On June 23, 2026, the UN General Assembly adopted a 2026 Political Declaration on HIV/AIDS by a vote of 149 in favor, 8 against and 14 abstentions. It is the first time the United States has voted against an HIV political declaration. And it is only the second time a UN declaration on HIV/AIDS has been put to a formal vote at all, the first being the 2021 text, when the US still voted yes.
The vote came at the close of the UN High-Level Meeting on HIV/AIDS in New York and leaves the declaration in force but the consensus behind it fractured. The US was joined in the no column by Russia, Israel, Burkina Faso, Burundi, North Korea, Niger and Senegal, and the 14 abstentions, nine of them from Middle East countries, included governments that supported parts of the text but refused to commit to the whole. UNAIDS Executive Director Winnie Byanyima called the outcome a declaration that “sets ambitious targets for the world to race to the 2030 goal of ending AIDS as a public health threat.” Doctors Without Borders said the US vote was “the first time the US has voted against an HIV political declaration.” The US no vote was delivered by Deputy US Representative to the UN Tammy Bruce, who framed it as a defense of the 95-95-95 treatment targets and a rejection of language she called “divisive.”
The First Non-Consensus Vote Since 2001
The 2026 declaration was adopted by a vote of 149 in favor, 8 against and 14 abstentions, and it is only the second time a UN declaration on HIV/AIDS has been put to a formal vote. The first was 2021, when Russia requested a vote on that year’s text and four countries voted against.
The 2021 tally was 165 in favor, 4 against and 0 abstentions, with the United States voting yes. Five years later, the yes column is down by 16, the no column has doubled to eight, and 14 countries that once voted yes have moved to abstention. The eight no votes in 2026 came from the United States, Russia, Israel, Burkina Faso, Burundi, North Korea, Niger and Senegal. The 14 abstentions, nine of them from countries in the Middle East, came at the close of the 2026 High-Level Meeting on HIV/AIDS in New York.
Negotiations on the declaration were led by Botswana and Georgia, with the Africa Group and the European Union shaping much of the final text. A last-minute oral amendment from Malawi, speaking for the Africa Group, removed the phrase “mutually agreed terms” from the technology transfer paragraphs, a change the European Union, Switzerland and Canada dissociated themselves from. The declaration lays out targets for the period to 2030, with a mandated 2031 follow-on meeting built in to test whether the gap between ambition and financing is closing.
- 149 in favor, 8 against, 14 abstentions: the June 23 vote on the 2026 declaration
- 2nd time: an HIV/AIDS declaration at the UN HLM has been put to a formal vote
- 2021 tally: 165-4-0: the first time consensus broke, with the US still voting yes
- 2031 follow-on meeting: built into the declaration as a five-year accountability window
Why the Eight Voted No
The US vote was cast by Deputy US Representative to the UN, Ambassador Tammy Bruce, who framed the rejection in two distinct critiques. First, Bruce said the declaration diverged from the 95-95-95 targets by “including divisive topics, reaffirming documents that do not enjoy consensus or which are not related to the fight against AIDS.” The 95-95-95 targets, adopted in 2021, require that 95% of people with HIV know their status, that 95% of those diagnosed be on antiretroviral treatment, and that 95% of those on treatment be virally suppressed. Second, Bruce objected to language on trade and technology transfer, saying the United States “cannot accept references without appropriate caveats” on intellectual property protection.
The June 24 statement on the US no vote from Doctors Without Borders said the US vote “marks the first time the US has voted against an HIV political declaration and comes at a critical moment in the fight to end AIDS,” and called it “a dangerous signal to the global community about the US government’s commitment to ending AIDS.” The same statement noted that “for a quarter century, the US has led global efforts to end HIV/AIDS and has been the largest bilateral funder of the response.” Bruce has not publicly responded to that criticism in the days after the vote.
| Country | Stated reason for the no vote |
|---|---|
| United States | Diverged from the 95-95-95 targets; included “divisive topics” and language on trade and technology transfer the US “cannot accept” |
| Russia | “At least 20 unacceptable provisions” linked to “intervention in domestic affairs”; objected to harm reduction and “non-consensus-based language on gender” |
| Israel | Trade-related clauses; accused a reference to the 2016 Durban Declaration on HIV of being “anti-Semitic” |
| Burundi, Senegal | Echoed Russia’s concern over “non-consensus-based language on gender” |
| Burkina Faso, Niger, North Korea | No specific public reason reported in coverage |
What the Declaration Commits To
For all the political friction, the declaration that came out of the meeting contains the most concrete package of HIV commitments the UN has endorsed in five years. Among the new items is a target to scale up access to pre-exposure prophylaxis, known as PrEP, to 20 million people by 2030, the first time such a target has appeared in a UN political declaration on HIV/AIDS.
