Countries supported by the Global Fund put over a million more people on antiretroviral (ARV) treatment, sustained tuberculosis treatment and distributed 34 million more insecticide-treated mosquito nets in 2025 than the previous year.

In 2025, some 26.9 million people were on ARVs (compared to 25.6 million), 7.4 million people were treated for TB, and 196 million mosquito nets were distributed (up from 162 million), according to the Global Fund’s results report released on Wednesday.

This was despite enormous challenges caused by the slashing of global health aid after Donald Trump was sworn in as president of the United States in January 2025.

Executive director Peter Sands said that the fund “responded swiftly and flexibly to protect people and programmes hit hardest by funding cuts”, helping countries to “maximise the impact of the resources that were available”.

He cited the rollout of lenacapavir, the twice-yearly injection that prevents HIV, and expanded use of AI-enabled digital X-rays for TB screening as examples of more effective and innovative services.

However, Sands conceded that some countries “managed to weather the changes with remarkably little impact” while “others were much harder hit”, and that HIV prevention services “were hit hard by reductions in domestic and international funding”.

Transition away from donor dependence

Sands said that the fund is “very closely engaged with countries” to achieve nationally financed health systems that are not dependent on external support.

The Global Fund is helping this transition by offering technical expertise, support to improve public financial management, co-financing incentives and pooled procurement.

When asked by Health Policy Watch whether the Global Fund was trying to assist in areas particularly targeted for defunding by the US, including “key populations” most at risk of HIV and South Africa, Sands affirmed support for both.

“We continue to focus our efforts on the people who are most at risk, and with HIV, that means key and vulnerable populations,” said Sands. “In South Africa, we have put particular effort on the rollout of lenacapavir, and see that as a crucial part of the broader strategy of reducing new infections in the country.”

“Key populations” vary from region to region, but usually include sex workers and men who have sex with men. The Trump administration has oriented its HIV support to preventing mother-to-child transmission.

Curbing malaria

Sands said that curbing malaria poses the most challenges, with the rise of people’s resistance to anti-malaria drugs and mosquitoes’ resistance to insecticide. 

The fund has expanded its distribution of mosquito nets treated with two insecticides, which are 45% more effective in the face of rising mosquito resistance. 

Compounding these challenges are conflicts in many of the countries most affected by malaria, and the impact of climate change. 

“The increasing frequency of extreme weather events often leads to upsurges in malaria,” said Sands.

“Demography is itself a challenge,” he added, explaining that many malaria-prevalent countries have “very rapidly growing populations”, which has resulted in reduced per capita health spending.

In the past year, there were 282 million malaria cases and 610,000 deaths, mainly among children under the age of five and pregnant women. 

“Malaria has a big mortality and morbidity impact on some of the very poorest communities in the world,” said Sands, and spending on the disease “is undoubtedly inadequate”.

“How do we get on the front foot and continue to drive progress on a disease that kills far too many young children, far too many pregnant women, and holds back economic and social development in so many of the poorest communities?”

Image Credits: Global Fund.