About 70% of people living with HIV will live in middle-income countries by 2020, but donors are withdrawing overseas development assistance (ODA) from upper middle-income countries (UMICs) on the basis that rising gross national income (GNI) leads to higher national health spending and eliminates the need for ODA for health. However, rising GNI doesn’t address inequality or discrimination. Many case studies, particularly from EECA, show that governments do not automatically take over HIV services when donors exit, especially for key populations. Hasty, poorly planned donor exits exacerbate the likelihood of a failed transition and have contributed to a resurgence of new HIV infections in EECA. We will not end AIDS by 2030 unless we ensure sustainable transitions or change donors’ approach to UMICs altogether to ensure ongoing investment in key populations wherever they are. At this session, organizers will challenge the assumptions that underpin our current development approach and demonstrate the critical role that political leadership plays in ensuring successful transitions, especially for key populations.

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