The declaration also includes the first reference to advanced HIV disease ever placed in a UN political declaration on HIV/AIDS, per a coalition of 18 feminist and HIV organizations. It commits governments to an HIV vaccine and cure research agenda with measurable actions and a named accountability timeline. The text retains language on integrated HIV and sexual and reproductive health services, sexual and gender-based violence, key populations and the role of community-led responses. It acknowledges “the lack of significant progress in expanding harm reduction programmes” and calls out “discrimination against people who use drugs, particularly those who inject drugs, through the application of restrictive laws.”
- PrEP to 20 million people by 2030: first such target in a UN HIV political declaration
- First reference to advanced HIV disease in a UN HIV political declaration
- HIV vaccine and cure research agenda with measurable actions and a named accountability timeline
- Recognition of HIV in conflict and climate crises, including the explicit link to increased sexual violence
- Language on closing digital divides and on access to justice for survivors of violence
That is also where the declaration shows its limits, and where the civil society response sharpened. The 18-organization feminist joint statement on the 2026 declaration, led by the International Planned Parenthood Federation and Frontline AIDS, said the declaration “weakens rather than strengthens” key commitments from 2021, removing the standalone paragraph on sexual and reproductive health and reproductive rights. The 2021 text’s $3.1 billion societal enablers financing commitment, which funded legal reforms, anti-stigma measures and community-led programs, was eliminated. The declaration also weakens language on decriminalization, the statement said, and adds a new standalone paragraph on the role of families that is not matched by equivalent language on protecting people from family-based stigma and violence. The new declaration asks governments to scale up long-acting prevention, local manufacturing and universal access, all by 2030, on a financing base that is shrinking in real time.
The Money Behind the 2030 Goal
The 2030 targets in the declaration are stacking up against a financing picture that is moving in the opposite direction. The text itself puts a number on the gap: $18.7 billion was available for HIV in 2024, against $21.9 billion required annually by 2030, a $3.2 billion shortfall that the declaration warns “will widen further due to recent, sharp reductions in HIV-related development assistance.” External funding contributed almost 80% of HIV prevention in sub-Saharan Africa, 66% in the Caribbean and 60% in the Middle East and North Africa in 2024, per the declaration.
The funding squeeze is already showing up in the program data. In 2025, global development assistance for health fell by 23%, the sharpest single-year drop ever recorded, per figures cited in reporting on the High-Level Meeting. HIV testing programs fell by 22% in high-burden settings between 2024 and 2025, and funding for condoms was cut by more than 90% in some countries. The America First Global Health Strategy projects a combined $4.3 billion reduction in US and Global Fund support to high-burden countries between now and 2029. In the same week as the UN vote, the State Department announced the permanent withdrawal of PEPFAR funding from South Africa, the country with the world’s largest HIV burden and home to more than eight million people living with the virus.
A new analysis in Nature Health, summarized in Global Health Watch issue 74, found that PEPFAR-supported HIV treatment declined in 2025 by approximately 2 million people, a 10% decrease compared with 2024. South Africa accounted for most of the decline, with a net drop of about 95,000 people previously counted as receiving direct PEPFAR support.
When we’re already seeing clinics shuttered, community programs halted, and prevention tools priced out of reach, now is not the time for the US to turn its back and retreat from a response it once led.
Mihir Mankad, the global health advocacy and policy director at MSF USA, made the comment in a June 24 statement on the US vote.
The declaration acknowledges that key populations face HIV prevalence rates “up to 25 times higher than the general population” while continuing to encounter barriers in accessing prevention, testing, diagnostic and treatment services. Sub-Saharan Africa has recorded a 59% decline in new HIV infections since 2010, while infections increased between 2010 and 2025 in the Middle East and North Africa by 77%, in Latin America by 13% and in Eastern Europe and Central Asia by 15%. Nearly 9 million people living with HIV remain off treatment, per the figures cited in coverage of the meeting. The split is the part the declaration’s targets have to absorb: a regional success story running into a financing collapse and rising incidence elsewhere.
