The movement working to save democracy isn’t who you think it is

On 27 January 2025 I addressed a room full of public health, youth empowerment, gender- and social justice donors. We were together to discuss the HIV response – and we were all terrified. Just days before, the U.S. president had paused PEPFAR, one of the world’s most successful public health programmes.

It wasn’t just PEPFAR we were worried about. It was the long-standing attack on global solidarity that had been fomenting for years. And we were right to be worried. In the months to come, donors all across Europe reduced their support for official development assistance (ODA). 

As funders who support evidence-based programming, we knew that pausing aid for even a day would lead to preventable deaths. But we knew something else, too. We knew that the drastic reduction in European and U.S. support for health programming was the result of – and would be an accelerator to – the recession of liberal democracy around the world. Because, despite the rhetoric, these cuts are not about reducing expenses. Rather, they are one of the many tactics used by the anti-gender movement to consolidate power and test the limits of democratic checks and balances.

And so, when the HIV movement pushed back, their advocacy wasn’t just about saving lives. It was about preserving democracy. 

Of course, the HIV movement long pre-dates the recent financing crisis. And there are many movements whose work are integral to building and maintaining democratic institutions. What makes the HIV movement of the 21^st century unique is the multiple roles it takes on in relationship to democracy: as canaries in the coal mine, as protectors of democracy and as innovators in democratic practice.

Canaries in the coal mine 

As civic space across the world shrinks, communities most impacted by HIV are often the first to be targeted. This means they are also the first line of defence against rising authoritarianism. Take the case of the National Gay and Lesbian Human Rights Commission (NGLHRC) in Kenya, which was denied legal registration due to the country’s criminalisation of same sex partnerships. After almost a decade-long legal battle, NGLHRC won a supreme court decision affirming their constitutional right to association – and with it created jurisprudence securing the right to association of other marginalised groups.

The role of LGBT groups and other key populations in the HIV response as the first line of defence against rising illiberalism will continue to grow proportionately to their criminalisation. Sadly, this criminalisation is likely to continue expanding, as seen in Burkina Faso’s September bill banning homosexual acts, and a slew of anti-homosexuality laws passed across the African continent in the last ten years. This attack is a cornerstone of the anti-gender movement. 

Protectors of democracy 

The tactics the HIV movement has honed over the years are the building blocks of democratically operating societies: securing government commitment to rights-based policy and holding governments accountable for these commitments. 

The CHANGE alliance is a prime example. Less than a week after PEPFAR was paused, CHANGE brought together over 1,000 activists, data crunchers, implementers and funders. The mobilising power of the movement enabled communities experiencing crises to prioritise high-impact work at the root cause of these crises – democratic backsliding in the U.S. The coalition focused advocacy on preserving funding that was legally appropriated by the U.S. Congress from being illegally withheld by the U.S President. Through a series of visually stunning demonstrations, lobbying and media work, CHANGE was able to preserve $400 Million for PEPFAR. It was just a drop in the bucket of the $6.5 Billion programme, but the importance was far greater than the dollars: CHANGE was, in effect, holding government accountable for the separation of powers required by the U.S. constitution, which the U.S. Congress itself was unable to achieve. 

In Nigeria, too, the HIV movement has been a cornerstone in government accountability work. After its’ members experienced harassment and violence at the hands of state officials, Nigeria’s Drug Harm Reduction Advocacy Network developed a confidential reporting mechanism for human rights violations. The reporting system was eventually integrated into the National Human Rights Commission, creating a permanent system for community monitoring and oversight of state institutions.

Innovators in democratic practice 

HIV organisations are not just protectors of democracy; they’re innovators in democratic practice, creating new forms of governance that respond to the historic moment at hand. This plays out across geographies at the national, international, and global levels. 

CARAM Asia and ACHIEVE, for example, worked to rethink the composition of the Philippine’s National AIDS Council (PNAC), which governs the country’s HIV programmes. Prior to their intervention, the PNAC was made up of civil servants and medical professionals. Through their advocacy, CARAM Asia and ACHIEVE institutionalised the inclusion of civil society groups representing communities most impacted by HIV. This led to a better alignment of HIV programming with community needs increasing the programme’s effectiveness and saving lives. Just as importantly, it established a replicable model for participatory governance structures, expanding community control of government in the Philippines. 

Much earlier, the global AIDS community did something similar. Recognising the colonial injustice of cash wealthy states setting health priorities for cash poor states via ODA, activists created a mechanism for equal co-decision-making. The result brought together wealthy and poor states, impacted communities, donors, and other stakeholders to sit on the board of the Global Fund to Fight HIV, Malaria, and Tuberculosis. Since its inception, hundreds of activists and implementors have sat alongside state representatives and donors to prove the efficiency of the Global Fund’s co-governance innovation. No where is this better seen than through the 70 Million lives that the Global Fund has saved.

Now, many of those same HIV activists are harnessing their experience to change the very structures that determine how global health and other global public goods are financed. Instead of a system where some contribute and others receive, where some set priorities and others follow, they’re building pilots where all contribute, all decide, and all benefit. This concept, known as Global Public Investment, has the potential to redefine representative democracy as we know it, and create a truly global community. 

On 27 January I stood in front of a room of terrified donors. We knew how coordinated the anti-gender movement is, how good it is at seeing the intersectionality of its issues, how long-term its vision is. We knew that this attack on the health of marginalised people would be just one of many attacks on democracy.

But we were also hopeful. We knew the incredible track record of the health, youth, gender and social justice activists working in the HIV response. We knew how quickly and powerfully the movement can come together to react. The question we had was: can we, as donors, do the same? To stand up for democracy and rights in the face of the anti-gender movement, we must be just as coordinated, just as intersectional and have just as long term a vision as they do. Vitally, we must stop siloing ourselves as “HIV funders,” “democracy funders,” etc. The HIV movement preserves democracy, and the democracy movement creates the necessary conditions for a rights-based HIV response. We cannot keep on passing the responsibility off to each other, saying “I don’t fund HIV work” or “I don’t fund democracy work.” Without each other, we will lose countless lives and the precious democracy we so value. With each other, we will build even more innovative democratic movements.