Several countries in West and Central Africa (WCA) region are in or at high risk of debt distress, repaying three times more than they invest in health. Donor commitments are also at risk. This report highlights the impact of tax, debt, and development assistance on HIV and health investments, offering updated data and solutions. Using granular country data, they call for increased international support, tax collection, and debt relief, and emphasize urgent reforms in global financial architecture and SDG financing.