Sweet Hope to End Bitter Pills for Multidrug-Resistant Tuberculosis

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Health

Rallying call to end TB by 2030. Credit: Busani Bafana/IPS

BULAWAYO, Jul 15 2025 (IPS) – Every day, Yondela Kolweni has to hold down her son, who screams and fights when it is time for his daily life-saving TB tablets—a painful reminder of her battle with the world’s top infectious killer disease.

“It is a fight I win feeling awful about what I have to do,” says Kolweni (30), a Cape Town resident and a TB survivor. “The tablets are bitter, and he spits them out most of the time, and that reminds me of the time I had to take the same pills.”

Kolweni’s five-year-old son is battling Multidrug Resistant TB (MDR TB), a vicious form of TB that is rising among children globally.

The global burden of MDR-TB among children and adolescents has increased from 1990 to 2019, particularly in regions with lower social and economic development levels, according to a recent study. In addition, the top three highest incidence rates of MDR TB in 2019 were recorded in Southern sub-Saharan Africa, Eastern Europe, and South Asia, while the top three highest rates of deaths in the same period were recorded in Southern, Central, and Eastern sub-Saharan Africa.

South Africa is one of 30 countries that account for 80 percent of all TB cases in the world and has the most cases of drug-resistant TB.

A Bitter Pill to Swallow

Kolweni’s son was diagnosed with MDR-TB five years ago, having tested positive for TB which has affected his grandmother and his mother. He was immediately on treatment, a drug cocktail that included moxifloxacin—a pill not for the yellow-livered.

“There were two medications he had to take, and there was one specifically, the yellow one, that he did not like, and with the color he knew what it was,” Kolweni told IPS in an interview, explaining a daily battle to get her son to take his meds.

It was down to a fight. She crushed the tablets, mixed them with a bit of water, and fed them through a syringe.

“We would sometimes hold him or wrap a towel around him so that we could feed him the medication, but he would still spit it out, which meant he was not taking the dosage he was meant to take,” said Kolweni. “We then came up with the idea to put his tablets in his yogurt, but that technique did not work because, being a smart kid, he took the bait but would soon spit out the medication.”

Moxifloxacin, an exceptionally bitter medicine, is one of the key drugs in the new all-oral treatment for multidrug-resistant tuberculosis (MDR TB). The treatment is a combination of the drugs Bedaquiline, Pretomanid, Linezolid and Moxifloxacin, known as BPaLM. The BPaLM regimen is specially formulated for children but is a bitter pill to swallow.

Sweet Medicine

But there is sweet hope. A new study, by Stellenbosch University and the TB Alliance, found that sweet, bitter-masked versions of Moxifloxacin significantly improve kids’ willingness to take the drug—easing the burden on parents and boosting treatment adherence.

Two formulations of moxifloxacin have been identified by children as tasting better than new generic versions of products currently on the market.

The results from the ChilPref ML study—a Unitaid-funded effort sponsored and led by Stellenbosch University in collaboration with TB Alliance—will help improve MDR TB treatment and adherence in children.

Dr. Graeme Hoddinott, of Stellenbosch University and the principal investigator of the study, notes that children cannot be treated in a humane manner for drug-resistant TB if the medicines taste so terrible that children refuse them or must be forced to take them.

Children diagnosed with drug-sensitive TB have good outcomes even within the four months because there is usually one tablet given, and there is a child-friendly formulation that dissolves easily to be given on a spoon or in a syringe, Hoddinott said. However, for drug-resistant TB, the situation is complicated. Most drugs for MDR TB are no longer used because of their toxicity and have been replaced by new drugs.

MDR-TB drugs are not child-friendly, Hoddinott admits. The active ingredient that kills TB in Moxifloxacin makes the pills incredibly bad tasting for children who have to take the medication daily for between six and nine months in cases of MDR TB.

“These drugs are incredibly bad tasting; they are genuinely awful to a point where adults who have been on extended TB treatment have been unable to administer the same drugs to their children because the smell evokes the time when they were sick,” Hoddinott told IPS. “It is a trauma to administer such bad-tasting drugs to a child, both for the parent and the child, particularly for the young children.”

The ChilPref study recruited just under 100 healthy children, ages 5–17, from two diverse settings in South Africa. The children evaluated flavor blends using a ‘swish and spit’ taste panel—tasting the medicine, which was dissolved in water, and then spitting it out without ingesting any of it.

