Documented impact on services

Stockouts of HIV medication and condoms are expected in the next 3-6 months.

The antenatal testing of pregnant women, delivery care for women living with HIV, early infant diagnosis and paediatric treatment services are all affected.

Data collection at some facilities/service points continues, but data quality control and data collation are affected

Human rights, key and vulnerable populations

There is disruption to PrEP services for adolescent girls and young women (AGYW), a reduced capacity of service delivery points for HIV prevention and a discontinuation of AGYW-specific outreach programs.

There is a limited availability of HIV testing services for AGYW, reduced availability of HIV prevention education and awareness campaigns, and reduction in the availability of counseling and social support services for AGYW.

All programmes on stigma and discrimination have stopped with key populations, AGYW, young people, people living with HIV and other populations affected.

Government convening, mitigation measures

The Ministry of Health has been convening impact assessment meetings, with a special commission set up for this purpose.

The ministry of justice has been leading an impact assessment on human rights violations and the protection of key populations. There have been consultations between the Ministry and organizations representing key populations.

The Ministry of Family and Child’s gender working group has conducted an assessment and a gender-based contingency plan is available.

Civil society impact, resilience and response

Civil society organizations in Haut-Katanga have conducted a risk assessment. Steps are also being taken to set up a public-private partnership with civil society organizations. Advocacy for the mobilization of local resources is underway.

Community-led organizations are at risk of closure or severe reduction in services.

There is an increased difficulty in accessing government or donor support, loss of funding for monitoring activities and a reduced ability to collect and report data.

The involvement of community-led organizations in policy design, advocacy, and work on societal enablers has been affected, resulting in a limited ability to advocate for key issues, a shift in focus due to funding constraints, and a reduced participation in policy discussions.

Service delivery by community-led organizations has been affected by the reduction or suspension of services, with an increased demand with fewer resources, loss of staff or funding cuts.

UNAIDS response

The MPox/HIV project for key populations is underway with partners in Kinshasa.

There is support for resource mobilization with a 2-year Department of Health project.

Support is being provided to the Ministry in charge of Gender and the Ministry of Human Development for the organization of a national HIV forum and mobilization of resources.

Advocacy with German and Canadian embassies, African Development Bank, World Bank and the EU to position the HIV response.

Data support is also being provided to assess the impact of the funding cuts on new HIV infections and AIDS-related deaths.

The sudden pause and suspension of US Government foreign assistance has resulted in a multifactorial increase in the risks, challenges, and uncertainty related to HIV commodity^[1] availability and management.

The analysis below presents findings from 56 countries (including 100% of PEPFAR-supported countries) which reported on the status of their HIV commodity stocks and supply chains between February and April 2025.^[2]

The nature of PEPFAR support is different in all countries, and inclusion in this fact sheet does not necessarily mean that PEPFAR funded HIV commodities or supply chains specifically in that country.

​This fact sheet reflects the situation based on information available as of 28 April 2025.  Given the rapidly shifting situation, the information presented could change significantly as the situation evolves.

