As part of the regional information and advocacy campaign “EECA Voices at AIDS 2026”, implemented by VirusOFF with support from the UNAIDS Office for the Eastern Europe and Central Asia, Asia and the Pacific regions, we are concluding our series of publications on the key signals from AIDS 2026 for the region.
After Rio, the central question for Eastern Europe and Central Asia is not a conference takeaway. It is practical: will people retain access to prevention, testing, treatment, PrEP, harm reduction, peer counselling, social support, legal protection and community-led services when funding changes?
This is what sustainability must mean today.
Not only a government budget. Not only procurement of medicines. Not only a strategy until 2030. Sustainability means the ability of the system to ensure that a person does not lose support because of war, displacement, stigma, criminalization, poverty or the closure of a civil society organization that had been their only point of trust.
The UNAIDS Special Report for AIDS 2026 shows that in 2025, 1.2 million people acquired HIV, 570,000 people died from AIDS-related illnesses, and around 9 million of the 41 million people living with HIV were not receiving treatment. The same UNAIDS report records that external financing for the global HIV response in low- and middle-income countries declined by 18% in 2025 compared with 2024. This has already affected prevention, testing and community-led services — the very components that often reach people most affected by HIV first.
For EECA, the situation is especially alarming. Between 2010 and 2025, the number of new HIV infections in Eastern Europe and Central Asia increased by 17%, while it declined in a number of other regions. UNAIDS also notes that among the 21 countries where new HIV infections are increasing, there are countries from our region, including Armenia and Kyrgyzstan. This means one simple thing: EECA cannot afford “sustainability” through cuts. If prevention, harm reduction, support and community services weaken, the region is not moving towards a sustainable model. It risks losing control of the epidemic.
In 2024, HIV prevention accounted for only 11% of total HIV funding in low- and middle-income countries. At the same time, 66% of prevention funding came from external sources. This is critical for EECA, because prevention often depends on international support and the work of civil society organizations: PrEP, post-exposure prophylaxis (PEP), condoms, self-testing, community-based testing, outreach, harm reduction, opioid agonist therapy, counselling and referral. If these services are cut, the consequences will not be abstract. Fewer people will get tested. Fewer people will learn about prevention. Fewer people will start treatment on time. More people will acquire HIV.
During a regional discussion at AIDS 2026, Denys Hodlevskyi, Regional Director, ITPCru (Eastern Europe), described this risk very practically: when the number of civil society organizations in a programme is reduced, coverage is reduced as well. If there are half as many organizations, half as many people can receive services.
AIDS 2026 spoke a great deal about new long-acting HIV prevention tools, including lenacapavir. But for EECA, the question is not whether a scientific breakthrough exists. The question is whether it will be accessible to people in the region.
UNAIDS notes that by the end of June 2026, more than 50,000 people had received twice-yearly lenacapavir in nine countries in sub-Saharan Africa. At the same time, the report states that the price for lower-income countries could be reduced to US$40 per person per year from 2027, while uncertainty remains for middle- and higher-income countries.
For EECA, this is a key issue. Many countries in the region are not low-income countries, but they face major access barriers: small markets, complex registration processes, patent restrictions, limited budgets, war, migration, stigma and criminalization.
Tetiana Deshko, Director of International Programmes at the Alliance for Public Health, emphasized that AIDS 2026 included extensive discussion of long-acting prevention tools, but access to them in Eastern Europe and Central Asia remains extremely limited. According to her, the region needs not hundreds, but hundreds of thousands of long-acting PrEP regimens, and communities must be at the centre so that medicines reach the people who need them most.
The conclusion is simple: innovation without registration, procurement, affordable pricing, trained providers, clear information and community participation remains not access, but a presentation.
UNAIDS warns that community-led organizations were among the first to feel the impact of cuts in international funding. In 2024, around 25% of external HIV funding went to non-governmental organizations and civil society. In 2026, a survey of 79 community-led organizations in 47 countries showed a 50% reduction in PrEP delivery by such organizations, a 50% reduction in support for people living with HIV, an 85% reduction in services for gay men and other men who have sex with men, an 82%reduction in services for sex workers, and a 72% reduction in services for people who have experienced gender-based violence. This is not simply a reduction in projects. It is a reduction in access.
In many EECA countries, community-led organizations are the first point of contact for people whom the formal system does not see or cannot retain: people who use drugs, sex workers, trans people, migrants, and people who fear stigma or criminalization.