Each child participant ranked the flavor blends among the three from each manufacturer and also rated the taste, smell and other characteristics of each. For moxifloxacin, there was a clear, strong preference for the new flavor blends (“bitter masker” and orange for Macleods, and strawberry and raspberry and tutti frutti for Micro Labs) over the existing commercially available flavors for both manufacturers. For Linezolid, there was no preference between the flavor blends.

“Ensuring children have access to effective and palatable TB treatments is a crucial step in improving adherence and treatment outcomes,” said Koteswara Rao Inabathina, one of the study’s authors and CMC Project Manager at TB Alliance.

“Through close collaboration with manufacturers, we have addressed critical unmet needs by developing practical solutions that make available and effective drug-resistant TB treatments not only accessible but also palatable and acceptable for children.”

The results of the ChilPref study showed that children preferred two new flavor blends of moxifloxacin, produced by Macleods Pharmaceuticals, India, and Micro Labs Pharmaceuticals, India. The results were communicated to the manufacturers, who are already updating their products.

“We are not surprised that a lot of kids did not like any of the tastings because we knew that they were horrible taste-wise, but we got a very clear signal for both manufacturers that the flavor blends we recommended were more preferred,” Hoddinott said. “We changed which flavor was going to market with relatively simple research.”

Dr. Cherise Scott, Senior Technical Manager at Unitaid, said the easier it was for children to take their medicines regularly, the more likely they were to complete their treatment successfully.

“We will not allow children to be neglected in global health responses simply because their needs are more complex.”

A Promising Treatment for MDR TB

As multi-drug-resistant TB transmission increases among children and adolescents, the development of new treatments is imperative, Hoddinott explained.

Moxifloxacin may also be increasingly used in the future for the treatment of drug-susceptible TB, which affects an estimated 1.2 million children globally each year.

Drug-resistant TB, has previously been one of the most difficult diseases to manage because of limited child-friendly treatment options, but scientists have made strides in developing new treatments for children, explains Dr. Anthony Garcia-Prats, one of the study authors and an associate professor at the University of Wisconsin-Madison.

“Now we are making sure that these medicines are appropriate for children, starting with an aspect that children and parents say is critical: taste,” Garcia-Prats said in a statement.

The new treatment is given when TB is either resistant to rifampicin, a critical first-line drug, or rifampicin and isoniazid, another first-line drug combination. These resistant strains are collectively referred to as RR/MDR-TB.

Annually there are an estimated 32,000 new cases of RR/MDR-TB among children 14 years and under—a population that is extremely sensitive to the taste of medicine, according to researchers.

This discovery could help improve adherence to TB medication and move a step closer towards the United Nations Sustainable Development Goal 3 to end TB by 2030.

“It is not a silver bullet,” Hoddinott cautions. “It does not solve everything, as people affected by TB still face many other challenges, and even the preferred flavor blends still do not taste nice. But, as part of the overall fight against TB in children, it’s an important step.”

Kolweni welcomes the development of masked TB medication.

“My experience with TB medication was not nice, and for children it is worse, and I think flavored tablets would make it easy for children to take, like  Gummies,” she said. “Every child loves flavors; even a suspension would be nice. My son would love it, and I will have no trouble getting him to take his medicine.”

Note: This article is brought to you by IPS Noram, in collaboration with INPS Japan and Soka Gakkai International, in consultative status with the UN’s Economic and Social Council (ECOSOC).

IPS UN Bureau Report

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Man, Sea, Algae: HOMO SARGASSUM’s Stirring Critique of Human Culpability in the Caribbean

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Arts

“Plastic Ocean” by Alejandro Duràn, one of the artworks previously on display in the UN lobby. Credit: Jennifer Levine/IPS

“Plastic Ocean” by Alejandro Duràn, one of the artworks previously on display in the UN lobby. Credit: Jennifer Levine/IPS

UNITED NATIONS, Jul 14 2025 (IPS) – The United Nations’ HOMO SARGASSUM exhibition served as a public immersion into the marine world and called upon viewers to take action in the face of the climate crisis, specifically regarding invasive species and water pollution.

