Obesity & HIV/AIDS: common causes, common solutions
As global health financing contracts and the international system undergoes reform, the convergence of HIV and obesity raises a fundamental question: are disease-specific responses still fit for purpose?
The growing overlap between HIV, obesity and other chronic conditions suggests the future may lie in more integrated, people-centred health systems.
Changing narratives
For many years, obesity and HIV were considered at two different extremes of global health. Obesity: an issue for ‘rich’ countries that could be addressed through individual lifestyle changes to ‘eat less, move more’. HIV/AIDS: an issue for ‘poor’ countries that required donor-funded prevention and treatment programmes to save lives. In the media, the stereotypical image of obesity sat in stark contrast to the image of HIV, usually associated with severe underweight.
In 2026, these distinctions or images, no longer hold. There are now over 1 billion people living with obesity, the majority (75%) in low- and middle-income countries (LMICs). Obesity is now recognised as a multifactorial chronic disease, requiring prevention, treatment and care in universal health coverage. Although many governments are committed to action on obesity, including through the WHO Acceleration Plan, stigma, limited access to obesity treatment and sustainable financing remain major challenges.
Several decades since the outset of the HIV/AIDS epidemic, there are now over 40 million people living with HIV. People living with HIV are aging: by 2030, more than one in five people living with HIV globally will be over 50, with higher rates of obesity-related non-communicable diseases (NCDs) including hypertension, diabetes, cardiovascular disease and cancers.
Although the majority of people living with HIV receive antiretroviral therapy (ART), which has substantially increased life expectancy enabling many people to live longer and more healthy lives, 25% of people living with HIV still lack access to treatment and stigma remains a barrier. Sustainable financing, in the context of catastrophic global funding cuts, is now a significant challenge.
While ART has transformed HIV from a fatal disease into a manageable chronic condition, some of the most effective modern treatments have been associated with weight gain, creating new challenges for long-term metabolic health, especially for women. The co-existence of HIV and non-communicable diseases (NCDs), including obesity, represent an emerging and urgent challenge for countries in sub-Saharan Africa where obesity has been described as the ‘new HIV epidemic’.
Applying the lessons of HIV
Despite the apparent differences, HIV and obesity share common challenges related to stigma, health inequities, and the need for coordinated action across prevention and treatment.
Both epidemics also carry a gendered signature that demands explicit attention. Women are disproportionately affected across both conditions: through higher rates of ART-associated weight gain, obesity driven by food insecurity and constrained bodily autonomy, and marketing of unhealthy products deliberately targeted at female consumers. The HIV response, at its best, recognised that gender inequality is not a complicating factor but a driver - and built rights-based, woman-centred approaches accordingly. The obesity response must do the same.
Learning from the HIV epidemic has implications for all countries now trying to address obesity and demonstrates the importance of facilitating widespread access to novel therapies using a public health approach while simultaneously strengthening regulatory action to address the commercial and social determinants of the disease, as well as the central role of people affected in driving the response.
“As with HIV in the early 2000s, tools to prevent and treat obesity are available, but too often are being ignored or obfuscated through government inaction, industry interests, and societal inertia. Debates on where to focus resources, programming, and attention on the prevention or treatment of clinical obesity are also reminiscent of the early HIV epidemic. Then, many prevention advocates regarded people with HIV as sad casualties of failed prevention programmes, too expensive and complex to treat. To destigmatise obesity, and effectively combat the obesity epidemic, it will be important to maximise the use of all prevention and treatment strategies simultaneously.”
Dr Nomathemba Chandiwana & Prof. W D Francois Venter
The obesity epidemic in LMICs is a political and economic one. Ultra-processed food and beverage industries have expanded aggressively into markets with weak regulatory environments, reshaping food environments faster than public health systems can respond. The HIV response, at its most effective, changed the political economy of the epidemic through regulation, litigation, and accountability. The obesity response requires the same logic: strong regulation of the ultra-processed food and beverage (UPF) industry, and political action that addresses the commercial determinants explicitly rather than defaulting to the safer language of individual choice.
In South Africa - where obesity rates in women are among the highest in the world, and the costs associated with overweight and obesity now account for 15% of government health spending - civil society, which was critical to ensuring a person-centred, rights-based response to HIV, is now mobilizing to address obesity. World Obesity Federation member, the Desmond Tutu Health Foundation (DTHF), expanded the HIV focus of its research and advocacy to cover HIV within the broader health context of NCDs and mental health in 2020 and runs integrated youth health clinics (see below).