SUMMARY

• Funding for antiretrovirals often comes from diverse sources and their availability and effective delivery to those who need them depends on well-coordinated stakeholder efforts. Some 14% of countries reported six or less months of stock in at least 1 antiretroviral line.
• The degree of public uncertainty and concern over the continued availability of and access to free antiretroviral treatment has increased significantly. Some 18% of countries flagged public reactions to uncertainty that could result in increased risks of antiretroviral treatment disruptions.
• The most frequent variations in antiretroviral dispensation in countries include reductions in multi-month dispensing periods and in dispensing of emergency supplies, restricted switches to alternative antiretroviral regimens, closures of certain antiretroviral treatment dispensing points, and antiretroviral stock redistribution. Authorities have often sought to preempt or respond to rumors and uncertainty by proactively communicating about antiretroviral availability.
• The Global Fund is helping address short-term HIV commodity gaps, including through existing (or incoming) antiretroviral stocks and through reinvestment of savings from grant implementation. National authorities are also securing supplementary domestic budget allocations to ensure HIV commodity availability and management.
• Despite the precarious situation faced by many community-led organizations because of the USG shift, they continue to play a central role in engaging and informing communities, addressing rumors, advocating for mitigation actions, and providing early warning on ARV availability, accessibility and cost.
• Significant disruptions affecting combination prevention commodities have been reported as a result of the USG shift. This is due to the dominant role played by PEPFAR in prevention commodity procurement, distribution or delivery in many countries. Some 23% of countries reported six or less months of condom or PrEP stocks.
• Around 21% of countries reported six or less months of stock in at least 1 HIV testing commodity. Careful monitoring of individualized country situations is necessary to mitigate any possible increase in stockout risks.
• Even when HIV commodities exist in-country, they may not always be reaching health facilities – creating patient-facing shortages that undermine trust in treatment continuity. Some 46% of countries reported supply chain management issues.
• The repercussions of the USG shift on the global HIV commodity markets should not be underestimated in the medium term. Sustained predictability in HIV commodity demand forecasts is essential to guarantee a stable supply, maintain prices, and ensure the availability of affordable generic medicines for national HIV responses.

CONTINUE READING

[1] Commodities include ARVs, HIV tests, VL and other lab tests, early infant diagnosis reagents and supplies, as well as prevention commodities (including PrEP and condoms).

[2] The data analysed comes primarily from three sources: 1) Open-text reporting by UNAIDS country offices through the UNAIDS tool “Monitoring HIV Programmes’ Continuity Amidst US Shifts” for the period 5 February – 28 April 2025; 2) UNAIDS country office ad-hoc email updates for the period 18 -24 March and 16-23 April, and 3) UCO / RST consultations with national and regional PLHIV networks on 18-20 March.

24th session of the United Nations Permanent Forum on indigenous issues, Agenda item 4: Discussion on the six mandated areas of the Permanent Forum (economic and social development, culture, environment, education, health and human rights), with reference to the United Nations Declaration on the Rights of Indigenous Peoples and the 2030 Agenda for Sustainable Development.

NEW YORK, 25 April 2025 — Indigenous Peoples often face higher rates of health risks, greater unmet needs for health and social services and poorer health outcomes than non-Indigenous populations. Indigenous Peoples in some contexts are more vulnerable to and disproportionately affected by HIV, tuberculosis and Hepatitis C due to multiple and intersecting inequalities that they face, including racism, poverty, discrimination and marginalization.

Through various initiatives, UNAIDS ensures that the rights and health needs of Indigenous Peoples, including Indigenous women and two spirit people, are part of its efforts. We remain committed to promoting intercultural sensitivity and inclusivity in planning and delivery, addressing the root causes of the HIV disparities faced by Indigenous communities.

UNAIDS is dedicated to addressing the significant disparities in HIV prevalence among Indigenous Peoples, particularly in Latin America, where, in some areas, rates can be up to six times higher than in the general population. This alarming situation arises from systemic challenges, including the lack of decentralized, differentiated, and interculturally sensitive health approaches tailored to the specific HIV needs of Indigenous communities.

To combat these inequalities, UNAIDS, together with other partners, facilitated the launch of an Indigenous-led Coalition on HIV in Latin America. This Coalition promotes a regionally coordinated approach, emphasizing the design and implementation of culturally appropriate strategies to tackle HIV within Indigenous populations.

The Global AIDS Strategy for 2021–2026 and the 2021 UNGA Political Declaration on HIV/AIDS have, for the first time, recognized Indigenous Peoples as a priority population for HIV response. UNAIDS defines priority populations as groups of people who in a specific geographical context (country or location) are important for the HIV response because they are at increased risk of acquiring HIV or disadvantaged when living with HIV, due to a range of societal, structural or personal circumstances. Both documents set bold targets to be met by 2025 among all demographic groups and geographic settings.