For the past month, an art exhibition entitled HOMO SARGASSUM took up residence in the New York headquarters lobby in connection to World Ocean Month and the 2025 UN Ocean Conference. Organized by the Tout-Monde Art Foundation. In its final week on display, visitors walked through the various projected films, sculptures and photographs. The exhibit closed on July 11.

The work is described as an immersive multisensorial art and science exhibition intended to bring together various experts in science, scholarship and creativity from the Caribbean to share their perspectives on the prevalent environmental and social issue. The exhibit is primarily an introspective study of sargassum, a type of seaweed or algae commonly found on the coast of the Americas and in the Caribbean.

Sargassum, which has proliferated significantly in recent years due to pollution and chemical fertilizer, releases toxic gases that harm nearby residents in water and on land. Animals struggle to survive, and humans experience respiratory failures and burns. This algae has inspired fear since Christopher Columbus recorded his crew’s sighting of the plant. Sargassum has also become a symbol recently for climate change in the Caribbean as well as the coexisting nature of marine and human life.

Co-curator and executive and artistic director of the Tout-Monde Art Foundation Vanessa Selk described the exhibit as a journey rather than a singular experience. She said, “Much like sargassum migrating through the Atlantic Ocean, we encounter natural and human-made challenges such as pandemics, pollutants and hurricanes. This narrative of the global ecological crisis, reflected in silent floating algae, warns us to change our existing paradigms and consider ourselves as one with our environment.”

Billy Gerard Frank, one of the featured artists in HOMO SARGASSUM, echoes this sentiment.

Frank created a mixed-media piece entitled “Poetics of Relation and Entanglement” with a painting featuring Columbus’ archival notes and sargassum pigment, as well as a film he shot on the island of Carriacou. The film centered on a large metal tank surrounded by sargassum, which had washed on shore and rusted onto the massive object. He specifically shot the film around the sargassum and the tank, an eyesore for the locals who used the beach and a barrier to boats trying to leave. Growing up in Grenada, Frank recalls sargassum as a mild inconvenience but explained how it has become more prevalent due to climate change.

However, only in recent years has conversation around sargassum shifted towards the impact of climate change and geographical inequities, like, as Frank noted, how smaller islands that produce significantly lower levels of pollution are the worst affected by climate change through natural disasters.

He referenced the recent Hurricane Beryl, a Category 5 storm that “completely devastated” islands like Carriacou. His inclusion of Columbus’ notes brings a decolonial perspective: the threats Caribbean islands face from mounting climate change are exacerbated by their history of occupation, mostly from European colonial powers. In a global organization like the UN where historical, geographical and environmental context is key to making any decision, such an interdisciplinary perspective is key.

From countless gifts from member states to various donations, the UN has been an artistic hub since its inception. As both a tourist attraction and space of work for international diplomats, the UN is a particularly ripe space for more radical, political art—notably Guernica, a tapestry based on a Picasso painting portraying the Spanish Civil War—due to its broad audience.

Speaking to IPS, Frank shared how influential art has been in political, social and intellectual movements, saying, “historically…creators, writers, and artists have been able to forge ahead and create new spaces…it gives us some hope that our work and the calling are even more important.”

Frank also told IPS how important it was for him to have the work featured at the UN.

“Because the UN is also a site of consternation right now, specifically with everything that’s happening globally. And in fact, that’s the space where this type of work should be, where there should be more conversation, and a space in which it could create a critical dialogue amongst people who work there, but also the public facing that too.”

IPS UN Bureau Report

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Conflict, Climate Change Push Migrants in Yemen to Return to Their Home Countries

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Humanitarian Emergencies

People in Yemen impacted by war and climate shocks receive aid from the IOM. Photo credit: Majed Mohammed/IOM Yemen

People in Yemen impacted by war and climate shocks receive aid from the IOM. Photo credit: Majed Mohammed/IOM Yemen

UNITED NATIONS, Jul 13 2025 (IPS) – Yemen’s humanitarian crisis, driven by conflict, economic collapse and climate shocks, leaves migrants desperate to return to their home countries.

In March 2025, the Global Data Institute Displacement Tracking Matrix recorded that 1,234 non-Yemeni migrants left the country.

Once a critical transit and destination point, Yemen is unable to support incoming asylum seekers. Yemenis are struggling to survive amidst a decade-long conflict and worsening climate change impacts. Over 4.8 million people are internally displaced, and 20 million rely on aid.