Lessons from South Africa
You can hear more about how South Africa is learning the lessons from the HIV response including the importance of advocacy, community engagement, collaboration and affordable pricing for treatments in this video.
The HIV response offers a more specific lesson than solidarity alone. Equitable access to antiretrovirals was not achieved through goodwill - it required compulsory licensing, hard-won flexibilities on Trade-Related Aspects of Intellectual Property Rights (TRIPS), sustained activist pressure led by people living with HIV on pharmaceutical pricing, and institutional innovations like The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund that mobilised financing at scale.
The question for obesity is whether new therapies will follow that trajectory, or whether they will follow insulin: technically available for a century, yet still inaccessible to millions. Several of the structural barriers that hamper access to medicines in LMICs are already visible, including intellectual property regimes that delay generic entry, industry pricing strategies unconstrained by public investment accountability, and bilateral trade agreements that can override the very flexibilities the HIV movement secured. Coordinated advocacy and action from across the obesity community, led by those with lived experience, will be required to overcome such challenges and ensure equitable access to treatment.
Towards integrated services
The global obesity epidemic is reshaping health systems and increasingly intersects with HIV care and long-term disease management. The growing prevalence of overweight and obesity among people living with HIV highlights the need for more integrated, person-centred care within primary health settings.
Fragmented services create barriers and costs. Integrating obesity prevention and management into HIV services offers an opportunity to address these interconnected health challenges through a single, coordinated model of care. For example, routine HIV appointments can incorporate weight and body mass index monitoring, nutrition assessment, lifestyle counselling, physical activity promotion, and screening for cardiometabolic risk factors alongside viral load monitoring and treatment adherence support.
Such an approach can improve health outcomes, reduce fragmentation of care, and make better use of limited healthcare resources, particularly in LMICs where HIV programmes are often among the strongest components of the health system. HIV programmes must evolve from focusing solely on viral suppression to supporting healthy weight and metabolic health throughout life.
In South Africa, the Desmond Tutu Health Foundation runs Mpilo Health Park – an example of youth-centred integration of movement, nutrition and sexual and reproductive health (SRH) services. Mpilo Health Park shows what is possible when physical activity, nutrition, mental health and SRH are brought together in a single, youth-friendly space. Located on 1.5 hectares opposite Masiphumelele High School—where young people face high HIV rates, early pregnancy, food insecurity and rising obesity—the park transforms a disused COVID-19 vaccination centre into a vibrant wellness hub. It proves that integrated obesity care can work, even with limited budgets and infrastructure.
Advocating for action
On June 22-23, member states of the United Nations (UN) gathered in New York for the High-Level Meeting (HLM) on HIV/AIDS. This meeting, held every five years since 2001, establishes the direction of the global response for the next five years.
Around the meeting, World Obesity and other advocates from the non-communicable disease (NCD) community highlighted how people living with HIV face significantly higher risks of NCDs, and the opportunities for health systems to reduce fragmentation of services through sustainably financed integration in primary health care.
The meeting adopted by vote a new UN Political Declaration on HIV and AIDS. World Obesity welcomes the Declaration and the recognition that integrated service delivery platforms are the essential foundations for sustaining HIV services and broader health outcomes, as well as the need for long-term care for people living with HIV that includes the integrated management of comorbidities. We also welcome the reaffirmation of the Greater Involvement of People Living with HIV/AIDS principle and the meaningful involvement, empowerment and leadership of community -led networks of people living with, at risk of or affected by HIV and their families, including clear targets in this area.
The challenge now is ensuring accountability for delivering the commitments stated in the Declaration. Both the HIV and NCD responses teach us that high-level meetings mean little without accountability for governments and the actors driving the epidemic. For obesity, this means addressing the commercial determinants - including through stronger regulation of the UPF industry - as well as strengthening health systems.
Imagining a new global health architecture
In the context of extreme funding challenges, and global health architecture and UN reforms that are shifting towards domestic sovereignty and financing, now is the time to re-imagine health systems that are fit for the post SDG world.
The increasing co-existence of HIV and obesity highlights how health systems - and global health - must move away from disease-specific silos towards people-centred, holistic, and stigma-free care that addresses infectious diseases, non-communicable diseases, and their shared determinants together.
Integrated primary care services can combine HIV treatment, obesity prevention and management, mental health support, and chronic disease screening within a single continuum of care. Achieving this vision will require a trained multidisciplinary workforce, sustainable financing models, and reformed global health institutions that prioritize long-term health outcomes, equity, and healthy aging across the life course.