These organizations do not only “provide services”. They explain, accompany, refer, protect rights, collect data on barriers, see disruptions first and hear first when people stop trusting the system.
The UNAIDS report also notes that data from 12 countries that analysed spending by community-led organizations show that more than half of their expenditure went to HIV prevention, testing, counselling, care and treatment, while another fifth went to social protection and economic support.
This is why sustainability cannot mean integrating services into the state system at the cost of the disappearance of communities. It must mean something else: public financing and recognition of community-led organizations as part of the health system.
For EECA, it is impossible to speak about ending AIDS as a public health threat without harm reduction and without services for people who use drugs.
Anton Basenko, Executive Director of the International Network of People who Use Drugs (INPUD), emphasized at AIDS 2026 that less than four years remain until 2030, and that Ukraine, despite the war, continues to try to be an example of resilience for the region, while harm reduction remains an indispensable part of the HIV response. During the regional discussion, he also described the impact of funding cuts on organizations working with people who use drugs: budget losses, staff reductions, shortages of harm reduction supplies, increased discrimination and police pressure. His conclusion was stark: what began as a financial crisis has become a crisis of public health, human rights and human dignity.
This must be one of the main conclusions after Rio: if harm reduction programmes weaken, EECA is not moving closer to the 2030 targets. It is moving further away from them.
UNAIDS, in its report for AIDS 2026, also warns of increasing legal barriers. In 2026, only 7 out of 193 countries did not criminalize at least one of the following: same-sex sexual relations, trans people, sex work, possession of small amounts of drugs, or non-disclosure, potential or actual HIV transmission. Sex work is criminalized in 168 countries, possession of small amounts of drugs in 152 countries, same-sex sexual relations in 66 countries, and trans people in 14 countries.
For EECA, this is not an external issue. Criminalization, police pressure, stigma and discrimination directly determine whether a person seeks testing, prevention or treatment.
If a person fears registration, disclosure of HIV status, job loss, violence, arrest or humiliation in a health facility, a service may formally exist but remain inaccessible in reality.
Human rights are therefore not a “separate chapter” in a strategy. They are a condition for the effectiveness of the HIV response itself.
The 2026 UN Political Declaration on HIV and AIDS sets clear targets: by 2030, mobilize US$21.9 billion annually for HIV in low- and middle-income countries; ensure financing for prevention, societal enablers and community-led services; increase domestic investments without service disruptions; and reduce out-of-pocket expenses.
Another target is that 30% of HIV testing and support services related to care and treatment should be provided by community-led organizations, including organizations of people from key populations and women’s organizations.
For EECA, this is a very concrete test. If countries speak about sustainability but do not have mechanisms for national or local financing of community-led organizations, do not finance prevention and do not protect services for key populations, such sustainability does not meet the 2030 targets.
After AIDS 2026, EECA needs not more general promises, but five practical decisions.
1. Protect prevention financing.
PrEP, post-exposure prophylaxis, self-testing, community-based testing, condoms, harm reduction, opioid agonist therapy and outreach cannot be the first areas to be cut.
2. Integrate community-led organizations into national financing systems.
Not only as temporary grant implementers, but as part of the health system: through social contracting, local budgets, state programmes, long-term agreements and community-led monitoring.
3. Plan access to innovation before launch.
Registration of a medicine is not access. Procurement, affordable pricing, training for providers, preparation of communities, information work and service pathways are needed.
4. Protect harm reduction and opioid agonist therapy as core elements of the HIV response.
Without them, the region will not reach the 2030 targets.
5. Combine state responsibility with international solidarity.
Public financing must grow. But transition cannot mean the abrupt disappearance of services in countries living through war, displacement, economic pressure or shrinking civic space.
After Rio, the question for EECA is not whether the word “sustainability” will appear in strategies. It will.
The question is different: will a person be able to receive a test, prevention, treatment, support and protection of rights when international funding is declining and state systems are not yet ready to fully take over what communities have carried for years?
If the answer is “yes”, this is sustainability.
If the answer is “no”, this is not sustainability, but a transfer of risks onto people.
AIDS 2026 gave the region important visibility. The election of Andriy Klepikov, Executive Director of the Alliance for Public Health, as the next President of the International AIDS Society was an important signal for Ukraine and the whole EECA region.
But visibility must turn into decisions.
And for EECA, sustainability after Rio must mean one thing: people must not lose access to support at the very moment when they need it most.
