s largest single historical sponsor of antiretroviral medication in Africa, and other game-changing innovations in HIV/AIDS prevention and treatment since 2003.  

However, Chris Collins, CEO of Friends of the Global Fight, said at a pre-conference media briefing that “bipartisan commitment to the program remains solid in the United States.”  That, despite the fact that what he described as “misinformation” held up the five-year reauthorization of PEPFAR by the US Congress in 2024 – with Congress ultimately agreeing only to a one year authorisation, until 2025. 

Addressing the same briefing, PEPFAR’s head, Ambassador John Nkengasong, warned that “now is not the time to sit back; we must sustain the gains we have all worked so hard to make against this pandemic and accelerate our efforts to end it.”

International AIDS Society president and chair of the conference Sharon Lewin warned against “regressive policies, attacks on human rights, the spread of misinformation, cuts to global health funding, and waning trust in international institutions”.

 “We’ve seen incredible breakthroughs at AIDS 2024, including a new case of long-term HIV remission and a promising twice-yearly injection [lenacapavir] to prevent HIV,” added Lewin.

“To end HIV as a threat to public health and individual well-being, we need an evidence-based HIV response and a political climate that respects science.”

Debt relief call

UNAIDS Executive Director Winnie Byanyima called for debt relief for low-income countries that are unable to meet their citizens’ needs – including HIV prevention and treatment – and service their debt.

“In Angola, Kenya, Malawi, Rwanda, Uganda and Zambia, debt servicing is more than 60% of all the government revenue that is collected. Sierra Leone spends 15 times more on public debt servicing than on the health of its people,” said Byanyima.

“The choking debate must be restructured and restricted now.”

Appeal to Gilead to allow generic production of ‘miracle drug’ lenacapavir

She also called on Gilead, the manufacturer of the “miracle drug” lenacapavir – the twice-yearly injection that protected 100% of women from HIV infection in a recent trial – to “make history” by licensing generic manufacturers to produce it more affordably through mechanisms such as the Medicines Patent Pool (MPP).

“Gilead has an opportunity to take us closer to ending AIDS as a public health threat,” Byanyima told AFP in an interview at UNAIDS’ headquarters in Geneva.

“Those people hiding from the law — gay men, trans women — who could come out just twice a year to get their injection and be safe,” she said. So could young women in Africa, fearing stigma and domestic violence.

Lenacapavir was approved for use in 2022 for HIV patients in the United States and the European Union. But its cost of around $40,000 a year in the US currently puts it out of reach for most low- and middle-income countries.

Ukrainian leader urges action 

The AIDS 2024 conference includes a special focus on eastern Europe and central Asia, a region with one of the fastest-growing HIV epidemics in the world. 

“While most other regions around the globe have managed to stabilise their HIV epidemics, in eastern Europe and central Asia, it is rapidly increasing,” Andriy Klepikov, AIDS 2024 Regional Co-Chair, told delegates to the event.

“Only half of people living in our region are on antiretroviral therapy, nowhere near the global target of 95%. At the root of the region’s epidemic are drug use, stigma and harmful policies – exacerbated by violent conflict.”

Klepikov asked delegates to imagine the sound of air raid sirens, which he described as the background soundtrack of daily life in Ukraine.

“I would like to sound a siren today about the [HIV and AIDS] danger in eastern Europe and central Asia,” he added.

“Progress will require major change and innovation, removing policy barriers and respecting the rights of the communities most affected by HIV.”

Impact of Uganda’s anti-LGBTQ law

Trans man Jay Mulucha, head of Fem Alliance Uganda, gave a moving address about the impact of Uganda’s 2023 Anti-Homosexuality Act, which introduces harsh penalties for a range of same-sex activities.

He said that being HIV positive and trans meant that “we are always discriminated against when we go for treatment” and face “corrective rape”.

His organisation’s Uganda office had been closed down, as has the homeless shelter it provided for trans people, “meaning that we are unable to supply HIV and social services for our community.”

Mulucha said his life is constantly in danger and Uganda’s LGBTQ community remains “isolated and vulnerable” – despite recent international pressure on the government of Yoweri Kaguta Museveni, who has now been in power since 1986.

“The sanctions and penalties being placed by the international community on the Ugandan government are working, but the lifting of these sanctions needs to be contingent not on changes in policy, but on evidence of changes in implementation,” said Mulucha. 

“You need to listen to the communities and hear what we are saying. We are still suffering and need your support more than ever. So the funding that is being denied to the government should be funnelled directly into LGBTIQ organizations and communities in Uganda.”

Image Credits: Steve Forrest / IAS, Steve Forrest / IAS, teve Forrest / IAS.