Civil Society Drafts a Counter-Declaration
Inside the UN, governments spent the week trading amendments. Outside it, a parallel text was being signed. Global civil society groups led by Health GAP, the US-based AIDS treatment access organization, drafted and circulated a People’s Declaration on HIV and AIDS as a counter to the official declaration, and over 400 organizations have signed on.
The People’s Declaration was framed as “the declaration the world actually needs; written by and for the people most affected by HIV,” in a joint feminist statement signed by 18 organizations including the International Planned Parenthood Federation, Frontline AIDS, the ATHENA Network and the Global Network of People Living with HIV. The civil society side of the High-Level Meeting put a human face on the response, with leaders including Keren Dunaway of ICW Global, Florence Riako Anam of the Global Network of People Living with HIV, Jeremy Tan of Youth LEAD Asia Pacific, Catherine Nyambura of the Athena Network and Lilian Benjamin Mwakyosi of KWetu Hub. Health GAP, the lead organizer, has framed the People’s Declaration as a call to governments to “reaffirm commitments, rights, and investments to end HIV for everyone, everywhere.” The text itself demands a fully funded response, the decriminalization of key populations, the integration of HIV services into primary healthcare, and a transfer of medical technology that does not depend on bilateral negotiation between pharmaceutical companies and individual governments.
The demands the People’s Declaration makes are also the demands the text makes of the next five years. The 2031 follow-on meeting the official declaration mandates is also the natural deadline for the People’s Declaration, with civil society using the counter-text to hold both the 149 yes-voters and the eight no-voters to their public positions. The signature list is, in a sense, a roster of the organizations that will be holding both groups accountable over that window. AVAC’s framing of the week, in its Global Health Watch issue 74, was that the official declaration “matters because it keeps one thing alive: a shared standard governments can still be judged against,” and the 400-organization signature list is now that standard.
The political geography of the 400-organization coalition is the inverse of the no-vote column. Where the United States, Russia and Israel are the loudest objectors inside the General Assembly, the People’s Declaration is being advanced by organizations in countries the US vote put on the opposite side of the line. The same coalition that produced the People’s Declaration has been clear about who is meant to enforce the parallel standard, with the 18-organization feminist joint statement ending by declaring the coalition “committed and positioned to drive and support the implementation of these commitments across national, regional, and global spheres.” On the question of who sets the terms of the response in a moment when the US has stepped back, AVAC’s analysis identified the signature list as the practical answer, made up of networks including ICW Global, the International Community of Women Living with HIV Eastern Africa and harm reduction and sex worker organizations on five continents. The 2031 follow-on meeting is the deadline, and the parallel text is the standard.
Africa Sets the Terms
Africa’s response to the US position is also being drafted outside the General Assembly. On the morning the High-Level Meeting opened, an op-ed in The Guardian co-authored by Dr. Jean Kaseya, Director General of Africa CDC, and HE Ambassador Amma Adomaa Twum-Amoah, the African Union Commissioner for Health, opened with the Bundibugyo Ebola outbreak as a reminder that the continent cannot wait on “distant supply chains or other people’s goodwill.” The piece laid out the Common Africa Position, built on the Africa Health Security and Sovereignty agenda that African heads of state have already adopted. It made three demands: put domestic HIV financing inside national budgets, make medicines affordable with real technology transfer and local manufacturing, and integrate HIV care into primary healthcare with community organizations and African-owned data systems at the center.
Inside the General Assembly, the Africa Group was the actor that removed the “mutually agreed terms” language from the technology transfer paragraphs through Malawi’s oral amendment, over the objections of the United States, the European Union, Switzerland and Canada. The vote in New York produced a declaration that includes the Africa Group’s preferred language on local manufacturing, and a no-vote column that contains none of the African states the Group speaks for. The data is also on the continent’s side: sub-Saharan Africa recorded a 59% decline in new HIV infections between 2010 and 2025, per figures cited in the declaration.
The US HIV Picture at Home
The US vote in New York arrives as the country’s domestic HIV infrastructure is being cut. The CDC’s HIV prevention programs were among those hit hardest by staff layoffs and budget reductions at the agency in 2025, and the cuts have been felt most in states with the highest infection rates.
