Brazilian HIV advocates said they had anticipated the sharp fall in donor funding for HIV and argued that other countries should have pursued greater independence from foreign aid. They were speaking at the Aids 2026 conference in Rio de Janeiro.
Juliana Cesar, political liaison coordinator at the Brazilian HIV NGO Gestos, said the dissolution of USAID may "feel like a rupture," but that her organization had seen it coming for a long time.
A public health system independent of foreign aid
Brazil's HIV prevention and treatment programmes are entirely independent of foreign assistance because they operate under the country's Unified Health System. That system supports milestones such as the elimination of HIV transmission to newborns, achieved in 2025.
However, Brazil still faces limits on access to the latest HIV preventions and treatments due to negotiations with pharmaceutical companies, and NIH funding cuts could also reduce HIV-related research in the country.
Cesar said Brazil's position is unique because healthcare has been a constitutional right since 1988. After the constitution was signed, civil society pushed to make HIV prevention and treatment part of the Unified Health System. "It has been earmarked into our budgets. We have to make sure that we have enough money for that," she said.
Lessons from Brazil's financial transaction tax
Gestos has advocated for other countries to adopt measures similar to Brazil's Financial Transaction Tax, which directed money from every financial transaction into the public health system. Cesar said the tax is now being phased out as Brazil turns to the right, and she acknowledged it was not implemented ideally because the same percentage applied to every citizen regardless of income.
She said she has long encouraged other countries to consider such approaches for financial independence from foreign policy shifts and greater autonomy to design HIV programmes for their own populations. Her suspicion that foreign aid would shrink dramatically started more than a decade ago.
"We have been tracking negotiations at the UN since the 2000s, and we would see the trends," Cesar explained. She pointed to increasingly restrictive language and conditions around funding for sexual and reproductive health and rights and for LGBTQ+ communities, both essential to HIV prevention. After 2012, she saw conditions "that would exclude the very communities that we should serve." Nations sought "common ground" on funding, but it "would become stricter and stricter."
Tied aid and the push for health sovereignty
Ailish Brennan, a policy analyst at Harm Reduction International, said foreign aid agreements often require countries to buy HIV medications from donor countries such as the US. "It's sort of like pumping money back into the donor country economy," she said. Domestic production of HIV medicines could be "part of a broader shift towards 'health sovereignty' and genuine country ownership over health systems."
Brennan also said countries could protect HIV prevention and treatment by redirecting foreign aid that currently goes to "narcotics control." A Harm Reduction International report found nearly $1bn of foreign aid, including USAID money, went to policing and criminalisation of drug-related offences between 2012 and 2021. Incarceration can increase HIV rates by concentrating high-risk populations, such as people who inject drugs, and limiting their access to healthcare.
Brennan said that money could have funded hundreds of thousands of sterile syringes, which help prevent HIV, along with other health measures.
Brennan and Anton Basenko, executive director of the International Network of People Who Use Drugs, also said HIV prevention funding has long relied on the commitment of frontline workers. When compensation is deprioritised, burnout can follow. Basenko said that after the cuts, many HIV prevention organisations "are surviving on the goodwill, unpaid labor, and extraordinary commitment of their staff and volunteers. But resilience should never be mistaken for sustainability."
