Brazil HIV advocates say they foresaw USAID cuts for years

Advocates describe health sovereignty as a path to independence from foreign funding

Brazil’s independence from foreign assistance for HIV prevention and treatment has positioned its advocates to warn other countries about the risks of relying on foreign aid, according to speakers at the Aids 2026 conference in Rio de Janeiro.

Juliana Cesar, political liaison coordinator at the Brazilian HIV NGO Gestos, said during a conference session that while the dissolution of USAID might “feel like a rupture,” it was something she and her colleagues had seen coming for a long time. Cesar said in an interview that she first began to suspect dramatic reductions in foreign aid more than a decade ago, after tracking negotiations at the United Nations since the 2000s.

“We have been tracking negotiations at the UN since the 2000s, and we would see the trends,” she said. The trends included increasingly restrictive language and conditions around using funding for sexual and reproductive health and rights and for LGBTQ+ communities, both essential for HIV prevention. After 2012, Cesar said she was increasingly seeing funding “conditions that would exclude the very communities that we should serve.”

Brazil’s HIV programs fall under the country’s Unified Health System, which operates under a right to healthcare enshrined in its 1988 constitution. After the constitution was signed, civil society members advocated for HIV prevention and treatment to be part of the system. “It has been earmarked into our budgets. We have to make sure that we have enough money for that,” Cesar said. The system allowed Brazil to achieve elimination of HIV transmission to newborns in 2025.

Gestos has advocated for other countries to implement a Financial Transaction Tax similar to Brazil’s, which took money from every transaction and put it toward the public health system. Cesar said the tax is now being phased out as Brazil has taken a turn to the right, and she acknowledged that the tax was not implemented in an ideal way because the same percentage was imposed on every citizen regardless of income.

Cesar urged other countries to consider measures like this, as they provide financial independence from foreign policy whims and give governments autonomy to tailor HIV programs to their citizens.

Ailish Brennan, a policy analyst at Harm Reduction International, pointed out that foreign aid agreements frequently require recipient countries to purchase HIV medications from donor countries such as the United States. “It’s sort of like pumping money back into the donor country economy,” she said. Brennan said domestic production of HIV medications could be “part of a broader shift towards ‘health sovereignty’ and genuine country ownership over health systems.”

Brennan also noted that countries could preserve HIV prevention and treatment programs by redirecting foreign aid that had gone toward narcotics control. A report from Harm Reduction International showed that nearly $1 billion worth of foreign aid, including money from USAID, went toward policing and criminalization of narcotics-related offenses between 2012 and 2021. Brennan said incarceration can increase HIV rates by concentrating high-risk populations, including people who inject drugs, and limiting their access to healthcare. She said the money could have instead funded hundreds of thousands of sterile syringes, which help prevent HIV.

Anton Basenko, executive director of the International Network of People Who Use Drugs, said many HIV prevention organizations in the wake of the cuts “are surviving on the goodwill, unpaid labor, and extraordinary commitment of their staff and volunteers. But resilience should never be mistaken for sustainability.”