Most migrants come from Ethiopia and Somalia, searching for safety or work in the Gulf countries. However, many become stranded in Yemen due to the harsh conditions and abuse.

The International Organization for Migration (IOM) found that in 2024, around 60,900 migrants arrived in Yemen with no means to survive. Subsequently, they are exposed to severe protection risks, including physical and sexual violence, exploitation, abduction, detention, and debt bondage.

“With limited humanitarian resources and few service providers on the ground, migrants often suffer from hunger, untreated medical conditions, and lack of shelter. Many are stranded without access to even the most basic services,” said the IOM to IPS.

“Meanwhile, public hostility toward migrants has increased, as they are increasingly viewed as competing with vulnerable Yemeni populations for scarce assistance. The ongoing conflict in Yemen further compounds these vulnerabilities, with migrants caught in airstrikes, exposed to explosive ordnance, and lacking access to safety.”

Women and girls are the most vulnerable group of migrants traveling through Yemen. They are disproportionately threatened with gender-based and sexual abuse.

“I’ve been beaten, detained, and exploited in Yemen,” said a 24-year-old Ethiopian woman to IOM. “Most nights, I went hungry. After everything that happened to me, I am happy to go back to my home and family.”

Severe climate impacts also make it increasingly difficult for both migrants and Yemenis to access food and water. Around 17.1 million Yemenis are struggling with food insecurity, and climate-related issues are only exacerbating this crisis.

The June 2025 Migration, Environment, and Climate Change (MECC) Country Report on Yemen by the IOM says that Yemen is the 12th most water-scarce country in the world. This significantly influences food insecurity, as rising temperatures caused by climate change create unpredictable rainfall.

In some areas, severe droughts are turning fertile farmland into arid deserts, forcing farmers to plant new crops or move in search of better conditions. Meanwhile, in other communities, heavy rain is sparking extreme flooding. Impacted areas are decimated by soil erosion and disease from contaminated water.

“Areas that used to experience heavy rainfall have now suffered from drought, and farmers have to adapt to this drought by either planting drought-resistant crops, changing their livelihoods, or migrating to another location. And some areas used to suffer from drought but now experience heavy rainfall, where the intensity of rainfall has led to the emergence of new diseases brought by floods,” said an official in the General Authority for Environmental Protection responsible for planning and information to the IOM.

Together, brutal conflict and a lack of access to vital necessities significantly limit migrants’ ability to return to their home countries. The IOM reported that in 2020, around 18,200 people risked their lives traveling by sea. Overcrowded vessels traversing rough waters often capsize, killing dozens on board.

For others, their journey back home leads them through heavily war-inflicted areas. Without proper assistance, migrants are left to navigate through dangerous frontlines, risking death from armed violence and landmines.

However, programs like the IOM’s Voluntary Humanitarian Return (VHR) aim to facilitate migrants’ safe return home. VHR is one of the only solutions for stranded migrants to voluntarily return in a safe and dignified manner.

So far, the IOM has helped 66 migrants safely return this year. This is a significant drop compared to the 5,200 individuals returned in 2024.

“IOM provides lifesaving protection and health service through Migrant Response Points (MRPs) in Aden, Sanaa and Marib and Community-based Care centers in Aden and Sanaa, as well as through mobile teams along the migratory routes funded by ECHO and UK FCDO,” said the IOM to IPS. “Since 2015, IOM has been facilitating Voluntary Humanitarian Return (VHR) as the only viable solution for stranded migrants who wish to return home voluntarily, safely, and with dignity.”

The IOM is backed by numerous groups such as the European Union, the King Salman Humanitarian Aid and Relief Centre (KSrelief), the US State Department’s Bureau of Population, Refugees and Migration, and the governments of Germany, France, Norway, and Finland. Unfortunately, despite widespread support for the program, more donations are urgently needed. The IOM is struggling to help migrants due to significant funding cuts.

“As migration flows continue to surge, the demand for safe and dignified return options for migrants has reached critical levels,” said Matt Huber, IOM’s former Chief of Mission in Yemen. “Without immediate funding support, the continuity of this vital programme is at risk, leaving thousands of vulnerable migrants stranded in precarious conditions with many experiencing serious protection violations.”

