UNAids deputy head on US aid freeze: ‘We’re facing a deep systemic shock’

HIV/Aids may have faded from the public’s daily radar, yet it remains a pressing public health challenge. In 2023, 39.9 million people worldwide were living with the virus, 1.3 million were newly infected, and 630,000 lost their lives to the disease. In that year, 30.7 million people received antiretroviral therapy – now threatened by the abrupt suspension of US funding.

Stegling, who has dedicated much of her career to the fight against Aids, outlines the challenges facing UNAids, which, until now, has relied on the United States for 44 per cent of its budget.

Le Temps: With the US covering nearly half of UNAids’ funding, what would be the impact of potential US funding cuts on its work?

Christine Stegling: At this stage, we cannot yet fully assess the consequences. The Trump administration is still within its 90-day review period to decide on its course of action. We were all aware that it would result in a significant disruption, but we had not anticipated the extent of it. Now, the entire framework of international development is being called into question. We must figure out how to regroup. Our priority is to monitor the situation in the affected countries and ensure that waivers apply to maintain ongoing treatment for people living with HIV. Governments have the ability to compensate for any short-term funding shortfalls. This is crucial as organisations embedded within affected communities play a vital role in bridging the gaps, and their work has been instrumental in UNAids’ success in combating HIV.

Does the dismantling of the US development agency mark the beginning of a new era?

The US funds 70 per cent of global humanitarian aid, so it is clear that it will have widespread repercussions for all of us. But on top of that, UN member states are also cutting back their contributions, as seen with Switzerland. This combination of events is truly unfortunate. We must prepare for a different future and adapt accordingly – it would be irresponsible not to.

What figures illustrate the challenge facing your agency?

We are already operating with a significantly smaller budget than the one approved by our UNAids Programme Coordinating Board. While the Board sanctioned a $160 million budget, we will never actually be able to spend that amount. We are adjusting and working hard to secure the backing of some stakeholders to sustain key initiatives that are already underway. 

At this stage, I cannot provide precise figures because the situation is highly volatile. However, the freezing of US aid through USAid has a knock-on effect on our partners, including the UN Population Fund, the UN Office on Drugs and Crime and even the UN refugee agency. As a result, everyone is preparing for the worst-case scenario, a moderate scenario and the most favourable scenario. The key question is where will the most critical funding gaps emerge. The human rights component of our work is particularly at risk, which could have serious consequences for the communities we work with. UNAids has always prided itself on being somewhat unique, with NGOs represented on our Programme Coordinating Board. However, we must not avoid reality – we’re facing a deep systemic shock.

The US plays a leading role in the President’s Emergency Plan for Aids Relief (Pepfar). How does its work align with UNAids?

The funds in question are allocated by Congress and distributed through various agencies, including USAid, the Department of Defense and the Centers for Disease Control and Prevention. We have worked closely with each of these bodies, but particularly with Pepfar over the years. Last year, we collaborated with around 30 countries to develop a sustainable HIV response in partnership with the Global Fund to Fight Aids, Tuberculosis and Malaria, as well as the Bill & Melinda Gates Foundation. Our role as a UN entity is to coordinate all actors involved in these highly multilateral efforts.

Millions of people still rely on daily treatment in some African countries. Could the decisions from Washington put their lives at risk?

When I say that treatment should continue, that is one thing, but the entire support system is now being disrupted. Programmes for prevention, counselling and services to encourage people to get tested are all on pause. There will be more infections with every hour while we could’ve prevented it. Some governments, like Ethiopia’s, have pledged to partially make up for the funding gap. We will need to closely monitor any treatment interruptions. In marginalised communities, some patients will face long waits for care, making it even harder to stabilise their health.

The US situation is causing concern, but Switzerland has acted similarly, completely cutting its funding to UNAids…

This decision was made in two stages. Last year, Switzerland reduced its contribution by 80 per cent from 10 million Swiss francs, and this year, it was cut entirely. We had greatly appreciated Swiss support up until now – not only financially but also politically. Switzerland has always been highly engaged in our work, as it is aligned with its broader philosophy. Any funding withdrawal is unfortunate, especially at this moment. We will, of course, continue working with the Swiss government, but the loss is particularly painful at a time when the international system seems to be collapsing around us.

Switzerland claims it is redirecting its focus to the Global Fund to Fight Aids. Does this make sense?

It is crucial that Switzerland continues supporting the Global Fund. However, for it to be effective, it needs us. We coordinate 11 UN agencies and maintain a presence in every country. We facilitate the Global Fund’s programmes by bringing together governments and civil society. UNAids was established as a dedicated multilateral platform within the UN, and if one component of the international HIV response architecture begins to fail, the entire structure is at risk.

Is your agency in danger?

I believe we all are. This is what happens when 70 per cent of the global response to Aids is funded by a single country like the United States. But what we are witnessing is even more significant: a fundamental disruption of the development sector and the multilateral system as a whole. Regardless of the outcome, the system will need to reorient itself in the aftermath of such a severe shock.