Africa has earned the right to set the terms of the fight to end Aids by 2030, but with external health aid falling by an estimated 70% between 2021 and 2025, the continent must now lead the transition or absorb the shock, according to Dr Jean Kaseya, director general of Africa Centres for Disease Control and Prevention, and HE ambassador Amma Adomaa Twum-Amoah, commissioner for the African Union department of health.
Africa's Progress and the Funding Gap
Over two decades, Africa helped turn the epidemic around. Aids-related deaths have fallen by 59% since 2010 and new infections by 68%. Nearly 22 million Africans are alive today on daily treatment. However, the model that brought the response this far, in which Africa delivered while others financed and directed, is ending. The Common Africa Position for the 2026 High-Level Meeting at the UN in New York on HIV/Aids is Africa's answer, built on the Africa Health Security and Sovereignty agenda, which heads of state adopted to treat health as a matter of sovereignty rather than charity.
Three Main Demands
The position rests on three main demands. First, domestic HIV financing has risen over the past decade and must now rise faster, moving inside national budgets, primary healthcare, universal health coverage and social protection. Finance and health ministers will have to plan that shift together. International solidarity is still needed, but the terms have changed. Every dollar should back one national plan, one budget, and one monitoring framework. Africa CDC's target is concrete: at least 20 countries financing half or more of their own health spending by 2030. Partners are asked to fund that future, not to run it.
Access and Local Manufacturing
Second, Africa needs reliable supply of antiretrovirals, diagnostics, and innovative prevention tools such as long-acting pre-exposure antiretroviral prophylaxis (e.g., lenacapavir). Lenacapavir could reach 9 to 11 million people and accelerate progress towards ending Aids by 2030, but only at a price an African budget can bear. The African pooled procurement mechanism (APPM), led by Africa CDC, turns scattered demand into a continent's bargaining power. The African Medicines Agency supports local manufacturing. The continent's aim is to locally manufacture at least 60% of its health product needs by 2040. That takes political commitment and a permanent, binding route for real technology transfer to African manufacturers.
Systems and Rights
Third, the systems that hold it together must be strengthened. HIV care has to be folded into primary healthcare, with testing, treatment and maternal health reaching people through one door. Communities living with HIV need funding and formal standing. Stigma, gender-based violence and punitive laws keep people from care, and a serious declaration will defend the dignity of everyone who needs these services, including migrants and refugees. Data must be held in country-owned systems under African control. The systems also have to hold under pressure, so that the next outbreak does not erase a decade of progress.
For 25 years the world asked whether Africa could deliver the Aids response. It can, and it has. The question this June is whether the world will back Africa to finish the job on African terms, or spend another generation managing the continent's dependence.
