HIV Prevention Advocacy Agendas | Three Countries, One Window: Why HIV Prevention Needs Advocacy Now

South Africa, Malawi and Zimbabwe have each made progress in HIV prevention programming. New infections in Malawi have declined by 79% since 2010, and Zimbabwe has seen an 80% decline over the same period, putting both countries on track to achieve their 2030 goals. At the same time, all three countries are facing a period of funding transition and uncertainty, just as new prevention technologies such as lenacapavir (LEN) and long-acting cabotegravir (CAB-LA) create opportunities towards epidemic control.

Within this context, Genesis Analytics has developed HIV Prevention Advocacy Agendas to inform countries on the most urgent, evidence-informed policy and financing actions needed over the next one to two years to sustain and strengthen HIV prevention programmes.

Why HIV prevention advocacy matters now

Across all three countries, external funding for HIV prevention is under real strain:

In South Africa, PEPFAR support was sharply reduced, with around 70% of the annual US$400 million COP budget cancelled in 2025, and the US$115 million bridge budget due to end in July 2026, with no further US HIV support expected after that.
In Malawi, HIV prevention relies entirely on external funding, and the country's HIV Prevention Strategy (2021-2025) is coming to an end, with a new Integrated National Strategic Plan for HIV, TB and Malaria currently in development.
In Zimbabwe, government has halted negotiations for a new five-year, US$367 million bilateral health agreement with the US, and the Global Fund has reduced Zimbabwe's HIV allocation from US$508.7 million in Grant Cycle 7 to US$455.2 million, with Grant Cycle 8 further reduced to US$412.9 million for 2027 to 2029.

At the same time, all three countries are at pivotal moments in domestic decision-making, including South Africa's provincial HIV conditional grant, Zimbabwe's AIDS Levy and Global Fund Grant Cycle 8 request, and Malawi's own Grant Cycle 8 submission and new Integrated National Strategic Plan.

How the agendas were developed

Genesis Analytics followed a three-step approach in each country:

Landscaping: a rapid review of epidemiology, policy, programme performance, financing and macro-fiscal context, producing country-specific HIV prevention snapshots that identify key risks, opportunities and advocacy priorities.
Economic modelling: using the Thembisa model for South Africa and HIV Synthesis model for Malawi and Zimbabwe, to assess the impact, cost-effectiveness and budget implications of priority prevention investments.
Country engagement: workshops and key informant interviews that integrated stakeholder perspectives, implementation realities and community insights, refining and localising the priorities.

This process produced four outputs in each country: HIV prevention snapshots, economic evidence, advocacy agendas and advocacy resource packs, all focused on the most urgent policy and financing actions for the next one to two years.

What the evidence shows, country by country

South Africa has around 8 million people living with HIV, around 6 million people on ART, and around 150,000 new infections a year. It runs the largest HIV treatment programme in the world, spending approximately US$2 to 2.6 billion a year on its national HIV response, of which less than 10% goes to HIV prevention. Prevention spending of around US$200 to US$300 million a year is almost half externally funded, compared with only around 15% for care and treatment, meaning PEPFAR and Global Fund reductions have hit prevention hardest. Modelling suggests that high uptake of LEN (2 to 4 million people a year) could reduce HIV incidence to below 0.1% by 2032, eliminating HIV as a public health threat ten years earlier than the status quo. The advocacy agenda calls for protecting the HIV conditional grant, accelerating and optimising LEN scale-up, and sustaining community-led HIV prevention, noting that sex workers in South Africa are twice as likely to be offered PrEP at community drop-in centres (40%) as at public health facilities (19%).

Malawi had 990,000 people living with HIV and 12,000 new infections in 2024. HIV prevention needs are projected to peak at US$108.7 million in 2029, three times higher than 2022 spending of US$36.7 million, yet prevention accounted for only 7.3% of total HIV spending in 2021/22 and relied entirely on external funding, compared with 26% domestic funding for testing and 30% for care and treatment. By 2029, prevention is projected to require 22% of total HIV investments. The agenda calls for aligning Malawi's Global Fund Grant Cycle 8 request with the National Strategic Plan's target of allocating 25% of HIV resources to prevention by 2027, rapidly scaling LEN and CAB-LA (Malawi's Pharmacy and Medicines Regulatory Authority approved LEN in December 2025 after a 46-day expedited review), and creating an enabling environment for prevention, including addressing legal and policy barriers facing key populations.

Zimbabwe had 1.3 million people living with HIV and 15,000 new infections in 2024, and is entering its new National Strategic Plan (ZNASP V, 2026-2030) under severe fiscal constraints and donor uncertainty. HIV prevention resource needs are projected to peak at US$97.0 million in 2029, around 35% more than the US$71.9 million reported in 2023. Zimbabwe's AIDS Levy generated around US$70 million in 2025, with US$90 million projected for 2026, of which 10% is allocated to HIV prevention each year, well short of the Global HIV Prevention Coalition's call for 20% of domestic HIV resources to go to prevention. Modelling suggests that restoring investment in VMMC, PrEP and LEN in line with ZNASP V targets could avert more than 40,000 infections and over 2,000 deaths a year, and that this scenario becomes cost-saving within 11 years. The agenda calls for translating ZNASP V into a prioritised, costed operational prevention plan, meeting ZNASP V targets for VMMC and LEN scale-up through the Global Fund Grant Cycle 8 request, and formally integrating community-led service delivery into the public health system.

Country-specific advocacy toolkit resources

We have put together resource packs for each country, available here. The folder is organised into three country folders: South Africa, Malawi and Zimbabwe.

Each country folder contains: