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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The Risks Artificial Intelligence Pose for the Global South

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Artificial Intelligence

UN Secretary General António Guterres addresses the session “Strengthening multilateralism, economic - financial affairs and artificial intelligence” on July 6 at the 17th summit of BRICS in Rio de Janeiro. For the first time ever, artificial intelligence was a major topic of concern at the BRICS summit. Credit: UN Photo/Ana Carolina Fernandes

UN Secretary General António Guterres addresses the session “Strengthening multilateralism, economic – financial affairs and artificial intelligence” on July 6 at the 17th summit of BRICS in Rio de Janeiro. For the first time ever, artificial intelligence was a major topic of concern at the BRICS summit. Credit: UN Photo/Ana Carolina Fernandes

UNITED NATIONS, Jul 14 2025 (IPS) – Artificial intelligence (AI) is rapidly developing and leaving its mark across the globe. Yet the implementation of AI risks widening the gap between the Global North and South.

It is projected that the AI market’s global revenue will increase by 19.6 percent each year. By 2030, AI could contribute USD 15.7 trillion to the global economy. However, the increases to nations’ GDP will be unequally dispersed, with North America and China experiencing the most gains while the Global South gains far less.

The risks of AI to the Global South

Due to smaller capacities to fund research, development and implementation, fewer countries in the Global South are adopting AI technology. Access to affordable AI compute to train AI models is one of the AI field’s greatest barriers to entry in the Global South, according to the 2024 UN report, “Governing AI for Humanity.”

Further, AI is designed to create profitable market extraction that does not benefit the global majority, according to Vilas Dhar, President and Trustee of the Patrick J. McGovern Foundation. As countries in the Global North are AI’s primary investors, it is being developed to address their needs.

“The result is a quiet erosion of political and economic autonomy,” he said. “Without deliberate intervention, AI risks becoming a mechanism for reinforcing historical patterns of exploitation through technical means. It also risks losing the incredible value of diverse, globally minded inputs into designing our collective AI future.”

Across the world, people risk losing their jobs to AI, but many countries in the Global South are reliant on labor intensive industries, and AI poses a greater threat to increasing unemployment and poverty. Particularly children, women, youths, people with disabilities, older workers, creatives and people with jobs susceptible to automation are at risk.

According to Daron Acemoglu, professor at the Massachusetts Institute of Technology, labor-replacing AI poses a greater threat to workers in the developing world, as capital-intensive technology may not be useful in these nations where oftentimes capital is scarce and labor is abundant and cheap. Technology that prioritizes labor-intensive production is better suited to their comparative advantage.

“Because advanced economies have no reason to invest in such labor-intensive technologies, the trajectory of technological change will increasingly disfavor poor countries,” he said.

If these trends continue, these nations will experience increased unemployment and fall behind in the deployment of capital-intensive AI, due to limited financial resources and digital skill sets. More AI policies and guidelines, as well as education on data privacy and algorithmic bias, could assist in reducing this inequality.

Evidently, AI threatens to widen the gap between the Global North and South, as AI capacities are consolidated within a small group of institutions and regions. In Dhar’s view, AI will need to be designed to serve people and problems rather than be focused on profit maximization.

“If left unaddressed, this imbalance will cement a way of thinking about the world that mirrors the development of the Internet or social media – a process we do not want to replicate,” Dhar said.

Opportunities of the new technology

But the development of AI also poses opportunities for the Global South.

AI could design context-specific systems for local areas in the Global South that are not just based on the Global North, according to Dhar. “It can unlock new models of inclusion and resilience,” he said.

For example, AI could aid farmers in decision-making by informing them of weather and drought predictions using geospatial intelligence, as well as of marketing price information. AI could also help train farmers and other producers. It can also be used to improve education and healthcare in nations where these are major issues harming their populations and stunting development.

Acemoglu said that AI should be developed to complement rather than replace human labor for these benefits to become possible. “That will require forward-looking leadership on the part of policymakers,” he said.

AI in conflict

AI is also starting to make an appearance in conflict. In Ukraine, autonomous drones are being used, which are capable of tracking and engaging enemies, as well as BAD.2 model robot dogs, which are ground drones that can survey areas for enemies. Autonomous machine guns are also used, in which AI helps spot and target enemies.

The use of AI in conflict poses an ethical dilemma. AI could protect human lives on one side of the conflict but pose a great threat to the lives on the other end of the battlefield. This also raises the question of whether AI should be given the power to engage in harm.

But perhaps the use of AI can reduce the number of people engaging in conflicts harming developing countries and move these people to other sectors where they can realize more potential and aid their country’s economic development.

What international frameworks should do

Clear international frameworks must be established to prevent a rise in inequality and a greater gap between the Global North and South.

