With only 54 months remaining in the campaign’s countdown to 2030, people living with HIV, tuberculosis survivors and community-led organisations are delivering a direct warning to governments: programmes designed without meaningful community leadership are unlikely to reach the people most at risk.
That message emerged during the Naresh Yadav Memorial PLHIV Leadership Summit, organised as an affiliated event around the 26th International AIDS Conference. Participants from countries including India, Eswatini, Kenya, Georgia, Nepal and South Africa argued that communities must move beyond symbolic consultation and receive real authority to design, deliver, monitor and improve health services. The original Citizen News Service report on the leadership summit described community representatives as partners with practical knowledge, not merely beneficiaries of government programmes.
The global promise is part of Sustainable Development Goal 3.3, under which countries committed to ending the epidemics of AIDS and tuberculosis as public-health threats by 2030. That wording does not mean every HIV infection or TB case will disappear by the deadline. It means reducing transmission, illness and deaths to levels at which the diseases no longer represent major public-health threats.
Ending AIDS and TB Requires More Than Medical Tools
The world already possesses many of the tools required to make extraordinary progress. HIV can be diagnosed with reliable tests, controlled with antiretroviral treatment and prevented through approaches that include condoms, pre-exposure prophylaxis, harm-reduction services and effective treatment that achieves viral suppression.
Tuberculosis is preventable and usually curable, while rapid molecular tests and shorter treatment regimens can improve diagnosis and care. Yet the availability of medical technology does not guarantee that people can reach it.
Stigma, discrimination, criminalisation, poverty, gender inequality, transport costs and fear of mistreatment can all prevent individuals from entering formal healthcare systems. Community-led organisations often reach people whom clinics and national programmes struggle to serve because they understand local languages, identities, concerns and social realities. The Global Fund’s community systems guidance recognises that affected communities can respond quickly to local needs and connect with marginalised populations facing barriers to conventional services.
This is why community leaders object to being invited into discussions only after priorities and budgets have already been decided. Consultation may allow a person to speak, but leadership gives that person power to influence what happens next.
The HIV Response Faces a Dangerous Funding Crisis
Progress against HIV has saved millions of lives, but the epidemic is not ending quickly enough. UNAIDS states that approximately 1.3 million people continue to acquire HIV each year, illustrating how far global prevention efforts remain from the 2030 objective. Its new Global AIDS Strategy for 2026–2031 calls for a 90% reduction in both new HIV infections and AIDS-related deaths compared with 2010 levels.
Those targets are becoming harder to reach as financing weakens. UNAIDS reported that global development assistance from multiple donor countries declined by 23% in 2025, the sharpest recorded reduction, with serious consequences for HIV programmes in heavily affected low-income countries.
Funding cuts do not affect only medicine purchases. They can close outreach centres, reduce peer-support programmes, interrupt testing campaigns and eliminate the workers who help people remain in treatment. A clinic may still possess antiretroviral medication, but treatment outcomes can deteriorate when patients lack transport, counselling, follow-up support or protection from discrimination.
Community representatives are therefore asking governments to finance community-led organisations directly rather than repeatedly praising their contribution without giving them sustainable resources.
Global TB Progress Is Far Behind the Required Pace
The tuberculosis outlook is equally urgent. The latest WHO tuberculosis fact sheet estimates that 10.7 million people developed TB in 2024 and 1.23 million died from the disease, including approximately 150,000 people living with HIV. TB remained the leading cause of death from a single infectious agent and a major cause of antimicrobial-resistance-related mortality.
The WHO Global Tuberculosis Report 2025 found that TB incidence had fallen by only 12% between 2015 and 2024. The End TB Strategy milestone called for a 50% reduction by 2025 and the 2030 target requires an 80% decline. TB deaths fell by 29% during the same period, still far from the 75% milestone for 2025 and the 90% reduction required by 2030.
Drug-resistant TB presents an additional challenge. Only about two in five people estimated to have drug-resistant disease accessed treatment in 2024, leaving a substantial gap in diagnosis and care.
