NAVIGATING A SEA CHANGE FOR THE HIV RESPONSE
A nearly imperceptible shift, with outsized implications.
As the HIV landscape transforms rapidly, new research shows that HIV philanthropy stayed largely static leading up to the current crisis—a clear signal that bold change is needed to end HIV as a global health crisis in our lifetimes.
For more than two decades, Funders Concerned About AIDS has examined the flow of philanthropic resources for HIV through our annual resource tracking report. Our goal is for this data to serve as a GPS for donors: illuminating priorities, exposing gaps, and equipping grantmakers to direct resources where they can have the greatest impact.
This year’s report, analyzing 2024 grantmaking data, shows that HIV philanthropy totaled $719 million — a decline of less than 1% from the record high of $722 million in 2023.
This slight decline stands in sharp contrast to the upheaval the HIV response has experienced in 2025. Drastic cuts to public aid, shrinking civic space, and escalating hostility toward already marginalized communities have fundamentally altered the landscape. Where grantmakers once complemented relatively stable public investments, we now face a new reality: receding political will, public funding disruptions, and reduced access to prevention and care. These factors are driving growing inequities that threaten the health, rights, and dignity of communities impacted by HIV — many of whom already face profound risks in today’s political environment.
For funders, the question is clear. How do we use the data in this report to forge a more resilient and equitable HIV response?
Indeed, donors will play an increasingly vital role in what comes next. Historically, philanthropy has accounted for roughly 2% of the global HIV response. But as government support erodes and multilateral investments falter, that balance may shift dramatically — making it imperative to deploy every grant with precision and purpose.
This year’s findings reveal persistent concentration in HIV philanthropy: the top two funders continued to account for two-thirds of total grantmaking, and one has announced plans to sunset by 2045. General operating support declined sharply, and funding fell in hard-hit regions such as Eastern and Southern Africa, the Caribbean, and Latin America. At the same time, there were some more hopeful signals. Funding increased for nearly all key populations, who represent more than half of new infections globally and 80% of those outside sub-Saharan Africa. Resources also grew to regions such as the Middle East and North Africa, South Asia and the Pacific, Eastern Europe and Central Asia, and the U.S. and Canada.
These data offer more than a snapshot of past grantmaking; they are a tool for navigating what comes next. HIV resources must be strategically aligned with the needs of impacted geographies and communities, including key populations—an umbrella term used in this report to describe groups disproportionately affected by HIV, such as gay and bisexual men, transgender people, sex workers, and people who use drugs, many of whom face intersecting stigma, criminalization, and exclusion. While communities may use different language to describe themselves—emphasizing agency, resilience, or shared experience—these findings reveal clear gaps in the HIV response that have only grown more urgent in the last year. Below, we highlight key opportunities for funders to address these gaps and sustain progress.
5 URGENT ACTIONS FOR PHILANTHROPY TO TAKE NOW
1. ADDRESS NEEDS IN GLOBAL HOT SPOTS
Philanthropic funding fell by 16% ($30.5 million) in Eastern and Southern Africa, even as new HIV transmissions increased by 9%. The Caribbean also saw double-digit funding declines. Meanwhile, funding in Latin America and East & Southeast Asia both dipped by 6%, modest declines that nonetheless risk undermining recent progress in reducing new infections.
As the region with the most countries supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), communities and clinics in Eastern and Southern Africa have been hit especially hard by recent funding cuts. In Mozambique, treatment initiation fell 14% between February and May, while treatment interruptions rose 39% from April to May 2025. In South Africa, the termination of USAID funding in February 2025 led to an 8% drop in HIV testing and a 30% decline in new treatment initiation.2 These disruptions highlight the urgent need for funders to support continuity of care.
2. FUND PROGRAMS TARGETED TO MOST IMPACTED COMMUNITIES
While funding for key populations increased overall, grantmaking levels continue to fall far short of community needs. Support for gay and bisexual men and other men who have sex with men also declined by 2%, even as these communities remain disproportionately affected by HIV.
As these most impacted communities face rising stigma and reduced access to care, sustained investment in these communities must be the cornerstone of the HIV response. New analysis warns that failing to adequately prevent HIV among key populations in just 25 PEPFAR-supported countries could add an average of 430,000 new infections each year — more than 4.7 million by 2035.3 To achieve real impact, funders should prioritize programs designed with and for these communities.
3. EXPAND ACCESS TO INNOVATIONS LIKE LONG-ACTING PrEP
Funding dropped by 14% ($9 million) for pre-exposure prophylaxis (PrEP), despite its proven efficacy in preventing HIV transmissions. Of the $54 million in HIV philanthropy for PrEP, 38% of it went to the U.S. alone. Another 43% went to all of Sub-Saharan Africa, including research-related work impacting the region.
While innovations like long-acting PrEP offer great promise, investment in HIV prevention and research remains misaligned with needs. Global Fund and PEPFAR commitments to provide long- acting injectable PrEP for 2 million people by 2028 are an important start, but fall far short of the scale required to achieve impact, with global targets calling for 20 million PrEP users by 2030.4 Public funding cuts also threaten access to lifesaving PrEP for an estimated 719,000 people, underscoring the need for funders to ensure medical breakthroughs translate into real-world access.5
4. SHIFT U.S.-BASED FUNDING TO LOCAL COMMUNITIES
Funding to the United States increased by $32 million overall, but the majority of that growth went toward national-level grants rather than locally based efforts. At the same time, funding for Black, Indigenous, and other people of color declined by 12%, despite these communities remaining among those most heavily impacted by HIV in the U.S. PrEP-related funding for BIPOC communities in the U.S. dropped by 42% from 2023 to just $10 million.
As the U.S. government pulls back on Medicaid and other domestic programs, HIV funding in the United States is under threat. With approximately 1.2 million people living with HIV and roughly 600,000 relying on PrEP for prevention, cuts to testing, prevention, and community-based services are jeopardizing hard-won gains. These reductions fall hardest on Black and Latino communities, LGBTQ+ populations, and people in the U.S. South, making it critical for funders to protect progress by resourcing organizations on the front lines.
5. RESOURCE LONG-TERM CAPACITY, NOT SHORT-TERM OUTPUTS
General operating support plunged by 32% ($29 million) after trending upward in recent years, and leadership development and capacity- building support also declined. These reductions make it harder for organizations to adapt and respond to fast-changing conditions. In addition, advocacy funding — one of the most impactful and least funded strategies for combating HIV — dipped by 5%. Together, sustained general operating and advocacy support are essential to building strong, community-based movements that can organize, lead, and advance durable HIV responses beyond individual projects.
Funding pullbacks have exposed the fragility of many community- based organizations, making sustained general operating support more urgent than ever. After the PEPFAR funding freeze, 36% of partners closed within a week, and another 19% said they could not survive more than a month.6 With HIV criminalization rising, funding advocacy is essential to create environments where prevention, treatment, and care can succeed.
SHAPING THE PATH FORWARD TOGETHER
When public funding can no longer be taken for granted, we must find new ways to keep resources flowing to community organizations and leaders on the front lines of the HIV response. While philanthropy alone can’t fill the void left by public resources, our work has never been more essential. Funders, community organizations, advocates, and people most impacted by HIV each have a role to play in shaping what comes next — because when we act together, we’re unstoppable.
Adapting to this sea change is how we create our own current: one strong enough to absorb shocks, prevent deeper harm, and ensure resources reach the people most affected by HIV and least included in evolving public health agendas.
This moment offers an opportunity to build a more diverse and sustainable response, including:
- New donors to counter growing concentration in HIV philanthropy
- New voices from the most impacted, yet persistently underrepresented regions, particularly the Global South
- New funding strategies that eliminate redundancy and prioritize key populations
In an environment where every grant must stretch further, giving must be coordinated, strategic, and precise. That is why FCAA exists. Our work moving forward is grounded in a clear truth: medical advancements to end the HIV crisis have moved faster than political will. Guided by our new strategic plan, FCAA will focus over the next five years on helping donors act and adapt in a rapidly changing landscape, sustaining the systems that make strategic philanthropy possible, and charting a course forward rooted in equity and impact.
We urge you to use the insights in this report to become the bright spots — the beacons that illuminate a path beyond the barriers. Despite the challenges ahead, we are encouraged by the resolve across our donor community. An end-of-year rapid response survey of grantmakers in this report showed that 37% of respondents increased their giving for 2025, totaling just over $5 million among those who reported amounts. Actions like these form a rising tide — shaped by courage, care, and collective action — that will carry us through this moment and toward an AIDS-free future.
To our members, partners, allies, and all who made this report possible: thank you. We are proud to work together to shape a future anchored in justice, health, and human rights for all.
In Solidarity,
View endnotes for each of these sections on page 23 of the full report PDF.
