Domestic Revenues, Debt Relief and Development Aid: Transformative Pathways for Ending AIDS by 2030 in Eastern and Southern Africa

Eastern and Southern Africa—home to the largest share of the global HIV burden—is facing a growing financing squeeze that threatens progress toward ending AIDS by 2030. This report brings into sharp focus a critical reality: the challenge is no longer just about delivering effective HIV programs, but about sustaining them in an increasingly constrained financial environment. Rising public debt, limited fiscal space, and uncertain donor funding are forcing governments and partners to make difficult trade-offs, often at the expense of health investment.

Rather than treating financing as a technical issue, the report reframes it as a system-wide challenge that cuts across leadership, programming, financing, and community delivery. It makes a compelling case that current approaches are insufficient and calls for a coordinated shift built on three pillars: stronger domestic revenue systems, meaningful debt relief, and smarter, more predictable development aid. Crucially, it highlights that no single solution is enough—progress depends on how well these elements work together.

Ultimately, the report is both a warning and an opportunity: without urgent, coordinated action, gains in the HIV response could stall or reverse—but with the right financing shifts, there is still a viable path to ending AIDS by 2030.