The global HIV response at a crossroads: protecting gains and advancing sustainability amid funding disruptions.

The global HIV response faces a crisis as abrupt funding cuts, particularly from the USA, threaten decades of progress. Governments across Africa report widespread disruptions in essential services, including HIV testing, treatment, and prevention. Reliance on previously stable partnerships and external funding has left many programmes vulnerable to sudden financial shock. Achieving self-reliance will require national health system integration, streamlined service delivery, digital health solutions to extend health system functions, and diversified funding sources, including greater mobilisation of domestic resources, innovative financing, and impact investment. Although some countries have made major strides towards self-reliance, urgent actions are needed to protect against harms to individuals and communities due to service delivery interruptions. Governments should lead efforts to integrate the continuum of HIV services into broader health systems, and donors should pivot towards strategic support, including technical assistance and catalytic funding for commodities and services that mitigate harms. Without decisive action, funding disruptions could result in catastrophic increases in infections and mortality, undermining the global HIV response for the next generation.