Brazil Eliminated Mother-to-Child HIV in 2025 — Is Health Independence the Answer?

For healthcare leaders grappling with the fallout of foreign aid retrenchment, Brazil's experience at the AIDS 2026 conference offers both a cautionary tale and a blueprint. The country's Unified Health System (SUS) not only shielded its HIV programs from the USAID dissolution but also enabled a landmark public health achievement: eradicating new HIV infections among newborns by 2025. This outcome underscores the critical importance of building domestic financing and infrastructure to ensure continuous care, even as global funding patterns shift.

At the AIDS 2026 conference in Rio de Janeiro, Brazilian HIV advocates delivered a sobering message to the global health community: the unraveling of USAID and other donor support was not a sudden shock but a foreseeable trend that nations should have prepared for long ago. Juliana Cesar, political liaison coordinator for the Brazilian NGO Gestos, told conference attendees that while the dissolution of USAID “might feel like a rupture,” her organization had seen the writing on the wall for years. Behind her warning lies a stark contrast: Brazil’s own HIV prevention and treatment programs remain entirely insulated from foreign aid volatility because they are embedded within the country’s Unified Health System (SUS), a publicly funded healthcare network rooted in the nation’s 1988 constitution.

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Juliana Cesar, political liaison coordinator for the Brazilian NGO Gestos, told conference attendees that while the dissolution of USAID “might feel like a rupture,” her organization had seen the writing on the wall for years.

The constitutional right to healthcare, won through sustained civil society advocacy after the end of military rule, provided the legal and fiscal foundation for Brazil’s independence. In the decades that followed, HIV activists successfully lobbied to ensure that antiretroviral therapy, prevention, and testing would be integrated into the SUS, making Brazil one of the few middle-income countries to achieve complete self-sufficiency in its HIV response. This structural autonomy has yielded tangible results. In 2025, Brazil reached the World Health Organization’s elimination threshold for mother-to-child HIV transmission—no new infections among newborns. Cesar credits the earmarked budgeting of SUS for these gains, noting, “It has been earmarked into our budgets. We have to make sure that we have enough money for that.”

The contrast with many of Brazil’s global counterparts could not be sharper. Across sub-Saharan Africa and parts of Asia, national HIV programs remain heavily dependent on bilateral assistance, particularly from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and USAID. For these countries, the donor retreat represents an existential threat to treatment continuity, supply chains, and patient outcomes. Cesar’s frustration is palpable when she reflects on the broader reluctance to follow Brazil’s lead. “We have been saying this for years,” she emphasized, pointing to past recommendations that other nations adopt financing mechanisms similar to Brazil’s Financial Transaction Tax (FTT), which from the 1990s until its abolition in 2007 channeled a fraction of all financial transactions directly into the public health system. That tax, she argues, could have provided a sustainable domestic revenue stream for HIV programs elsewhere, shielding them from the political whims of donor countries.

The implications for global health governance are profound. The USAID dissolution not only disrupts service delivery but also fractures the international research ecosystem. Cesar highlighted that cuts to the U.S. National Institutes of Health (NIH) could curtail HIV-related clinical trials and implementation science in Brazil, where such collaborations have historically advanced prevention tools and treatment protocols. This dual threat—donor withdrawal and research funding decline—risks slowing the momentum toward the UNAIDS 95-95-95 targets and the broader goal of ending AIDS as a public health threat by 2030.