For the first time ever, AI was a major topic of discussion at the 17th BRICS summit, which serves as a coordination forum for nations from the Global South, in Rio de Janeiro. BRICS member countries signed the Leaders’ Declaration on Global Governance of Artificial Intelligence, which presents guidelines to ensure AI is developed and used responsibly to advance sustainability and inclusive growth.

The declaration called on members of the UN to promote including emerging markets and developing countries (EMDCs) and the Global South in decision-making regarding AI.

“New technologies must operate under a governance model that is fair, inclusive, and equitable. The development of AI must not become a privilege for a handful of countries, nor a tool of manipulation in the hands of millionaires,” Brazilian president Luiz Inácio Lula da Silva said at the summit.

However, the UN report “Governing AI for Humanity” found that 118 countries, most of which are in the Global South, were not part of a sample of non-UN AI governance initiatives, while seven countries, all of which are in the Global North, were included in all initiatives.

According to Dhar, global governance must create a more equitable distribution of power that entails sharing ownership and embedding the Global South at every level of institutions, agreements and investments, rather than simply for consultation. These nations must also be aided in building capacity, sharing infrastructure, scientific discovery and participation in creating global frameworks, he said.

In his remarks at the BRICS summit, UN Secretary-General António Guterres expressed his concern over the weaponization of AI and stressed the importance of AI governance that is focused on equity. He said in order for this to be done, the current “multipolar world” must be addressed.

“We cannot govern AI effectively—and fairly—without confronting deeper, structural imbalances in our global system,” Guterres said.

Dhar emphasized that the inclusion of every person in the conversation on AI is crucial to creating legitimate global technological governance.

The future of AI is being negotiated with immediacy and urgency,” Dhar said. “Whether it becomes a force for collective progress or a new vector for inequality depends on who is empowered to shape it.”

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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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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How Mongolia Can Expedite It’s Just Transition Plans to Include Its Nomads

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Youth

Gereltuya Bayanmukh speaks about her motivations to become involved in climate activism. Credit: Leo Galduh/IPS

Gereltuya Bayanmukh speaks about her motivations to become involved in climate activism. Credit: Leo Galduh/IPS

ULAANBAATAR, Jul 9 2025 (IPS) – Youth activist Gereltuya Bayanmukh still reflects on the events in her formative years that inspired her to become a climate activist. When she was a child, she would visit her grandparents in a village 20 km to the south of the border between Russia and Mongolia.

She was happy to see each of the nomadic people in their traditional gers power up their settlements using solar power.

“I remember seeing my neighbors own a solar panel and a battery to accumulate power. They were turning on lights and watching TV using solar power. Nowadays, they even have fridges,” she says.

She thought the herders made a conscious choice about their lifestyles and understood the need of the hour in the face of the looming climate crisis. That is to say, switch to renewable energy and power a safer future.

“This was the reason I became a climate activist,” she says.

No matter how unwitting her notion about her community achieving self-sufficiency with renewable energy was, the findings about what entailed this system revealed something else.

“I later learned that the solar panels were partially subsidized by the government as a part of the nationwide government to equip 100,000 nomadic households with solar energy,” she says.

What she perceived turned out to be a nationwide renewable energy scheme by the Mongolian government for the nomadic herders.

The scheme, called the National 100,000 Solar Ger [Yurt] Electricity Program, introduced in 2000, provided herders with portable photovoltaic solar home systems that complement their traditional nomadic lifestyle.

At least 30 percent of Mongolia’s population comprises nomadic herders. Before 2000, when the scheme came into effect, herders had limited or no access to modern electricity. By 2005, the government managed to equip over 30,000 herder families through funds from several donor nations.

However, the full-scale electrification effort for herders was beginning to stagnate. The 2006 midterm custom audit performance report by the Standing Committee on Environment, Food and Agriculture of the Parliament carried sobering revelations.

The scheme in its initial phase was poorly managed: there was no control over the distribution process, with some units delivered to local areas landing in the hands of non-residents violating the contract, failure to deliver the targeted number of generators, misappropriation of the program funds, and inability to repay the loans within the contractual period.

However, in the third phase–2006-2012–the program was able to expand its implementation with the support of several international donors, including the World Bank.

“At first, I thought how great that we started out with the renewable energy transition, giving access to renewable energy at a lower price. And it was even in 1999. That was when I was just four years old. I believe we were on our way to building a future like this. Like we visualized here. The future of green nomadism. However, my optimism faded when I read the midterm audit report and discovered that the program had been (just as) poorly managed as the first part. It was only with the assistance of the international partners that the program finished well,” says Gereltuya.

Gereltuya is the co-founder and board director of her NGO, Green Dot Climate, which focuses on empowering youth as climate activists and raising awareness and practical skills for climate action.

