Podcast Summary: This Week in Global Development

Episode: Impact of HIV Funding Cuts, and the Rise of Digital Public Infrastructure

Date: December 4, 2025
Host(s): Adva Saldinger, with guests Katherine Chaney and Jenny Lee Rivello

Episode Overview

This episode examines the latest challenges and changes in global development, focusing on significant HIV/AIDS funding cuts, evolving U.S. foreign aid strategies, the latest WHO guidance on weight loss drugs, and the rapid advancements and debates surrounding digital public infrastructure (DPI) across the Global South. The show features on-the-ground insights, expert interviews, and threaded themes of equity, agency, and innovation in the development sector.

Key Discussion Points & Insights

1. World AIDS Day & HIV Funding Cuts

[00:04–03:26] Discussion led by Jenny Lee Rivello

• Major Funding Declines: Several countries have seen severe reductions in pivotal HIV prevention services due to foreign aid cuts, particularly from the U.S.
  • Example statistics:
    • Burundi: 64% decrease in people receiving PrEP (pre-exposure prophylaxis) from Dec 2024 to Aug 2025.
    • Nigeria: 55% reduction in distributed male condoms (Dec 2024–Mar 2025).
    • Uganda: 65% drop in male circumcision procedures (Dec 2024–Jun 2025).
    • Botswana: 88% drop in male circumcision (Jan–May 2025).
• Double Challenge: Funding cuts coincide with a deteriorating global human rights environment, with a noted increase for the first time since 2008 in countries criminalizing same-sex sexual activity and gender expression.
• Quote [02:11, Jenny]:
  “When you talk to the HIV community, they'll tell you there's no one tool that can, you know, end AIDS or that can end this crisis.”
• Potential for a Major Setback: UNAIDS warns of up to 3.9 million new infections in the next five years if trends continue.
• Highlight: Lenacapavir Roll-out: While U.S. support for this long-acting, injectable HIV prevention drug is seen as progress, its effectiveness is undermined if distribution channels for prevention are shrinking due to funding cuts.
• Quote [03:26, Adva]:
  “If a lot of these programs that would have reached these communities are not getting the funding they need, that might make the delivery piece more difficult.”

2. US Foreign Aid: Partnerships & Priorities

[05:14–11:45] Discussion led by Adva Saldinger and Katherine Chaney

a. Private Sector Engagement (Case: Zipline Drones)

• Pay-for-Performance Model: The U.S. is shifting from grant-based aid to contracts tied to performance and ongoing logistics on the ground.
  • Zipline’s drone delivery program stands as a model for innovative, results-driven aid—balancing public good and sustainable, potentially profitable local service delivery.
• Quote [06:41, Katherine Chaney]:
  “For a long time people saw Zipline’s work in Africa as sort of a place where they could test a more profitable model in markets like the U.S. … but actually see a perhaps profitable future in Africa.”

b. Faith-Based Organization Involvement

• Earlier, More Meaningful Consultation: African faith-based groups report being engaged earlier in U.S. bilateral health negotiations, suggesting a new “America First” strategic tone.
• Concerns Persist: Key questions remain about future funding allocations for these groups once deals are struck at national levels.
• Quote [08:59, Jenny]:
  “They're not just being called to participate in funding opportunities—they are being engaged … even when their own governments have not essentially consulted them.”

3. Spotlight: Women’s Health & Midwifery in Mexico

[11:45–15:56] Interview with Liselle Lifschitz Gudino, Mujeres Aliadas

• Empowerment Model: Mujeres Aliadas takes an intercultural, midwifery-centered approach to rural, indigenous women’s health in central Mexico.
• Impact: Their work aims to overcome shame around women’s bodies and put agency in women’s hands.
• Policy Change: Recent grant and a historic political moment (female presidency in Mexico) accelerates recognition and regulation of midwifery nationwide.
• Quote [13:47, Liselle]:
  “We say the revolution starts within our body because it’s our first territory.”

4. Weight Loss Drugs: Access and Implications

[16:06–20:39] Discussion led by Jenny Lee Rivello

• Generic Semaglutide: The patent expiry in key markets sets the stage for dramatic (potentially 80%) price drops.
• Equity Concerns:
  • Even with generics, supply may funnel towards rich markets, leaving diabetics and LMICs behind.
  • Overprescription for weight loss could create shortages for diabetes management.
• WHO Guidance: Recommends use for adults (excluding pregnant women), alongside behavioral therapies. Guidelines are conditional pending long-term safety data.
• Quote [18:52, Jenny]:
  “Experts are saying these drugs may become accessible, but … it shouldn’t be seen as a silver bullet.”
• Brand vs. Generic Dilemma: Brand revenues still fund donation programs critical for lowest-income countries—careful balance needed.

5. Digital Public Infrastructure (DPI): Trends & Tensions

[20:39–31:21] Deep-dive with Katherine Chaney

• Definition: DPI is likened to digital “roads and power lines”—foundational rails for payments, identification, and data exchange.
• Pandemic Lessons: Covid-19 highlighted the value of robust DPI for rapid and targeted social support.
  • Example: Togo’s Novisi platform for digital cash transfers.
• India as a Model: India’s Aadhaar ID and universal payment interface show the potential of state-driven DPI, aided but not dominated by philanthropy (Gates, et al.).
• Shift Towards Local Agency: African countries now demand “aid to agency,” wanting interoperable, future-ready systems—not fragmented donor-driven pilots.
• Key Risks:
  • Digital Divide: Connectivity, device access, and gendered disparities—especially risk for women and rural communities.
  • Data Protections: Inadequate safeguards raise concerns of misuse or weaponization of personal data.
  • Quote [30:13, Katherine Chaney]:
    “You can imagine how that could go wrong, including weaponization by governments actually targeting people based on data that was collected.”
  • Tension: Donors bring their own priorities—who controls the technology and reaps its benefits?
• Survey Insight: 80% of development professionals recognize DPI, but many have little direct experience; digital payments like M-Pesa most familiar.

Notable Quotes

• “There's no one tool that can, you know, end AIDS or that can end this crisis.” — Jenny Lee Rivello [02:11]
• “Zipline has worked in Rwanda for years … actually see a perhaps profitable future in Africa.” — Katherine Chaney [06:41]
• “They're not just being called to participate in funding opportunities—they are being engaged.” — Jenny Lee Rivello [08:59]
• “We say the revolution starts within our body because it’s our first territory.” — Liselle Lifschitz Gudino [13:47]
• “Experts are saying these drugs may become accessible, but … it shouldn’t be seen as a silver bullet.” — Jenny Lee Rivello [18:52]
• “You can imagine how that could go wrong, including weaponization by governments actually targeting people based on data that was collected.” — Katherine Chaney [30:13]

Timestamps for Key Segments

• 00:04–03:26 — HIV/AIDS funding cuts & global prevention setbacks
• 05:14–08:00 — US funding: Zipline drones, pay-for-performance, private sector
• 08:00–11:45 — Faith-based partnerships and engagement concerns
• 11:45–15:56 — Midwifery and women’s health in rural Mexico (interview)
• 16:06–20:39 — Weight loss drugs, generics, and WHO guidance
• 20:39–31:21 — Digital Public Infrastructure: definitions, examples, debates

Episode Tone

The hosts and guests maintain a frank, informed, and globally-minded tone. The discussions blend data-driven analysis, on-the-ground anecdotes, and a persistent focus on respecting local agency and surfacing the voices of often-marginalized groups.

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