UNAIDS: Rising debt in sub-Saharan South Africa is claiming many lives

Fiona from a health centre in Uganda visited a client and her son, who received training and support on delivering HIV-free babies

A report released Thursday by UNAIDS details how the debt crisis is jeopardizing progress in ending AIDS in sub-Saharan South Africa countries, which account for the vast majority of people living with HIV globally — 25.9 million out of a total of nearly 40 million.

If debt servicing and budget crunches are not addressed within the next three to five years, countries will lack the resources to support their AIDS response, the report says.

Further data show that the region's 56% reduction in new HIV infections since 2010 will not be sustained if fiscal space is constrained.

In Angola, Kenya, Malawi, Rwanda, Uganda and Zambia, sovereign debt servicing now accounts for more than half of government revenues.

Even after debt relief measures are implemented, Zambia will devote two-thirds of its budget to debt servicing between 2024 and 2026, UNAIDS said.

UNAIDS Executive Director Bayanima said there is an urgent need to reduce public debt and strengthen domestic resource mobilization to create fiscal space to fully fund the global HIV response and end AIDS.

Debt repayment

Global health security is at risk when countries are unable to meet health care needs due to debt repayment, Baianyima said. This is particularly true in West and Central Africa, where spending on HIV responses has fallen significantly since 2017.

The report shows that West and Central Africa needs to mobilize US$4.18 billion in 2024 to fully fund the HIV response. If efforts are not stepped up today to stop new HIV infections, this demand will climb to $7.9 billion by 2030.

The report notes that in 2022, low- and middle-income countries allocated US$20.8 billion to HIV response through various donations, but this is still insufficient to effectively fund the HIV response.

To fully respond to HIV needs in 2024, Eastern and Southern Africa needs US$ 12 billion, which will rise to US$ 17 billion by 2030 unless new HIV infections decline.

Necessary measures

The report notes that sub-Saharan South Africa countries need to strengthen their tax systems and increase fiscal contributions to secure more domestic resources to effectively respond to the "pandemic" they face.

World leaders cannot allow resource scarcity to hinder global progress towards ending AIDS as a public health threat by 2030, Baianyima said.

Youth activists from New York attended the conference

Young people play an active role in driving progress in the HIV response, Baianyima said.

UNAIDS is working with two "influencers" living with HIV from Kenya and South Africa who will participate in the Summit of the Future and the UN General Assembly in New York to call on world leaders to invest in health services that support young people living with HIV.

Limo, a young Kenya AIDS activist, said: "I hope leaders leave New York aware that we are not beneficiaries, we are equal rights holders." We want adolescents and young people to have meaningful and ethical engagement in all areas of the AIDS response. ”

South Africa advocate Njema said these meetings alone could not end AIDS and that real solutions were needed. Young people living with HIV play a key role in the community's fight against AIDS.

Engage young people in the conversation

Njema said the world would only benefit if young people were included in the global HIV response. "No discussion of AIDS, whether at the policy level or in community practice, can be done without us."

As young people living with HIV also face stigma and discrimination, including from doctors, they will lobby world leaders at the General Assembly to uphold the human rights of young people, which is critical to ending AIDS as a public health threat.