IPS UN Bureau Report

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Bonn Climate Talks: Why World Needs to go Further, Faster, and Fairer

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Climate Change

The June Climate Talks, SB62 under the UNFCCC, in Bonn 16-26 June, Photo Credit: UN Climate Chang/Lara Murillo

The June Climate Talks, SB62 under the UNFCCC, in Bonn 16-26 June, Photo Credit: UN Climate Chang/Lara Murillo

SRINAGAR & BONN, Jul 11 2025 (IPS) – This 62nd meeting of the Subsidiary Bodies (SB62) from June 16 to 26, 2025 revealed the persistent complexities and political tensions that continue to challenge multilateral climate governance. 

The United Nations Framework Convention on Climate Change (UNFCCC) convened its 62nd meeting of the Subsidiary Bodies (SB62) from June 16 to 26, 2025 – a critical juncture in the global climate negotiation process ahead of the 30th Conference of the Parties (COP30) set for November in Belém, Brazil.

Often referred to as a “mini-COP”, SB62 serves as a mid-year platform where negotiators and technical experts advance discussions on implementing the Paris Agreement and lay the groundwork for decisions at the COP.

While some progress was made on adaptation and procedural issues, key areas such as climate finance, technology, and scientific assessments remained contentious. Interviews with climate experts Jennifer Chow of the Environmental Defence Fund and Meredith Ryder-Rude shed light on systemic challenges within the UNFCCC process and offered insights into pathways for more effective climate action.

Jennifer Chow of the Environmental Defense Fund

Jennifer Chow of the Environmental Defense Fund

Deadlock That Foreshadowed the Tense and Fractious Atmosphere

The Bonn conference brought together government delegations, UN agencies, intergovernmental organisations, Indigenous and youth representatives, and civil society observers. The Subsidiary Body for Implementation (SBI) focused on operational matters including finance, capacity-building, and gender equality, while the Subsidiary Body for Scientific and Technological Advice (SBSTA) addressed scientific guidance and technical issues such as carbon markets under Article 6 of the Paris Agreement.

Brazil, as COP30 host, fielded the largest delegation with 173 provisional attendees, signalling its intent to influence the upcoming COP agenda. The Brazilian COP presidency outlined three priorities: reinforcing multilateralism, connecting climate regime outcomes with people’s everyday lives, and accelerating Paris Agreement implementation through institutional reforms.

Yet the meeting’s opening was marked by a two-day delay in adopting the agenda, largely due to disagreements over including discussions on developed countries’ finance obligations under Article 9.1 of the Paris Agreement. This early procedural deadlock foreshadowed the tense and fractious atmosphere permeating the conference.

How Scientific Discussions Remained Politically Sensitive

Adaptation emerged as a focal point, with negotiators agreeing on a refined list of global adaptation indicators, including measures related to access to financing — a key demand from developing countries. Steps were also taken toward transitioning the Adaptation Fund to operate exclusively under the Paris Agreement framework and clarifying loss and damage reporting procedures.

Nonetheless, the broader finance discussions exposed deep divides. The collective quantified goal (NCQG) of USD 300 billion, established at COP29 in Baku, continues to be a source of dissatisfaction, especially among developing nations seeking more predictable and adequate funding. These finance issues cut across multiple agenda items, influencing adaptation, transparency, and just transition talks.

Scientific discussions remained politically sensitive. Although the parties agreed to “take note” of recent scientific reports from the World Meteorological Organisation, stronger language expressing concern about current warming trends was blocked by some countries. This reflected ongoing sensitivity around acknowledging the Paris Agreement’s 1.5°C temperature limit.

Streamlining, Trust, and Effective Finance Delivery

In an exclusive interview with Inter Press Service, Jennifer Chow, Senior Director for Climate-Resilient Food Systems at the Environmental Defense Fund, highlighted structural challenges impeding UNFCCC efficiency and effectiveness:

“As is true for other multilateral processes, it is nearly impossible to address a growing list of issues efficiently without a concerted effort to prioritise, simplify approaches, and partner with others who may not require budgetary support. I think this is more pertinent to focus on than funding fluctuations.”

