CIVICUS speaks about HIV response in Africa with Samuel Matsikure, Key Populations Lead at Aidsfonds. Aidsfonds led the Love Alliance global partnership, which operated from 2021 to 2025 and worked to raise awareness, challenge criminalisation and support a global HIV response.

HIV remains a major global public health and human rights issue, disproportionately affecting excluded communities, including LGBTQI+ people, sex workers and people who use drugs. Criminalisation, discrimination and stigma block access to prevention, treatment and care, while punitive laws and repression undermine organising, funding and advocacy. Love Alliance was created to confront these barriers. It supported community-led organisations to build power, access resources and drive legal and policy change. By strengthening grassroots leadership and civic space, Love Alliance made the HIV response a fight for rights, accountability and long-term structural change.

What makes HIV an important issue?

HIV remains a major global public health and human rights issue. Millions of people worldwide still depend on access to prevention, treatment and long-term care.

LGBTQI+ people, sex workers and people who use drugs are among those most affected. At the same time, they are among the most criminalised and politically marginalised. Laws, stigma and discrimination block access to healthcare, expose people to violence and suppress organising, making effective, rights-based HIV responses almost impossible. This is the gap Love Alliance was created to address.

Love Alliance was a five-year global partnership supported by the Dutch Ministry of Foreign Affairs and coordinated by a consortium led by Aidsfonds. It worked with key populations in Africa to strengthen community-led movements, expand access to HIV and sexual and reproductive health services and challenge the structural drivers of exclusion. Our focus was on shifting power to affected communities so they could protect their rights, influence policy and sustain their own movements.

What’s it like to be part of those excluded communities today?

Across Africa, we are seeing a coordinated anti-rights backlash, often framed through what are characterised as ‘anti-homosexuality’ and ‘pro-family’ narratives. This has driven a wave of regressive laws and public rhetoric that legitimise discrimination, hate speech and violence against LGBTQI+ people and other marginalised communities.

Uganda’s Anti-Homosexuality Act, for example, introduced extreme penalties, including life imprisonment and the death penalty. In Burundi, the president has twice publicly called for the stoning of homosexuals. In Burkina Faso, the military authorities announced a ban on same-sex marriages as part of changes to marriage laws that now only recognise customary and religious unions. In Nigeria, directives approved in December 2024 further restricted LGBTQI+ people’s rights, including barring them from serving in the armed forces.

These dynamics are unfolding alongside a broader crackdown on civil society. As state control increases and civic space shrinks, there is even less room for LGBTQI+ advocacy and community organising. Zimbabwe’s Private Voluntary Organisations Amendment Act, for example, has tightened control over civil society and the media, making it harder to operate and share counter-narratives.

As a consequence, activists are facing increased arrests, intimidation and surveillance, and many communities are being pushed underground, making it harder to meet, mobilise, fundraise and advocate safely.

How is this hostile environment affecting health access?

The impact on health access has been severe. Criminalisation, fear and political hostility are reshaping how services operate and who can safely use them.

Safe spaces and drop-in centres are closing because organisations fear arrests, raids and mistreatment. Funding cuts in early 2025 forced many organisations to interrupt HIV treatment delivery, lay off staff and reduce outreach services, leaving many people without reliable support.

At the same time, governments are integrating HIV services into general public health systems. In already hostile and overstretched environments, marginalised populations fear they will be deprioritised or excluded altogether, particularly where their identities or work are criminalised.

Activists report constant fear, emotional exhaustion and trauma. This weakens dialogue, limits collective action and makes it harder to share experiences or identify service gaps. In response, movement-building networks have become essential safety nets, helping communities share information, coordinate responses and support one another during funding cuts and political crises.

How did Love Alliance support communities in this context?

Love Alliance prioritised flexible funding so partners could respond quickly to crises, including through emergency protection, legal support and psychosocial care. This flexibility was essential in contexts where arrests, closures and sudden policy changes were constant risks.

As in-person organising became more dangerous, we supported online programming to help communities stay connected and visible in criminalised contexts. Digital health tools and social media became key for maintaining access to information, services and community support.

We also invested in community-led monitoring, enabling communities to document service failures and rights violations and advocate with evidence when speaking out publicly was too risky. Alongside this, Love Alliance supported research across nine countries to map anti-rights forces that spread hate speech across borders and help communities develop strategies to counter them, including through alliances between HIV, human rights and other social justice movements.

Through long-term movement building, organisations strengthened relationships with health ministries, national AIDS councils and structures of the Global Fund to Fight AIDS, Tuberculosis and Malaria. These connections meant engagement could continue even when funding was cut and political pressure increased.

What policy changes are most needed, and what type of support can the international community provide?

Decriminalisation of same-sex relationships, sex work and drug possession is essential, as well as strong protections for civic freedoms. Without legal reform and open civic space, health responses will continue to fail people, particularly those most affected.

Governments must be held accountable for their commitments to end HIV. This requires properly resourced, inclusive services and active support from local institutions, not just national pledges. Local and national authorities must uphold human rights, meet global health commitments and ensure key populations are not excluded from care.

The international community has a critical role to play. It must move beyond funding short-term projects and invest in movement infrastructure, including activists’ wellbeing, safety, coordination and leadership. Funding should include emergency flexibility so organisations can adapt quickly to legal backlash or service disruptions. Diplomatic missions can also play a stronger role by offering political backing, safe convening spaces and protection for sensitive policy dialogues.