These figures explain why communities are demanding urgency rather than another round of distant commitments. Continuing at the current rate would leave the world significantly short of its targets.
HIV and TB Services Cannot Remain Separated
HIV and tuberculosis frequently affect the same communities and individuals. TB was the leading infectious killer of people with HIV in 2024, yet patients may still encounter separate programmes, appointments, records and service locations.
Community leaders are calling for integrated care that allows one person to receive HIV testing, TB screening, treatment support, reproductive healthcare, mental-health services and assistance with related chronic conditions through a coordinated system.
Integration matters because a person does not experience health problems as separate government departments. Someone living with HIV may also need TB preventive treatment, hypertension care, nutritional support and protection from gender-based violence. Fragmented programmes increase travel costs, appointment burdens and the risk that a patient will be lost between services.
The WHO End TB Strategy explicitly recognises that success depends on adapting responses to different national and community settings rather than imposing a single model everywhere.
Peer-Led Programmes Can Reach People Formal Systems Miss
The leadership summit offered practical examples of what community ownership can achieve. Pooja Mishra of Youth Lead Voices described a virtual peer-support initiative that identified 1,857 people for HIV testing, registered 1,156 young people living with HIV and helped 788 achieve viral suppression.
The model worked because young people communicated with their peers in ways that felt safer and more relevant than traditional institutional outreach. Community members understood how fear, disclosure concerns and social pressure influenced whether another young person would seek testing or remain in care.
Similar approaches can help locate people with possible TB symptoms, support treatment completion and identify problems with medicine availability or clinic behaviour. Community-led monitoring gives patients a structured way to report long waits, discrimination, missing medicines and other service failures.
The Global Fund’s community engagement framework supports meaningful community participation in the design, delivery, monitoring and governance of HIV and TB investments rather than limiting involvement to occasional feedback.
Women and Marginalised Groups Face the Greatest Barriers
Progress measured through national averages can conceal deep inequality. Women living with HIV may face violence, economic dependence or discrimination in healthcare settings. People who use drugs, sex workers, migrants, rural populations and LGBTQ communities may encounter punitive laws or social conditions that discourage them from seeking help.
Community leaders from Asia-Pacific and Eastern Europe warned that organisations serving these populations are often underfunded while the political and civic space available to them is shrinking. In some locations, independent community groups may be the only trusted source of care for people who fear formal institutions.
Human rights are therefore not separate from disease control. A diagnostic test has little value when a person is too frightened to enter the clinic offering it. Treatment cannot prevent illness or transmission when discrimination drives patients away from care.
Leadership Must Include Budgets and Decision-Making Power
Trusting communities to lead requires more than placing representatives on conference panels. Community organisations need direct, flexible and predictable financing. They must participate when national priorities, budgets and performance indicators are decided.
They also require access to programme data and the authority to hold service providers accountable. Lived experience can reveal problems that national statistics overlook, including why patients abandon treatment, why a particular clinic is avoided or why services fail to reach one neighbourhood.
UNAIDS’ 2026–2031 strategy places community leadership among the essential results required to end AIDS as a public-health threat. It calls for communities to shape policy, deliver services and strengthen accountability while national responses become more sustainable and integrated.
The Final 54 Months Must Focus on Implementation
The central warning from people living with HIV and TB survivors is that the world does not lack declarations. It lacks implementation at sufficient speed and scale.
Governments must protect treatment continuity, expand testing, integrate HIV and TB services, remove discriminatory barriers and fund community systems capable of reaching populations left behind. International donors must avoid abrupt withdrawals that collapse effective programmes before domestic financing can replace them.
The next 54 months will reveal whether community leadership is treated as a public-relations message or as an operational requirement. Medical science has created a realistic path towards ending AIDS and TB as public-health threats. Reaching that destination now depends on whether governments are willing to share power with the people who understand the epidemics most directly.