Chow claimed that the proliferation of agenda items and ballooning delegation sizes have complicated negotiations. “There are too many agenda items—and delegations have ballooned as a result. The secretariat and bureau could closely examine the COP, CMA, and SB agendas, propose streamlining, and develop a list of agenda items to sunset over the next two years, as some issues may no longer require negotiation. In some areas, constituted bodies can take up the work. Closing agenda items does not have to equal a lack of ambition.”

She also pointed to the trust deficit within the process.

“We can focus on giving more time for areas of convergence and less ‘unlimited’ time on issues where there is no consensus. Additionally, we need to give more leadership roles to Small Island Developing States (SIDS) and Least Developed Countries (LDCs). We have conflated progress review and rule-making, and renegotiating matters that were already agreed upon can erode trust.”

On countries’ climate plans, Chow stressed the need to prioritise implementation. “A plan is a plan. Evidence of implementation and progress towards 2030 commitments should be highlighted just as much as new 2035 commitments. Let’s not lose sight of the critical decade and sprint to 2030. Stronger implementation now will result in more ambitious plans later.”

Environmental Defense Fund's expert Meredith Ryder-Rude

Environmental Defense Fund’s expert Meredith Ryder-Rude

Meredith Ryder-Rude, also from the Environmental Defense Fund, shed light on the reasons behind stalled adaptation finance negotiations and the challenges of ensuring funds reach vulnerable communities.

“The recent negotiations stalled because the sticking point has historically been disagreement over which funding sources can be ‘counted’ towards adaptation finance goals. There is no disagreement over the urgent need for dramatically higher adaptation finance, but political and ideological differences remain over what types of funding from developed countries are truly delivering adaptation outcomes.”

She explained the complexity of adaptation finance integration.

“Guidance directs countries to mainstream adaptation in development, economic, and financial planning. Given distrust between parties and the severe impacts and costs involved, finding middle ground is difficult. Developed country budgets are tight, and those controlling funds are often not closely involved in climate discussions or understanding of multilateral climate funds, creating a big gap to bridge.”

On improving the effectiveness of finance delivery, Ryder-Rude highlighted the importance of capacity building in recipient countries. “One of the most critical ways to ensure climate finance reaches vulnerable communities effectively is increasing absorptive and financial management capacity at the local level. Funding levels have remained largely static for decades. We focus much on unlocking more funding—the supply side—but more attention is needed on the demand side.”

She pointed to promising models emerging from developing countries. “National-level organisations serve as aggregators managing multimillion-dollar grants from multilaterals and disbursing smaller grants to local community groups. They mentor these groups to increase independence and ability to manage larger sums over time. Eventually, local organisations can manage funding directly with donors. We need more small grant programmes, more national aggregators familiar with local contexts, and generally more trusting, flexible financing—especially for adaptation.”

Empowering most vulnerable remains critical to the UNFCCC’s future effectiveness

Meanwhile, with the world approaching the COP30 in Belém, Brazil, the outcomes of SB62 reveal both the urgency and difficulty of advancing ambitious climate action. Key issues expected to dominate the COP agenda include operationalising the new collective quantified goal for climate finance, finalising rules for carbon markets under Article 6, and translating adaptation frameworks into real-world support.

Countries were expected to submit updated Nationally Determined Contributions (NDCs) aligned with the 1.5°C target; however, nearly 95 percent missed the informal February 2025 deadline, raising concerns about political will and transparency.

Brazil’s presidency faces scrutiny over inclusiveness and transparency, especially regarding its proposed Circle of Finance Ministers tasked with developing a new climate finance roadmap. Questions about Belém’s capacity to host an effective COP add another layer of complexity.

Geopolitical challenges—including the notable absence of a formal U.S. delegation due to previous administration policies—further underscore the fragility of global climate leadership. In this context, rebuilding trust, streamlining negotiating processes, and empowering the most vulnerable remain critical to the UNFCCC’s future effectiveness.

IPS UN Bureau Report

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UN Funding Crisis Threatens Work of Human Rights Council

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Opinion

The Human Rights Council is an intergovernmental body within the UN system responsible for strengthening the promotion and protection of human rights around the globe, and for addressing situations of human rights violations, and making recommendations on them, according to the UN. It has the ability to discuss all thematic human rights issues and situations that require its attention throughout the year. It meets at the United Nations Office at Geneva (UNOG).

