Does the UN Political Declaration on HIV/ AIDS Even Matter Anymore?
It's complicated. And what disappointed me most had nothing to do with the Declaration.
I remember what these meetings used to feel like. You raced to get a good seat. The side rooms filled fast, the corridors were loud and full of energy. We believed something consequential was about to happen and were thrilled to be there for it.
But that is not what the 2026 High-Level Meeting on HIV/AIDS felt like.
The rooms were emptier this time. A core group of committed people showed up — mostly advocates, negotiators, UN agency staff, the hardcore faithful. The themes that echoed across side events were also very telling: integration of HIV into primary health systems, community leadership, and innovation. UNDP organized a session on community-led responses. WHO was a visible presence, framing the integration of HIV alongside hepatitis, TB and malaria elimination. UNAIDS also used its side session to put communities at the center, reminding the room that the response cannot be rebuilt through ministries and multilateral agencies alone.
But there was only one moment all week when I felt something closer to the old energy — and it was when the conversation turned to long-acting PrEP. Everything else felt like same old same old.
Does this still matter?
On June 23, the United Nations General Assembly adopted a new Political Declaration on HIV and AIDS by a vote of 149 in favor, 8 against, and 14 abstentions. Diplomats applauded. UNAIDS called it a road map. Advocates and implementors called it a floor. You can read more about what’s in here (from UNAIDS).
The countries that voted no: the United States, Russia, Israel, Burkina Faso, Burundi, North Korea, Niger, and Senegal.
Then consider the trend line: The 2021 declaration also broke consensus — Russia requested a vote and four countries voted against. But in 2021, the tally was 165 in favour, 4 against, 0 abstentions. And the United States voted yes.
The yes votes fell by 16. The no votes doubled. Fourteen countries that once voted yes now refused to commit either way. And the country that created PEPFAR, that has invested over $120 billion in the global AIDS response since 2004, crossed to the other side of the ledger.
That is not just a broken UN consensus but a collapsing political foundation on which every dollar of the global AIDS response was built.
What a Political Declaration Is — and Isn’t
The 2001 Declaration of Commitment on HIV/AIDS helped unlock the political will and financing that built PEPFAR and the Global Fund. The 2011 and 2016 declarations produced the 90-90-90 and 95-95-95 targets that still organize the global response today. Political declarations have mattered.
But they have mattered because of what came after them . They worked when a declaration unlocked new dollars, when it moved a government to act, when it gave advocates a hook to hold power accountable. So the real question is not whether governments can still negotiate language. It is whether the global health machinery behind the AIDS response, the financing, implementation, diplomacy, and accountability system that turns declarations into action, still functions.
The Machinery Is Broken
In 2025, global development assistance for health fell by 23% — the sharpest single-year drop ever recorded. Between 2024 and 2025, HIV testing programs fell by 22% in high-burden settings. Funding for condoms was cut by more than 90% in some countries. The United States — the single largest historical funder of the global AIDS response, whose PEPFAR program has been severely transformed— arrived in New York without meaningful new financing commitments and under the shadow of its own America First Global Health Strategy, which projects a combined $4.3 billion reduction in U.S. and Global Fund support to high-burden countries between now and 2029.
The declaration itself puts a number on the financing gap: $18.7 billion was available for HIV in 2024 against a required $21.9 billion annually by 2030 — a $3.2 billion shortfall, with every indication it will widen. It is the distance between the commitments governments signed onto this week and the resources they are willing to put behind them.
And the epidemic itself is not cooperating with the narrative of steady progress. While sub-Saharan Africa has made the most substantial gains — a 59% decline in new HIV infections since 2010 — the declaration acknowledges that infections actually increased between 2010 and 2025 in three regions: the Middle East and North Africa by 77%, Latin America by 13%, and Eastern Europe and Central Asia by 15%.
Nearly nine million people living with HIV remain off treatment. Criminalization of key populations is increasing. And the declaration that just passed calls for achieving 95-95-95, universal access, long-acting prevention, and local manufacturing — all by 2030. Everyone in that room knew the math does not work.
📎 A Side Note on the Vibes:
This may have been the first UN High-Level Meeting on HIV/AIDS where AI was visibly present everywhere: in prepared remarks, side-event talking points, and delegate statements. You could hear it. The polished sameness was disappointing, but it also had one useful effect: it made the sharper, more political interventions stand out even more.
The most clarifying thing said all week didn’t come from the General Assembly floor. It came from an op-ed published in The Guardian on the morning the meeting opened — co-authored by Dr. Jean Kaseya, Director General of Africa CDC, and HE Ambassador Amma Adomaa Twum-Amoah, the African Union Commissioner for Health. Opening with the Bundibugyo Ebola outbreak as a reminder that Africa cannot wait on distant supply chains or other people’s goodwill, they offered a ledger of hard-won progress before landing on this: “Africa has earned the right to set the terms of that fight.”
What they present is the Common Africa Position, built on the Africa Health Security and Sovereignty agenda that African heads of state have already adopted, makes three clear demands: put domestic HIV financing inside national budgets, make medicines affordable with real technology transfer and local manufacturing, and integrate HIV care into primary healthcare with community organizations and African-owned data systems at the center.
Which Brings Us Back to the United States
One thing was conspicuously absent from the HLM all week: the bilateral approach. Country-to-country health agreements, the America First framing, the model in which the U.S. negotiates directly with governments outside multilateral structures. Interestingly, none of that found traction in New York. What the room did, instead, was double down on multilateralism. The Global Fund, UNAIDS, WHO, UNDP — the architecture that the United States helped build and has recently worked to circumvent was celebrated and reinforced.
But well all know that the United States still matters. That matters to say plainly, because the temptation in this environment is to either oversell American indispensability or to write the U.S. off entirely. Neither is honest.
What the U.S. does on PEPFAR, on the Global Fund, on public-private partnerships, on community-led programming will shape the trajectory of the AIDS response in ways that no other single country’s choices will.
But here is what has to change: the U.S. needs to be honest about what works.
What works is integration — HIV services folded into primary healthcare, reaching people through systems that exist for other reasons too, that survive when a vertical program loses its funding. What works is community leadership — not as a talking point but as a financing commitment, formal standing for the organizations that actually know where people are and how to reach them. What works is real access — lenacapavir at a price that an African ministry of health can plan around, not a price that requires a donor to intercede every procurement cycle. What works is outcomes: viral suppression, incidence decline, people who know their status and stay in care.
What does not work is a sugar-coated HIV response designed to survive Washington politics. One that funds what is comfortable, reaches who is easiest to reach, and reports metrics that look good in congressional testimony while avoiding the hardest epidemiology.
Key populations — gay and bisexual men, sex workers, people who inject drugs, and transgender people — remain central to the epidemic. The declaration the U.S. voted against says this plainly: these communities and their partners account for 49% of new adult HIV acquisitions globally, and far higher shares in some regions. A response that cannot name these communities or fund programs that reach them is not serious about ending HIV.
The Promoting Human Flourishing in Foreign Assistance executive order has already restructured how U.S. foreign assistance can engage with key population programming. The most recent PEPFAR data has made those same communities nearly invisible — stripped from the reporting frameworks that once made the U.S. response accountable to the people it was supposed to serve. When U.S. Ambassador Tammy Bruce explained the no vote this week by citing “divisive topics,” she was naming, without naming, exactly this: the decision to treat the communities most affected by HIV as a political liability rather than a programmatic priority. That choice has a body count.
The irony reached its peak this same week. While the U.S. delegation stood in the General Assembly and voted against a declaration on the grounds that it strayed from the 95-95-95 targets, the State Department simultaneously announced the permanent withdrawal of PEPFAR funding from South Africa, the country with the world’s largest HIV burden, home to more than eight million people living with the virus. And the stated justifications had nothing to do with health. (read my stack last week)
You cannot claim fidelity to 95-95-95 while withdrawing $400 million a year from the country that needs it most, for reasons that have nothing to do with AIDS. The position is not principled. It is not even coherent.
So: Does It Matter?
Yes — but not for the reasons the applause suggested.
The 2026 Political Declaration matters because it keeps one thing alive: a shared standard governments can still be judged against. It matters because it gives advocates a legal and political hook. It matters because the 2031 follow-on meeting it mandates creates a five-year window in which the gap between ambition and financing either gets closed or becomes permanent.
And it matters when health ministers are fighting finance ministers over HIV line items. In those rooms, a UN Political Declaration becomes a mandate. It says: our country agreed to this, in front of the world, and now we have to write the check.
But the declaration does not matter as a driver of the next phase of the AIDS response. That phase is already being driven out of Addis Ababa, out of the 400 organizations that signed a People’s Declaration because the official one wasn’t enough. It will matter when governments return to data-informed implementation, measurable outcomes, successful country transitions, community accountability, and sustained financing.
And then there was this. In a week of mostly low energy and mostly familiar faces, the most alive I felt in any room was watching young advocates stand up and describe their governments’ responses with clarity, urgency, and zero patience for the gap between what is being promised and what is being delivered.
People like Keren Dunaway of ICW Global; Florence Riako Anam of the Global Network of People Living with HIV; Jeremy Tan of Youth LEAD Asia Pacific; Catherine Nyambura of the Athena Network; Lilian Benjamin Mwakyosi; Erika Castellanos of Gate; and Michael Ighodaro of GBGMC. These are not the architects of the current system. They are a generation that has grown up inside the AIDS response, that knows the data, that has watched the promises cycle and the gaps widen, and that is no longer asking for a seat. They have the skills, the relationships, the moral authority. What they need is the keys to the car.
What gives me something close to hope, coming out of this week, is not the declaration. It is them. It is the people who will work to make the declaration actually matter in the days and months ahead.
Work to do.
p.s. Inside the United Nations, José Vela Zanetti’s mural Mankind’s Struggle for a Lasting Peace shows bodies under pressure: fractured, muscular, unfinished, reaching toward something larger than themselves. It is not a peaceful image. It is a reminder that peace is built through conflict, power, and choice.
That felt like the right image for this week’s High-Level Meeting on HIV/AIDS. The meeting was supposed to renew global commitment to ending AIDS. Instead, it revealed a deeper fracture: between countries willing to name the communities most affected by HIV, and those still trying to sanitize the epidemic for political comfort. Still, UNAIDS deserves credit for helping hold a fractured system together by keeping communities in the room, centering their voices in the process, and mobilizing the countries that were willing to defend a serious, evidence-based response.