Work is under way to develop the next Global AIDS Strategy for 2026-2031. It will inform deliberations of the 2026 High-Level Meeting of the UN General Assembly on HIV/AIDS and its expected Political Declaration.

It is important to make sure that the progress and challenges in addressing the AIDS epidemic among Indigenous Peoples are adequately considered in the development of the new Global AIDS Strategy. Meaningful participation and contribution of Indigenous Peoples will be essential. The current representation of Indigenous Peoples —through the membership of National Native American AIDS Prevention Center (NNAAPC), representing the geographic region of North America— in the NGO Delegation of the UNAIDS’ Programme Coordinating Board (PCB) is an important avenue for effectively including community voices in the development of the new Strategy. Indigenous Peoples’ organizations have also been invited to participate in the global consultations on community leadership, and regional and country consultations in Latin America and Caribbean.

UNAIDS calls on Member States, UN and other stakeholders and partners to strengthen efforts for the empowerment and participation of the Indigenous Peoples in the decision making related to their health, including HIV.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

In 2010, at age 23, Ayu Oktariani learned she was HIV positive. Not only did she lose her husband to AIDS, but during her pregnancy her daughter became infected with HIV.

“I had no chance at all to protect my family,” she said. “I had no information about HIV and even less knowledge about HIV and pregnancy.”

Ten thousand children were infected with HIV in Asia and the Pacific in 2023, around 30 every day. Although HIV prevention services helped avoid nearly 72,000 new HIV infections among children since 2015, over one-third of pregnant women in Asia Pacific in need of medicine to prevent HIV transmission to their child, and to keep themselves well, do not have access.

Today, Ms Oktariani and her daughter are accessing antiretroviral treatment and are thriving. In addition, Ms Oktariani now heads Indonesia’s national network of women living with HIV - Ikatan Perempuan Positif Indonesia (IPPI). Through its Emak (mother) Club, IPPI helps women living with HIV to get the information and care that did not reach her and so many others in time.

“We support pregnant women living with HIV to get on treatment, make sure they access maternal and child health services based on their needs and ensure all the babies get prophylaxis (preventative medicines) and Early Infant Diagnosis. We do it with the hope that mothers can give birth to healthy babies, free from HIV,” she explained.

Ms. Oktariani spoke at the launch of the Regional Roadmap for the Triple Elimination of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B in the Asia and Pacific Region. This resource offers guidance to strengthen national strategies and operational plans to end these three diseases among children by 2030. 

The roadmap tracks the progress of 21 countries since 2018. It outlines strategic priorities to pick up the pace, including policy leadership, universal service access, integration with reproductive and child health systems, community engagement and strengthened monitoring.

In the region, Thailand, Malaysia, Sri Lanka and the Maldives have already achieved the dual elimination of mother-to-child transmission of HIV and syphilis. These four countries are also on the way to eliminating mother to child transmission of hepatitis B. Bhutan, Cambodia, China and Mongolia, are also making solid progress, however, other countries still face significant challenges. 

The roadmap specifically calls for increased monitoring of syphilis and hepatitis B, and for hepatitis B strategies to be integrated into programmes and policies to prevent transmission. 

Sri Lanka eliminated HIV and syphilis in children in 2019 and maintained validation in 2023. It is now on-track to add hepatitis B to the list thanks to continuous work to strengthen maternal and child healthcare. 

China launched its HIV prevention programme 24 years ago and has fully integrated these services with maternal and child healthcare. The national rate of mother-to-child HIV transmission is now 1.3%.

In Nepal which has the region’s best overall HIV prevention results, the 2021-2026 National HIV Strategy aims to eliminate these three diseases along with congenital hepatitis C and other sexually transmitted infections.  

In the midst of an HIV outbreak, Fiji is developing a Triple Elimination Strategy aligned with global and regional frameworks. It hopes to capitalize on the fact that virtually all its deliveries take place in hospitals. 