NEW YORK / GENEVA, Jul 11 2025 (IPS) – The United Nations Human Rights Council (HRC) has expressed concern at the UN High Commissioner for Human Rights’ announcement that certain activities mandated by the council cannot be delivered due to a lack of funding. The council has sought clarity on why certain activities had been singled out.

Among the activities the commissioner says can’t be delivered is the commission of inquiry on grave abuses in Eastern Congo, an important initiative created—at least on paper—at an emergency session of the HRC in February in response to an appeal by Congolese, regional, and international rights groups.

The establishment of the commission offered a glimmer of hope in the face of grave and ongoing atrocities in the region, and it was hoped it might be an important step toward ending the cycle of abuse and impunity and delivering justice and reparations for victims and survivors.

It is not only the activities highlighted by the commissioner that are impacted by the funding crisis, however. Virtually all the HRC’s work has been affected, with investigations into rights abuses—for example in Sudan, Palestine, and Ukraine—reportedly operating at approximately 30-60 percent of capacity.

In discussions about the proposed cuts, several states—notably those credibly accused of rights abuses—have sought to use the financial crisis as cover to attack the council’s country-focused investigative mandates or undermine the Office of the High Commissioner’s broader work and independence. For example, Eritrea invoked the crisis in its ultimately unsuccessful effort to end council scrutiny of its own dismal rights record.

Amid discussions on the current crisis, there has been little reflection among states on how the UN got into this mess. States failing to pay their membership contributions, or failing to pay on time, has compounded the chronic underfunding of the UN’s human rights pillar over decades.

The United States’ failure to pay virtually anything at the moment, followed by China’s late payments, bear the greatest responsibility for the current financial shortfall given their contributions account for nearly half of the UN’s budget.

But they are not alone: 79 countries reportedly still haven’t paid their fees for 2025 (expected in February). Among those that haven’t yet paid this year are Eritrea, Iran, Cuba, Russia, and others that have used the crisis to take aim at the council’s country mandates or to undermine the work or independence of the high commissioner’s office.

Rather than seeking to meddle in the office’s work or reduce the HRC’s scrutiny of crises, states should work with the UN to ensure funds are available for at least partial delivery of all activities they mandate through the council, particularly in emergencies.

Urgent investigations into situations of mass atrocities are key tools for prevention, protection, and supporting access to justice. They cannot wait until the financial crisis blows over.

Lucy McKernan is United Nations Deputy Director, Advocacy, Human Rights Watch (HRW), and Hilary Power is UN Geneva Director, HRW

IPS UN Bureau

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HIV/AIDS Funding Crisis Risks Reversing Decades of Global Progress

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Health

About 9.2 million people across the world living with HIV were not receiving treatment in 2024, according to the UNAIDS report. At the launch of the report was Rev. Mbulelo Dyasi, Executive Director of SANARELA. Winnie Byanyima, UNAIDS Executive Director, Aaron Motsoaledi, Minister of Health of South Africa. Juwan Betty Wani, Programme Coordinator, Adolescents Girls and young women Network South Sudan. Helen Rees, Executive Director, Wits RHI. Credit: UNAIDS

About 9.2 million people across the world living with HIV were not receiving treatment in 2024, according to the UNAIDS report. At the launch of the report was Rev. Mbulelo Dyasi, Executive Director of SANARELA. Winnie Byanyima, UNAIDS Executive Director, Aaron Motsoaledi, Minister of Health of South Africa. Juwan Betty Wani, Programme Coordinator, Adolescents Girls and young women Network South Sudan. Helen Rees, Executive Director, Wits RHI. Credit: UNAIDS

UNITED NATIONS, Jul 10 2025 (IPS) – UNAIDS called the funding crisis a ticking time bomb, saying the impact of the US cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR) could result in 4 million unnecessary AIDS-related deaths by 2029.

A historic withdrawal of global HIV/AIDS funding threatens to derail decades of hard-won progress in the fight against AIDS, according to UNAIDS’ annual report, entitled Aids, Crisis and the Power to Transform. This funding shortage – caused by sudden and massive cuts from international donors – is already dismantling frontline services, disrupting lifesaving treatments for millions and endangering countless lives in the world’s most vulnerable communities.

“This is not just a funding gap—it’s a ticking time bomb,” said UNAIDS Executive Director Winnie Byanyima.

