DR ALLAN PAMBA
Twenty years ago, when I worked the wards as a young doctor in Kenya, HIV was still an overwhelming force. Even as treatment slowly became available in the West, many African countries remained without routine access, and too many of our patients came to the hospital prepared for the worst.
Much has changed since then. Today, millions across Africa are alive because diagnosis happens earlier, treatment is simpler and more accessible, and communities have become powerful partners in the response.
Change is inevitable, and this year’s call-to-action from the International AIDS Society, created to build momentum for the Road to Rio and the AIDS Conference 2026, reflects that: “#RethinkRebuildRise,” prompts us to honour the successes we have achieved but also to keep moving forward by reimagining our future.
We have built systems that were once unimaginable: laboratory networks spanning countries, integrated testing programmes, mobile outreach for hard-to-reach communities and strong local expertise that drives care where it matters most. Now, we face a new inflection point, which brings to mind an old Swahili proverb that translates thus:
“You can never cross the ocean until you dare to lose sight of the shore.”
Real progress requires the courage to move beyond what is familiar. We are all inclined to anchor our decisions to past experiences, past crises, past constraints, past failures. That instinct can protect us, but it can also limit our ability to imagine and build something better.
Africa’s success in its HIV response has repeatedly shown that we cannot chart a new course by looking only in the rear-view mirror. If we had clung to the limitations of the early 2000s, we would never have achieved the extraordinary gains we see today: stronger laboratory systems, community-led programmes, integrated testing and access to treatment that once felt impossible. This is living proof that Africa can reimagine what is possible; a truly transformative approach to the AIDS epidemic.
What lies behind us is only a fraction of what we can achieve. The health systems we are building now are more resilient, integrated to test for multiple diseases with just one blood sample, and, most notably, locally led. These will carry us far beyond the shorelines of our past challenges.
A shifting global landscape
For two decades, Africa’s HIV response has relied on a combination of domestic commitment and large-scale external funding. That global funding environment is now in a period of uncertainty. Major programmes are under pressure, budgets are tightening and donor priorities are shifting to a broader array of global health threats.
It needs to be said that these shifts do not diminish the value of past support. But they make one truth undeniable:
For essential health services to continue, grow and maintain the gains we have achieved thus far, Africa must reinforce the systems that sustain them; particularly diagnostics, and do so proactively, in haste.
The future is local
A recent article by the World Health Organization states:
“To boost supply chain resilience and regional self-reliance, WHO’s Global HIV, Hepatitis and Sexually Transmitted Infections Programmes Department, in collaboration with the Regulation and Prequalification Department, has been actively advocating for locally manufactured quality-assured medicines and diagnostics.
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