Papua New Guinea, which also faces rising new infections, is mobilizing resources for its own Triple Elimination Framework. It is currently focused on increasing testing and ensuring women in the provinces access treatment and community support. 

At the launch, Regional Directors from WHO, UNICEF and UNAIDS all emphasized the need for integrated services.

“The triple elimination agenda helps us to get the most out of every interaction and investment,” said Eamonn Murphy, Regional Director of UNAIDS Asia Pacific and Eastern Europe Central Asia. “No child should begin life with a disease we can prevent.”

Current implementation and disruptions

Documented impact on services

Due to the suspension of US-funded antiretroviral deliveries, critical gaps in ARV availability are expected as early as Q2 2025 for patients in ABC/3TC regimen.

Abacavir/Lamivudine 600/300 mg (ABC/3TC): The availability of the medication is approaching a critically low level. There are potential risks of a shortage of this medicine. The available supply will cover approximately 3.2 months (as of 01 March 2025), which means a stockout is expected by June 2025. The supply under COP23 that included the delivery of 229 packs was blocked. The delivery date to the country is currently unknown.

Lamivudine oral solution, 10 mg/ml (240 ml) 3TC fl: Delivery of 2,364 bottles for children was suspended, with no national procurement planned for 2026. Considering the expiry date of the majority of the remaining stock (June 2026), the treatment coverage is 16 months. The information is provided without considering the use of the medicine for PMTCT.

Nevirapine oral suspension 50 mg/5 ml (100 ml) NVP fl – the supply of 617 bottles is suspended. The treatment coverage with available stock is 15.4 months.

Raltegravir 100 mg (60 tablets) RAL 100mg – supply of 641 packs suspended. At the end of 2024, part of the ARV supply procured under COP23 with PEPFAR funding—579 packs (34,740 tablets)—was distributed to the oblasts. As patient enrollment and treatment optimization progress, the supply coverage will change. Considering the expiry date of the majority of the remaining stock (November 2026), the current supply coverage is 21 months.

Raltegravir 400 mg (60 tablets) RAL 400mg – the distribution of 3,471 packs to the regions is ongoing but will finish soon. Optimization based on treatment regimens using this ARV is underway, and new patients are also being initiated on therapy. Since the expiry date of most of the remaining ARV stock is set for 30 April 2026, the estimated stock coverage is approximately 14 months.

Tenofovir/Lamivudine/Dolutegravir 300 mg/300 mg/50 mg (90 tablets) TLD – In mid-March 2025, 168,397 packs of ARVs (15,155,730 tablets) procured under COP23 with US funding were delivered to the national logistics warehouse. The medicine is currently undergoing inventory control and is being prepared for distribution to the oblasts. The overall national supply coverage will amount to 9.4 months. A buffer stock of 41,273 packs (3,714,570 tablets) remains at the logistics warehouse.

Immediate Risk: Starting from April–May 2025, 193 patients out of 117473 patients on Abacavir/Lamivudine 600/300 mg (ABC/3TC) regime may face treatment interruption.

Collapse of PrEP Scale-Up and Discontinuation of Pilot CAB-LA Programs: In 2025, the PrEP program is at high risk due to halted procurement. The total stock of Tenofovir Disoproxil Fumarate 300 mg / Emtricitabine 200 mg, (TDF/FTC), across Ukraine amounts to 792,240 tablets. Based on the average monthly consumption of 150,346 tablets, the estimated supply coverage of TDF/FTC for PrEP is approximately 5.3 months. A request was submitted for 140,850 packs of TDF/FTC to be funded by the US. However, due to the suspension of US funding, this procurement is currently in question. An urgent procurement of the quantity requested using Global Fund resources is being considered.