Despite major strides in 2024, including a decrease in new HIV infections by 40 percent and a decrease in AIDS-related deaths by 56% since 2010, the onset of restricted international assistance, which makes up 80 percent of prevention in low- and middle-income countries, could have disastrous effects. The report, mostly researched at the end of 2024, concluded that the end of AIDS as a public health threat by 2030 was in sight.

However, in early 2025 the United States government announced “shifting foreign assistance strategies,” causing them to withdraw aid from organizations like the President’s Emergency Plan for AIDS Relief (PEPFAR), which had earlier promised 4.3 billion USD in 2025. PEPFAR is one of the primary HIV testing and treatment services in countries most affected. Such a drastic decision could have ripple effects, including pushing other major donor countries to revoke their aid. The report projected that if international funding permanently disappears, they expect an additional 6 million HIV infections and 4 million AIDS-related deaths by 2029.

At a Press Briefing, Assistant Secretary-General for UNAIDS Angeli Achrekar noted the importance of PEPFAR since its inception in 2003, calling it one of the most successful public health endeavors. She expressed hope that as the US lessens its support, other organizations and countries are able to take up the global promise of ending AIDS without eroding the gains already made.

Achrekar noted “acute shifts” in a weakening of commitment from countries less directly affected by HIV/AIDS since the US has pulled funding.

UNAIDS also reports a rising number of countries criminalizing populations most at risk of HIV – raising stigma and worsening gender-based violence and non-consensual sex, two of the highest HIV risk-enhancing behaviors. The report showed the primary groups who lacked care were child HIV infections and young women, which is likely related to government campaigns  “attacking HIV-related human rights, including for public health, with girls, women and people from key populations.”

These punitive laws include criminalization or prosecution based on general criminal laws of HIV exposure, criminalization of sex work, transgender people and same-sex sexual activity and possession of small amounts of drugs. These laws have been on the rise for the past few years, and in conjunction with limited funding, the results for HIV/AIDS-positive patients could be fatal.

Recently, scientific breakthroughs have been made regarding long-acting medicine to prevent HIV infection. Health workers have seen tremendous success, both with new technologies like annual injections and the potential for more growth in the form of monthly preventative tablets and in old prevention techniques like condom procurement and distribution and access to clean, safe needles for drug users. However, due to various global conflicts and wars, supply chains have been disrupted, often harming countries not in the thick of the altercation but reliant on products like PrEP, an HIV prevention medication.

Although many countries most afflicted with the AIDS crisis have stepped up, promising more national funding for the issue, and many community networks have doubled down on their efforts, the disruption of supply chains and the lack of international frontline health workers cannot be solved overnight. To entirely restructure how healthcare is provided takes time – something those with HIV do not always have.

Areas like sub-Saharan Africa, which in 2024 housed half of the 9.2 million people not receiving HIV treatment, have been particularly affected by the recent changes. The majority of child infections still occur there, and combinations of “debt distress, slow economic growth and underperforming tax systems” provide countries in sub-Saharan Africa with limited fiscal room to increase domestic funding for HIV.

Despite the loss of funding, significant progress has been made to protect essential HIV treatment gains. South Africa currently funds 77% of its AIDS response, and its 2025 budget review includes a 3.3% annual increase for HIV and tuberculosis programs over the next three years. As of December 2024, seven countries in sub-Saharan Africa have achieved the 95-95-95 targets established by UNAIDS: 95% of people living with HIV know their status, 95% of those are on treatment, and 95% of those on treatment are virally suppressed. UNAIDS emphasized the importance of this being scaled up to a global level.

Achrekar observed, referring to countries whose domestic funds towards AIDS have increased, that “prevention is the last thing that is prioritized, but we will never be able to turn off the tap of the new infections without focusing on prevention as well.”

She reiterated the importance of countries most affected by the HIV/AIDS crisis establishing self-sustaining health practices to ensure longevity in both prevention and treatment.

Achrekar praised the global South for their work in taking ownership of treatment while still calling upon the rest of the world to join.

She said, “The HIV response was forged in crisis, and it was built to be resilient. We need, and are calling for, global solidarity once again, to rebuild a nationally owned and led, sustainable and inclusive multi-sectoral HIV response.”

IPS UN Bureau Report

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