Health Equity, Community Voices, and the Fight for UNAIDS
For people living with and affected by HIV, tuberculosis, and malaria, health equity is not a vague and pompous phrase, pretentious even. It is about equal dignity, access, and justice.
Blogarticle by Alexei Lakhov.
Health equity means that sex workers, gay and other men who have sex with men, transgender people, people who use drugs, migrants, and other marginalized groups, often sidelined in policy, can access prevention, treatment, and care without facing stigma, discrimination, or political neglect. True equity goes deeper than equality -- it tackles the roots of injustice, not just the numbers. This principle has shaped the core mission of UNAIDS, the Joint UN Programme on HIV/AIDS. Since its inception in 1996, UNAIDS has stood apart in the UN system -- drawing together member states, cosponsors (meaning other UN agencies such as UNDP, UNODC, WHO and others) and civil society under one unified strategy. Its’ mandate spans not only biomedical response but also human rights, justice, and community representation. It unites global data and strategy with grassroots realities, amplifying the rights and voices of those most impacted.
UNAIDS and the Global Fund: A Synergy Come True
UNAIDS and the Global Fund work hand in hand. While the Global Fund mobilizes and delivers resources on a massive scale, UNAIDS ensures those resources are deployed strategically and in ways that prioritize equity. UNAIDS builds consensus: it convenes governments, communities, donors, and technical agencies around shared commitments. It analyzes inequities, pushes for community leadership, and ensures that marginalized groups remain visible in policymaking.
The Global Fund finances what UNAIDS identifies as priorities rooted in equity. UNAIDS provides the compass; the Global Fund is the engine. Without this complementarity, funding risks becoming untethered from the very principles -- justice, inclusion, rights -- that drove gains in the HIV response.
When Progress Stalls: Communities Speak
But today, those principles are under threat. As UNAIDS embarks on a sweeping restructuring amid severe donor funding shortfalls that some voices, rather hastily, call the “sunsetting” of the Programme, the community alarm is loud. As the NGO Delegation to the UNAIDS Programme Coordinating Board declared:
“The global AIDS response is collapsing -- not because we lack solutions, but because we’ve abandoned the will to act. Let’s be clear -- you do not get to celebrate past victories while abandoning the present fight. You do not get to speak of “equity” while cutting the very programs that protect the world’s most vulnerable. This is not fiscal discipline; it is fiscal negligence.”
In another intervention, they asked delegates to imagine: “Close your eyes… imagine that you are watching a sunset. Picture the colours spread across the sky, how glorious they are. You’re in a place where you feel only joy, and there are loved ones standing beside you, maybe even those who have gone. And as you watch this perfect sunset, you know that there is nothing left to do. Everything you have worked for has been achieved.
This is the sunset that the NGO Delegation wants to see. Not until hundreds of thousands no longer die each year from a treatable condition; not until communities at risk no longer go without HIV prevention; not until women, girls, and key populations live free from stigma and discrimination. Our collective position should be that UNAIDS must sunset only when our work is done.”
These are not rhetorical flourishes. UNAIDS projects that if current funding trends continue, over 6 million people may become newly infected with HIV, 620,000 children may miss treatment, and four million more could die from preventable AIDS-related illnesses by 2029. For communities, this is not a tragedy waiting to happen; it’s already unfolding.
The Human Meaning of UNAIDS
Community representatives often remind policymakers that behind every restructuring plan are lived realities. As I put it in my intervention at the 56 meeting of the Programme Coordinating Board in June 2025:
“At different points in my life, I have been labelled drug user, former drug user, alcoholic, ex-alcoholic, convict, ex-convict, someone living with hepatitis, and someone cured of it. But when you list these identities, the meaning gets lost. Unfortunately, meaning is also lost in this room, where time after time people living with and affected by HIV are asked to prove that we matter, that we deserve a place in strategies, in budgets, in rooms like this.”
This is why UNAIDS -- and its cosponsors like UNODC -- remain essential. As the same intervention concluded:
“Cuts to global health and development funding are already costing lives. Any restructuring must not abandon those most at risk. We need continuity, not sharp weight loss on Ozempic. We need governments to invest not just in principles, but in peer-led services that work.”
It is precisely this insistence -- that equity is measured in lives, not in organigrams -- that makes UNAIDS’ unique role irreplaceable.
A Collective Call for Equity and Solidarity
This year’s Global Fund Replenishment theme around Health Equity is timely, urgent, and powerful. But achieving equity requires more than financing alone. It demands institutional guardianship to ensure those funds reach the most marginalized, the most criminalized, the most excluded.
As parliamentarians, diplomats, donors, and advocates read this issue of Informiert, consider this: the Global Fund and UNAIDS are not interchangeable; they are complementary. The Fund fuels lives; UNAIDS ensures those lives are valued, counted, and respected.
To achieve health equity by 2030 and beyond, we need UNAIDS -- not less of it, not a premature sunset, but a strong, community-grounded institution that can carry this work through to its rightful conclusion. Because health equity without UNAIDS is not equity -- it’s empty rhetoric.
Alexei Lakhov served as an NGO Europe delegate in the UNAIDS Programme Coordinating Board NGO Delegation in 2022-2024. Currently, he’s working as a part-time Executive Director of the European Network of People who Use Drugs, as well as Coact, HIV Justice Network, International Liver Cancer Movement consultant.
This article is part of the blog series on the 8th Replenishment Conference of the Global Fund. Since August 20, 2025, civil society organizations have been publishing weekly contributions on global health financing, equity, and the role of the Global Fund.