CAB-LA: The injectable form of PrEP, CAB-LA, is supplied to two pilot regions: Kyiv and Lviv. The estimated supply coverage is approximately 14.5 months. Immediate Risk: Starting from Q2 2025, the country will likely face inability to initiate new PrEP users among key populations and a disruption in the continuity of prevention for over 13 thousand people already enrolled in the programme.

Breakdown of HIV rapid diagnostics: There is uncertainty about timely delivery of rapid diagnostics tests. Stock balance – 14,823 tests (including 470 tests expiring on 05 June 2025 and 14,353 tests expiring on 08 October 2025). The current stock is expected to last until August 2025. A delivery of 8,480 tests is expected in June 2025.

As of April 2025, the U.S. Government has suspended humanitarian assistance programs, including those funded by PEPFAR, which previously provided essential HIV-related commodities. This suspension has: 1) Blocked planned shipments of antiretroviral medications (ARVs), including major components of pre-exposure prophylaxis (PrEP), 2) Left pending orders under the COP24 procurement cycle in limbo — notably 140,850 packs of TDF/FTC for PrEP, which were to be funded by PEPFAR.

Direct Impact on Service Availability

Disruption of PrEP Services: The uncertainty with procurement for 140,850 packs of Tenofovir Disoproxil Fumarate / Emtricitabine (TDF/FTC) under PEPFAR funding has placed the national PrEP program at risk. The current supply is expected to be exhausted by mid-August 2025, based on average monthly consumption.

No confirmed delivery timeline is available, jeopardizing PrEP continuity for individuals at high risk of HIV infection, PWID, SW, MSM, serodiscordant couples.

Risk of ARV Shortages: Delays linked to the waiver’s absence are contributing to projected shortages of several essential ARVs, particularly:

Abacavir/Lamivudine (ABC/3TC) – with a stockout expected as early as June 2025.

Some ARVs are at risk of expiring before use, due to supply overlaps and administrative uncertainty (e.g., 4,450 packs of ABC/3TC and 8,300 packs of Ritonavir).

Risk to Diagnostics: The current stock of rapid diagnostic HIV tests is expected to last until August 2025.

Government convening, mitigation measures

The Ministry of Health (MoH), through the Public Health Center (PHC), is conducting rapid assessments of ARV, diagnostic, and PrEP stock levels to identify urgent supply gaps. Efforts are underway to reallocate existing stocks from regions with surplus to high-need areas, prioritizing children, pregnant women, and patients on second-line regimens.

The Government of Ukraine, in consultation with partners, is exploring the use of unspent budget lines and Global Fund reprogramming to cover immediate gaps.

The Global Fund Country Coordinating Mechanism (CCM) is actively reviewing budget flexibility for 2025–2026 to prioritize life-saving commodities. UNAIDS to support technically an immediate application by Ukraine to be submitted to the Pandemic Fund for which Ukraine would qualify. WHO and UNAIDS are in dialogue with partners to map regional lab capacity and support logistics to shift patient samples for central testing if needed.

This crisis has accelerated dialogue on transition and sustainability planning, including an appeal to pharmaceutical companies and medical goods manufacturers to explore the possibility of receiving commodities as free humanitarian or charitable assistance.

Civil society impact, resilience and response 
In response to diagnostic test shortages, civil society organizations (CSOs) and local healthcare facilities have initiated internal redistribution of rapid HIV test kits purchased with local and regional budgets, as well as other budgetary programs.

Civil society platforms actively pushed for government and international donor action by: Submitting urgent appeals to donors for temporary humanitarian shipments of ARVs and PrEP, Coordinating with Global Fund implementers (e.g., 100% Life, Alliance for Public Health) to track deliveries rapid HIV test kits and PrEP supplies.

UN response

Advocacy for emergency procurement and resource mobilization: UNAIDS and UN partners are supporting national counterparts, including the Ministry of Health (MoH) and Public Health Center (PHC), in engaging international donors to mitigate disruptions in ARV and PrEP supplies.