One of the mottoes of her NGO is to change the youth’s and Mongolian people’s attitudes and practices around climate change issues as well as solutions.

In the past year, the NGO has been successful in reaching over half a million Mongolians, including nomads, helping them become more environmentally conscious and empowering the youth to be climate activists—makers and doers themselves.

“In the past year, we have reached over half a million Mongolians. Our Green Dot youth community has logged more than 100,000 individual climate actions, saving over 700,000 kg of CO₂, 25 liters of water, and 80,000 kilowatt-hours of energy. Next, we will aim for a million collective actions, a stronger community and a minimum of 50 collaborative climate projects in Mongolia,” Gereltuya said during her delegate speech at the One Young World Summit, a global event that brings in young leaders from around the world to discuss global issues, in 2023.

The state of Mongolia’s nomads in the current energy system

Mongolia as a country heavily relies on coal for energy production, which contributes to 90 percent of its energy production. Coming to just transition, the government aims for a 30 percent renewable energy share by 2030 of its installed capacity, as enshrined in the State Policy on Energy 2015-2030. Mongolia is also committed to reducing its greenhouse gas emissions by 22.7 percent by 2030 while the energy sector accounts for 44.78 percent of the total emissions as of 2020 according to Mongolia’s Second Biennial Update Report.

Gereltuya’s NGO, Green Dot Climate, has been mapping Mongolia’s energy systems for the past few years now. As of 2024, Mongolia’s electricity sector relies on CHP [combined heat and power] plants and imports from Russia and China to meet its electricity demands.

Only 7 percent of its total installed energy comes from renewable sources, with the Central Energy System accounting for over 80 percent of the total electricity demand. “We found that about 200,000 households remain unaccounted for in the centralized energy grid calculations. These are likely the same nomadic families or their later generations who likely adopted their first solar systems at least two decades ago,” she explains.

Gereltuya says that her organisation meticulously compared the recent household data cited by the Energy Regulatory Commission of Mongolia to that of the total  number of households as per the Mongolian Statistical Information Service to find the numbers that went missing

Mongolia’s backslide into fossil-fuel economy

Although Mongolia has promised to increase its renewable energy share to 30 percent by 2030, it is still far behind in the race to achieve its target.

In the 2020 Nationally Determined Contribution [NDC] submission to the United Nations Framework Convention on Climate Change [UNFCCC], Mongolia set its mitigation target to “a 22.7% reduction in total national greenhouse gas (GHG) emissions by 2030,” which can increase to a 27.2 percent reduction if conditional mitigation measures such as the carbon capture and storage and waste-to-energy technology are implemented. Further, if “actions and measures to remove GHG emissions by forest are determined”, the total mitigation target would rise to 44.9 percent by 2030.

“Instead of focusing on decarbonizing its coal-based economy, Mongolia shifted to focus on carbon-sink and sequestration processes to reduce its emissions. This suggests that despite our many promises, policies and past efforts to mainstream renewables, we may still end up with business as usual. A case of bad governance, stagnation and vicious cycles,” she says.

Recommendations for Mongolia’s energy sector

Gereltuya’s NGO has been actively engaged in the survey ‘Earth Month 2025’ that is aimed at collecting specific recommendations from the youth voices in the country for the NDC 3.0 that the government is expected to submit in COP30. She shares a few recommendations that she believes can help improve the country’s energy systems.

On the demand side, households not connected to the grid should update and improve their solar home systems, especially now that the solutions are much cheaper and more efficient.

According to the 2024 World Bank ‘Mongolia Country Climate and Development Report,’ the average residential tariff for electricity in Mongolia was estimated to be 40 percent below cost recovery, and subsidies were worth 3.5 percent of GDP in 2022. The lack of cost recovery created hurdles in efforts to enhance energy efficiency and investment in renewable energy. In the context, those connected to the grid should pay more for their energy use to reflect the real cost of energy production and support renewable energy feed-in tariffs. There should be responsible voting of citizens demanding better policies and implementations and not trading in policies for short-term gains.

On the supply side, there is a need to stop new fossil fuel projects immediately: there are at least six such projects, including one international project under Mongolia’s current Energy Revival Policy, underway.

Secondly, Mongolia’s electricity infrastructure needs significant improvement. As the UNDP recently highlighted, Mongolia’s infrastructure is aging, inefficient and heavily subsidized.

Thirdly, fully utilize installed energy capacity, which is at only 30 percent, largely owing to the infrastructure inefficiency.

Fourth is to increase the overall renewable energy capacity five times to meet demand, which means 15 times the energy made in full demand. And phase out coal-based power, replacing it with fully renewable energy.

IPS UN Bureau Report

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