Georgia, one of three states with the highest HIV infection rates in the country, has lost support from the five CDC divisions that handle behavioral and clinical surveillance, prevention capacity, communications, HIV research, and quantitative sciences, per the CDC’s HIV prevention cuts in Georgia. Sara Ziegler, a former associate director at the CDC, told the Riverdale Standard that “we are going to see people die of AIDS in the U.S. in 2025. That wasn’t happening anymore, but it will again.” In 2022, Georgia recorded 2,575 new HIV diagnoses, and over 60,000 Georgians are living with the virus. State-level data show 52,528 people living with HIV in Georgia at a prevalence of 608.8 per 100,000 residents, one of the highest in the country, with a PrEP-to-need ratio near 8, among the lowest in the nation. The state’s northwest region also has high rates of opioid use, which increases the risk of HIV transmission through needle sharing.
The state’s response has been to push HIV prevention into places it can still reach. Beginning July 1, Georgia pharmacies can prescribe and administer PrEP and PEP under Georgia’s pharmacist PrEP prescribing law, signed by Gov. Brian Kemp in May, though the state board has until January 1, 2027 to designate which training programs count, and no payment model for pharmacists has been released. The Emory University Rollins School of Public Health has launched a pilot, Rx for Change, in partnership with AIDS United, the Black Public Health Academy, and the National Pharmaceutical Association, to train pharmacy teams and tie them to local community organizations in Georgia and Louisiana. The same week the General Assembly voted in New York, the State Department was ending PEPFAR support in South Africa and the CDC was eliminating public health associate positions in four Georgia counties, including Cobb, Gwinnett, Macon and DeKalb.
Frequently Asked Questions
When was the UN vote on the 2026 HIV/AIDS declaration, and what was the result?
Member states adopted the declaration on June 23, 2026, by a recorded vote of 149 in favor, 8 against and 14 abstentions, the second time a UN HIV/AIDS declaration has been put to a formal vote. The 2021 declaration was the first, passing 165 to 4 with 0 abstentions, with the United States voting yes at the time.
Why did the United States vote against the declaration?
Ambassador Tammy Bruce, the deputy US representative to the UN, said the text diverged from the 95-95-95 targets and included ‘divisive topics, reaffirming documents that do not enjoy consensus or which are not related to the fight against AIDS.’ Bruce also rejected the language on technology transfer, citing US positions on intellectual property protection. Doctors Without Borders called the vote ‘the first time the US has voted against an HIV political declaration.’
What does the declaration actually commit governments to do?
The declaration reaffirms the 2030 goal of ending AIDS as a public health threat and includes a new commitment to scale up access to PrEP to 20 million people by 2030, the first such target in a UN HIV political declaration. It also includes the first reference to advanced HIV disease in such a declaration, retains language on integrated HIV and sexual and reproductive health services, and acknowledges a $3.2 billion HIV financing gap in 2024. An 18-organization feminist coalition has criticized the text for removing a standalone paragraph on sexual and reproductive health and reproductive rights and for eliminating a $3.1 billion societal enablers financing commitment from 2021.
What is the People’s Declaration on HIV and AIDS?
The People’s Declaration on HIV and AIDS is a civil society counter to the official UN text, drafted and circulated by Health GAP and signed by over 400 organizations, including Frontline AIDS, the ATHENA Network, the International Community of Women Living with HIV Eastern Africa, the Global Network of People Living with HIV, and harm reduction and sex worker networks on five continents. The text sets out a fully funded HIV response, the decriminalization of key populations, the integration of HIV services into primary healthcare, and a transfer of medical technology not dependent on bilateral negotiation, and is being positioned as a parallel standard against which governments can be measured.
What happens next, and is the 2030 goal still in reach?
The declaration mandates a 2031 follow-on meeting as the formal accountability check on the five-year window to 2030. In the same week as the vote, the State Department announced the permanent withdrawal of PEPFAR funding from South Africa, the country with the world’s largest HIV burden. Global development assistance for health fell 23% in 2025, the sharpest single-year drop ever recorded, and PEPFAR-supported HIV treatment fell by 2 million people (10%) over 2024 levels, per an analysis in Nature Health cited by AVAC.
Disclaimer: This article is for informational purposes only and does not constitute medical, legal, or financial advice. HIV prevention, testing, and treatment decisions should be made with a qualified healthcare professional. Figures, vote tallies, and funding amounts cited here are accurate as of publication and may change as new data, government actions, and policy reviews are released.
