UNAIDS Framework Pushes for the Protection and Integration of HIV Care

UNAIDS has released a new framework aimed at ensuring the protection and integration of HIV care in contexts where health systems are under extreme pressure. The document, titled Operationalizing HIV Integration, was published on August 17, 2026, and outlines a phased strategy for countries to safely transition from standalone HIV programs to fully integrated national health systems. This shift is driven by the growing recognition that traditional models of HIV care, reliant on external funding and centralized structures, are increasingly unsustainable, especially amid shrinking international financial support and ongoing humanitarian crises. The framework introduces the concept of “protective verticality,” which emphasizes that integration should occur based on a country’s specific context rather than following a one-size-fits-all model. According to the report, countries must assess their readiness, including epidemiological trends, existing health infrastructure, and available resources, before moving forward with integration. This approach acknowledges that in environments such as active conflict zones, fragile states, or outbreak areas, maintaining separate HIV-focused services may be necessary to ensure continuity of care. The report warns against the risks of rapidly merging HIV functions into already strained national health systems, which could lead to the loss of critical services. The proposed three-phase model provides a structured pathway for countries to follow. The first phase, “Stabilization,” focuses on preserving the continuity of HIV services during times of crisis. This includes safeguarding access to treatment, preventing disruptions in care delivery, and ensuring that vulnerable populations remain connected to essential services. The second phase, “Connection,” aims to build stronger links between HIV programs and broader healthcare networks, fostering collaboration between local communities, health workers, and policymakers. Finally, the third phase, “Embed,” involves aligning HIV initiatives with national health strategies, ensuring long-term sustainability and integration into mainstream public health frameworks. This initiative comes at a particularly challenging moment for the global HIV response. International funding for HIV programs dropped by 18 percent in 2025, falling from $8.8 billion in 2024 to $7.3 billion in 2025, the lowest level in over two decades. This decline reflects broader economic pressures, including rising inflation, geopolitical tensions, and shifting priorities among donor nations. With fewer resources available to support HIV programs, there is an urgent need for more resilient, locally driven approaches that minimize dependency on external aid. The framework highlights the importance of adapting to complex emergencies, using the situation in the Democratic Republic of the Congo (DRC) as a case study. In May 2026, an Ebola outbreak in the eastern DRC created significant challenges for HIV care, as fear of infection led many individuals to avoid clinics and antiretroviral therapy distribution sites. In response, UNAIDS worked with local authorities to incorporate HIV-specific protections into the DRC’s National Ebola Preparedness and Response Plan. This included developing an HIV Mitigation Plan to maintain treatment access and reduce barriers for people living with HIV. These efforts exemplify the practical application of the “stabilization” and “connection” phases outlined in the framework. Similarly, the ongoing conflict in Sudan underscores the urgency of the proposed model. Since the outbreak of war in April 2023, medical supply chains have been severely disrupted, leading to the closure of 75 percent of hospitals in conflict-affected areas. This has had devastating consequences for HIV treatment, with thousands of patients facing interrupted care. The situation continues to evolve, with the war entering its 1,000th day in early 2026, highlighting the persistent challenges faced by health systems in protracted conflicts.