By Bunmi Yekini
The HIV response in East and Southern Africa is facing an unprecedented crisis following recent cuts in US funding. The latest bi-monthly update from UNAIDS’ Regional Support Team for East and Southern Africa (UNAIDS RST ESA) reveals the devastating impact on prevention, treatment, and community health systems.
A Seismic Shift in HIV Services
The US government, primarily through the President’s Emergency Plan for AIDS Relief (PEPFAR), has been the largest single donor for HIV prevention in the region. The funding cuts, however, have led to immediate disruptions in services, the retrenchment of thousands of health workers, and the closure of critical community programs.
“These cuts have created an enormous gap in service delivery,” said Anne Githuku-Shongwe, UNAIDS Regional Director for East and Southern Africa. “Many of the advances we have made in the HIV response are now at risk of being reversed.”
One rapid survey in a high-burden country showed that:
- 62% of respondents faced difficulties accessing pre-exposure prophylaxis (PrEP).
- 46% of people living with HIV experienced disruptions in treatment.
- 23% received reduced supplies of antiretroviral medication.
Prevention Services Severely Impacted
PEPFAR previously contributed an estimated $301.6 million for HIV prevention in 15 countries, accounting for about 45% of total HIV prevention funding. Several nations, including Malawi (88.5%), Zimbabwe (82.7%), and Mozambique (81.8%), were almost entirely reliant on US funds.
As a result of the cuts:
- Condom distribution, PrEP services, and voluntary medical male circumcision (VMMC) programs have been scaled back.
- The DREAMS program, which supported 2 million adolescent girls and young women across 10 countries, has shut down.
- Drop-in centers and outreach programs for key populations have been forced to close.
“The closure of the DREAMS program is particularly devastating for young women and girls,” said a UNAIDS country officer. “It means a loss of access to vital HIV prevention, sexual and reproductive health services, and gender-based violence support.”
Treatment Gaps and Vertical Transmission Risks
Although a waiver was introduced to ensure continued access to lifesaving antiretroviral therapy (ART), widespread service disruptions remain. Pregnant women living with HIV are at heightened risk, as funding gaps have led to inconsistent care, increasing the likelihood of vertical transmission from mother to child.
In Zimbabwe, the supply chain for early infant diagnosis and pediatric HIV treatment has been disrupted. In Kenya, panic about treatment availability has led some young people to ration or stockpile their ARVs.
Health Facility Closures and Workforce Crisis
The cuts have forced thousands of healthcare workers out of jobs, leading to major service disruptions. In:
- Kenya, around 41,000 doctors, nurses, and support staff relied on US funding.
- South Africa, 15,000 health workers were affected.
- Mozambique, more than 21,000 health workers have lost funding.
The crisis is particularly stark in Malawi, where 3,513 community health workers and 247 nurses are facing contract terminations. Ethiopia has yet to announce a plan to absorb the salaries of nearly 300 health workers previously supported by the US.
Community Systems on the Brink
Community-based health programs, which played a crucial role in HIV prevention and treatment, are collapsing due to lack of funding.
- In Angola, all community outreach programs in four provinces have stopped.
- In Eswatini, peer-led health facilities and local NGO services have ceased operations.
“The loss of community health initiatives is a major setback,” said a civil society leader in Eswatini. “These programs provided not just treatment but essential support systems for people living with HIV.”
Government and UN Responses
Governments across the region are scrambling to fill the funding void. Some notable responses include:
- Ethiopia has introduced a new payroll tax to fund HIV programs.
- Lesotho has developed a task team to map out mitigation strategies, including government-funded salaries for affected staff.
- Kenya and Rwanda have reported mobilizing domestic resources to sustain priority HIV programs.
UNAIDS is also stepping in, supporting countries in assessing the impact of the funding cuts and collaborating with partners such as UNICEF and WHO to explore alternative funding models.
Critical Gaps and the Future of HIV Response
Despite these efforts, the funding cuts have left significant gaps in:
- HIV prevention and treatment supplies, including ART, PrEP, and condoms.
- Health workforce sustainability, with thousands of staff laid off.
- TB diagnostic tools and medications, raising concerns about drug-resistant TB.
- Community-led advocacy and service delivery, which are no longer financially supported.
“The reality is that without urgent intervention, we risk undoing years of progress,” said Githuku-Shongwe. “Millions of lives are at stake, and we must act now to ensure the HIV response in the region does not collapse.”
A Call for Urgent Action
UNAIDS and other stakeholders are calling on international donors, regional governments, and the private sector to step up funding efforts. Without immediate action, the consequences could be catastrophic—not just for people living with HIV but for entire healthcare systems across East and Southern Africa.