HIV funding soars, but gap remains

Malawi has increased domestic HIV funding by 2 440 percent to K4.5 billion, but the allocation covers less than one percent of the K600 billion to K800 billion the country needs annually to sustain the national HIV response.

The huge mismatch has exposed the scale of Malawi’s dependence on donors as external funding contracts, raising concerns over the future of HIV treatment, prevention and community-based services.

The government allocation rose from just K178 million in 2024/25 to K4.5 billion in 2025/26, according to the Unicef Health Budget Brief.

But health experts say the dramatic increase, while necessary, remains far below what is required to keep the response running at its current scale.

National Aids Commission chief executive officer Dr Beatrice Matanje said the increase in domestic financing did not match the support previously provided by development partners.

“There is indeed a significant increase in domestic resource allocation, however, it does not fully cover or match what comes from development partners,” she said.

According to NAC data, Malawi’s annual HIV expenditure ranges between $350 million and $460 million, equivalent to roughly K600 billion to K800 billion.

Health rights advocate Maziko Matemba said the K4.5 billion allocation therefore represents only a fraction of the resources required for treatment, testing and prevention nationwide.

“While we laud the Ministry of Finance for changing the trajectory, this 2 440 percent jump is just the starting point of a long-overdue fiscal transition,” said Matemba, who is also chairperson of the Malawi Network of Aids Service Organisations.

He said Malawi remained heavily dependent on the Global Fund and bilateral partners, particularly for antiretroviral drugs and other essential commodities.

The funding gap also threatens services that operate outside hospitals.

Matanje said community outreach for treatment adherence and retention, condom distribution, HIV prevention among adolescent girls and young women, key population services and community-led monitoring had been affected by disruptions in external funding.

“Protecting treatment alone is insufficient. Sustained investment in prevention, retention and community delivery is essential to avoid increases in new infections and future treatment costs,” she said.

She urged government to establish a domestically funded HIV essential-services package covering treatment continuity, high-impact prevention and community delivery.

Treatment versus prevention

Professor Victor Mwapasa of Kamuzu University of Health Sciences said government had little choice but to increase domestic funding to prevent disruption of life-saving treatment.

“Government had no other way of doing it but to increase domestic funding, just to prevent severe disruption of life-saving HIV services,” said Mwapasa, a professor of epidemiology and public health.

But he said the funding gap meant some services could still be squeezed.

“The problem we have is that the reduction from the donors is much more than what we are putting at the moment,” he said.

Mwapasa warned that government could be forced to prioritise treatment over prevention, including condom provision, if resources remain constrained.

Such a shift could have long-term consequences by weakening efforts to prevent new infections and potentially increasing future treatment costs.

Matanje similarly warned that protecting treatment alone would not be enough to sustain Malawi’s gains against HIV.

Children among the concerns

Parliamentary Committee on Health chairperson Anthony Masamba said paediatric HIV interventions and community programmes required particular protection.

He said Malawi continued to record new infections and that rural communities faced challenges identifying children living with HIV and linking them to treatment.

Community organisations, he said, remain central to the response but are increasingly constrained by funding shortages.

Masamba said his committee was pushing for about K600 million for community interventions.

“Government should sustain HIV funding and invest in community responses where many cases are being identified,” he said.

Matemba said government should go further by systematically increasing domestic HIV financing.

He proposed that Malawi should, within three years, increase domestic HIV-specific spending enough to cover 20 to 30 percent of core commodity costs.

He estimates this would require an annual domestic HIV allocation of between K100 billion and K150 billion.

Aid withdrawal widens the hole

The financing squeeze comes as Malawi faces a broader contraction in external health assistance.

US government funding to Malawi’s health sector declined by an estimated 66 percent by July 1 2025, while global external financing for HIV programmes in low- and middle-income countries fell by 18 percent in 2025 compared with 2024, according to UNAids.

The development has forced governments across the region to increase domestic contributions.

UNAids says Malawi is among more than 50 countries that have reported planned increases in domestic public HIV budgets since 2025.

But the figures from Malawi show how difficult that transition could be.

Even after the 2 440 percent increase, government’s K4.5 billion allocation remains dwarfed by the estimated K600 billion to K800 billion annual requirement.

The country’s HIV response is guided by the 2023–2027 National Strategic Plan for HIV and Aids, which targets ending Aids as a public health threat by 2030.

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