UNAIDS is working with the MoH and other stakeholders to develop longer-term strategies for transition and sustainability, including Diversification of procurement sources, Programmatic optimization to prioritize high-impact interventions amid constrained resources.

Documented impact on services 

According to the Department of Health Consolidated Impact Assessment report, the three most impacted provinces regarding HIV and TB prevention services following the US funding cuts are Western Cape, Northwest and Gauteng.

The closure of key population clinics has disrupted access to routine services, including PrEP, and clients have been referred to public health facilities. The DREAMS programme and other services for adolescents and young people have also been impacted, including the mobile outreach services for high transmission areas. According to the International Treatment Preparedness Coalition, the funding cuts could compromise care in non-U districts as decision-makers have limited access to the stock visibility system (SVS) and national dashboards. The mobile application (SVS App) and web management portal (SVS Web) have been used to monitor the availability of medicines and other health commodities at over 3 000 public health clinics and over 300 hospitals since 2015.

Civil society impact, resilience and response

Community initiatives addressing HIV now hang in the balance following funding cuts. Some community-based organizations have been forced to shut down certain programmes while others have stopped operating entirely. These programs provide access to nutritious food in underserved areas, which is vital to improve children's overall treatment. Other programmes include protecting survivors of gender-based and sexual violence through provision of counselling services, HIV preventive medication and safe spaces for women.

Government actions 

The Minister of Health, Dr Aaron Motsoaledi, says a new budget allocation to the Department of Health is aimed at addressing longstanding backlogs and rebuilding the country’s strained healthcare system.

The Department of Health will spend ZAR1.4 billion to urgently procure critical medical equipment, including hospital beds and other consumables which have been in short supply across many public hospitals. This is in addition to strengthening healthcare staffing levels at the cost of ZAR 1.78 billion. 

Close the Gap campaign 

As part of the Close the Gap Campaign, the Department of Health is aiming to reach over 600 thousand men for linkage to HIV treatment. A men’s health clinic in KwaZulu-Natal, launched as a pilot project by the Department of Health has been hailed as a groundbreaking success. Health services provided to men include standard primary healthcare, VMMC, and prostate cancer screening. There are trained male nurses specifically assigned to these dedicated sections. Feedback received indicates that men appreciate the separate space where they feel “seen and heard”. Due to demand, the project has been expanded to five other municipal clinics.

Delegates at the World Health Organization (WHO) Intergovernmental Negotiating Body (INB) have today reached a consensus on the Pandemic Agreement. Negotiations began in 2021, with an aim of building a framework for pandemic preparedness, prevention, and response that learned from the COVID-19 and AIDS pandemics. 

The Joint United Nations Programme on HIV/AIDS (UNAIDS) and other stakeholder played an important role in supporting the process by advocating for an agreement that centres equity and human rights.  

In response to the news of the consensus Winnie Byanyima, Executive Director of UNAIDS, stated: 

“During COVID-19, we at UNAIDS watched in horror as the world failed to learn the lessons of AIDS, a pandemic we have been fighting for decades. The consensus reached today is a critical first step towards ensuring the world never makes the same mistakes again – and proof that, in a time of instability, global cooperation can deliver for humanity. 

This is an agreement with human rights at its heart, prioritising community engagement and whole-of-society and whole-of-government approaches to pandemic preparedness, prevention and response. But, while the agreement supports equitable access to lifesaving vaccines, tests, and medicines, it falls short of what developing countries called for, particularly regarding obligations to transfer technology. 

The Pandemic Agreement is not a panacea. If adopted by the World Health Assembly, a fairer response to future health crises will depend on member states taking concrete steps to implement the agreement. Governments will need clear implementation frameworks, including timelines for ensuring that all can benefit from affordable access to scientific innovation. 

But if this text is adopted and implemented, if it is honoured in spirit as well as in letter, it can lay the foundations for a more effective and equitable response to future health crises – and ensure that the next time a pandemic threat emerges, it will be met by a global health system that is fairer, safer, and more resilient.”