The global landscape of infectious disease and sexual health is becoming increasingly unstable. Long‑standing gains are being unravelled, not because science has failed, but because the political and economic systems that sustain prevention are being deliberately dismantled.
Across many regions, advances in vaccination, prophylaxis and harm reduction are being reversed amid major policy shifts, rising conflict, and sharp reductions in international development funding. This is leading to a systemic, pendulous and compounding shift that will take decades to recover from.
The dissolution of the United States Agency for International Development (USAID) and the freezing of billions in US foreign assistance marked a fundamental turning point. Simultaneously, governments across Europe and G20 countries have reduced aid budgets in favour of military spending and domestic austerity.
Global health programmes have been among the earliest and hardest‑hit casualties of this fundamental shift in financing and governance. Researchers and commentators describe this period as the “great aid recession,” with profound implications for disease prevention and care.
The consequences are especially acute in Africa and across the Global South. Health systems in these regions have long operated in a delicate balance, being heavily dependent on external funding to support service delivery, research capacity, and workforce development. When funding is withdrawn abruptly, the effects are both immediate and severe.
Clinics close. Surveillance systems weaken. Health workers leave. Preventable infections resurge.
These disruptions are intensified in settings already affected by armed conflict, political violence, and mass displacement. In such contexts, short interruptions can erase decades of progress, let alone such systemic shift.
With this context, Harm Reduction Journal has launched a new Call for Papers led by Prof. Beth Meyerson MDiv, PhD (University of Arizona, Tucson, US). The collection focuses on how exogenous shocks – policy shifts, donor withdrawal, conflict – are reshaping infectious disease and sexual health across Africa and the Global South. Its aim is to document how these global decisions are translating into local consequences and what communities are doing in response.
The collection recognises that moments of disruption require methodological pluralism rather than conventional outcomes studies. Qualitative research from frontline providers is essential as it reveals how services are altered, rationed, or lost. Rapid reports from NGOs and community organisations capture impacts in real time. Policy analyses trace how decisions made by governments reshape risk on the ground.
Comparative epidemiological studies are also important. They help quantify what is being lost and where. Health‑workforce research shows how quickly capacity erodes when funding and security disappear. Together, these approaches build a clearer picture of system collapse and adaptation.
Equally important are the voices of affected communities. Narrative, artistic, and visual contributions capture the lived realities of disruption, resilience, and harm in ways that conventional methodologies cannot fully capture.
All of these forms of research serve a shared purpose to support accountability. Without timely, diverse, and context‑specific evidence, the impacts of policy decisions remain abstract. This is particularly true when formal datasets that could document these decisions no longer exist...
This collection aligns directly with SDG 3: Good Health and Well-Being, SDG 5: Gender Equality, SDG 10: Reduced Inequalities, and SDG 16: Peace, Justice and Strong Institutions. Beyond that, accountability has been a key driving force behind the development of the collection: these outcomes are neither natural nor inevitable and evidence is essential to reversing the pendulum back to progress.