Honduras' HIV response is experiencing critical disruptions due to the U.S. funding pause for many HIV services. Approximately 100 healthcare workers had stopped providing lifesaving services following the initial U.S. stop-work-order last month, reducing access to essential HIV services like testing, prevention, and treatment for people living with HIV. These interruptions in access to HIV services create great individual – and public - health risks. While some affected healthcare workers were instructed that they could resume work on 24 February, it is not clear how many of them returned to work.  It is estimated that approximately 20 000 people live with HIV in Honduras. The country’s HIV response relies on external financial support for prevention among key populations. The Global Fund, PEPFAR and USAID have been supporting the country’s efforts to end AIDS as a public health threat.

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Sixteen new reports on the impact of the freeze of US foreign assistance on the global AIDS response were received from UNAIDS’ Country Offices during the week of 17-21 February. As of 21 February, at least one status report had been received from 55 countries, including 42 PEPFAR-supported and 13 that receive some US support.

Reports received over the past week show that waivers have led to the resumption of select clinical services, such as HIV treatment and prevention of vertical transmission, in many countries that are highly dependent on US funding. However, the durability of this resumption is unclear amid multiple reports that key US government systems and staff responsible for paying implementing partners are either offline or working at greatly reduced capacity.

Critical layers of national AIDS responses are ineligible for waivers, including many HIV prevention and community-led services for key populations and adolescent girls and young women. In addition, data collection and analysis services have been disrupted in numerous countries. Reports from UNAIDS’ Country Offices note that these interruptions have eroded the overall quantity and quality of HIV prevention, testing and treatment services. Human resources for health at health facilities are facing increased workloads, and patients are experiencing increased waiting times to receive life-saving services. US government statements to UN system organizations suggest US-funded programmes focused on gender equality and transgender populations may not resume.

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Sixteen new reports on the impact of the freeze of US foreign assistance on the global AIDS response were received from UNAIDS’ Country Offices during the week of 17-21 February. As of 21 February, at least one status report had been received from 55 countries, including 42 PEPFAR-supported and 13 that receive some US support.

Reports received over the past week show that waivers have led to the resumption of select clinical services, such as HIV treatment and prevention of vertical transmission, in many countries that are highly dependent on US funding. However, the durability of this resumption is unclear amid multiple reports that key US government systems and staff responsible for paying implementing partners are either offline or working at greatly reduced capacity.

Critical layers of national AIDS responses are ineligible for waivers, including many HIV prevention and community-led services for key populations and adolescent girls and young women. In addition, data collection and analysis services have been disrupted in numerous countries. Reports from UNAIDS’ Country Offices note that these interruptions have eroded the overall quantity and quality of HIV prevention, testing and treatment services. Human resources for health at health facilities are facing increased workloads, and patients are experiencing increased waiting times to receive life-saving services. US government statements to UN system organizations suggest US-funded programmes focused on gender equality and transgender populations may not resume.

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Due to the U.S. Government’s freeze of foreign assistance, 15,374 PEPFAR-funded HIV response staff across national and 27 priority districts have been affected, with an estimated HR cost of ZAR 4.6 billion (~USD 250 million), and approximately 222,000 people living with HIV, including 7,445 children under the age of 15, face disruptions in their daily antiretroviral therapy supplies.

Documented Impact on Services as of 20 February

• PEPFAR-funded Projects: Last week, PEPFAR-funded projects in South Africa received waiver letters, prompting a review of their activities. The CDC has communicated with beneficiary organizations, while USAID-supported partners remain closed.
• Service Disruptions: The closure of the TB/HIV Care clinic in Tshwane, Pretoria, has significantly impacted people living with HIV, particularly the homeless, of whom 70% are drug users.
• The halt in US Government support has led to a pause in the Ritshidze (“Saving Our Lives”) Community-led monitoring project. Established in 2019, the project monitors more than 400 public clinics and community healthcare centers, located in 27 priority districts and 8 provinces of South Africa. The facilities were chosen to cover nearly half of all people living with HIV on treatment in the country, with a focus on sites with large treatment cohorts and where the data show poor linkage and retention rates.

Human Rights, Key, and Vulnerable Populations

• People who use drugs: Service disruptions pose a high risk of needle sharing and antiretroviral interruptions due to the lack of referral letters required by some government facilities. This increases the risk of HIV viral rebound and transmission among the estimated 80,000 people who use drugs in the country.
• LGBTQ+ communities: Facilities like Engage Men’s Health, which support gay and bisexual men and men who have sex with men, remain closed. This closure heightens the risk of stigma, discrimination, and potential resurgence of new HIV infections among these marginalized populations.

Government convening and mitigation measures

• ART Dispensation: The Department of Health has implemented a 6-month antiretroviral therapy dispensation for eligible patients to reduce clinic visits and ease the workload on health workers.
• Telemedicine and Digital Health: Efforts are being made to strengthen telemedicine and digital health platforms for HIV prevention and treatment services.
• Private Sector and Civil Society Partnerships: The Department of Health is encouraging partnerships to support key populations' HIV services.

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JOHANNESBURG/GENEVA, 25 February 2025—UNAIDS welcomes South Africa’s plan to put an additional 1.1 million people living with HIV on life-saving treatment by the end of 2025 as a significant step towards ending AIDS as a public health threat by 2030.

At the launch of the Close The Gap campaign in Soweto South Africa’s Minister of Health, Aaron Motsoaledi, said, “We should not accept that AIDS is here forever. It is not. We want to end it. It’s all in our hands and it depends on our will. We can stop it so that in future we can work on other diseases. We are taking the last mile.”

UNAIDS described the plan as inspiring.

“This plan protects the human rights of people living with HIV, offering them hope and an opportunity to live healthy and fulfilling lives by getting them onto life-saving medication,” said UNAIDS regional director for East and Southern Africa, Anne Githuku-Shongwe. “As South Africa embarks on this inspiring journey, be assured that UNAIDS will continue its strong partnership with the government of South Africa to ensure that everyone living with and affected by HIV is protected through proven scientific and evidence-based interventions.”

In South Africa, there were 7.7 million people living with HIV in 2023, with 5.9 million people already accessing lifesaving antiretroviral treatment which enables them to live healthy and productive lives. Without treatment, people living with HIV are at risk of contracting opportunistic life-threatening infections because of their weakened immune system. 

At the launch, Gordon Didiza, a young man living with HIV urged other men to test for HIV and to start treatment if necessary. “I am grateful for treatment because it has kept me alive and healthy since I was diagnosed with HIV,” Mr Didiza has also survived tuberculosis.

While South Africa has the highest number of people living with HIV in the world, it has already made enormous progress in expanding the number of people accessing treatment for HIV, resulting in a 66% decrease in AIDS-related deaths since 2010. New HIV infections have also fallen by 58%. When people are taking effective HIV medication they no longer transmit the virus, meaning that treatment rollout alongside other HIV combination prevention measures, contributes to lower rates of infection and future cost savings.

Domestic resources account for around 74% of South Africa’s HIV response, which demonstrates the political will and commitment of the country’s leadership to end the AIDS pandemic. However, many services still rely on funding from the US government which accounts for around 17% of the country’s financing for the AIDS response. The sudden 90-day pause to US foreign assistance is putting some services at risk, especially HIV prevention services for young women and adolescent girls and other marginalized communities. More than 800 young women and adolescent girls aged 15—24 become infected with HIV every week in South Africa.

UNAIDS is working closely with the South African government and other partners to mitigate the impact and ensure the continuity of HIV services.

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.

The United States Government (USG) support to Zambia is estimated at $600 million annually, of which $367 million was committed for the national HIV response for 2025 under the Presidential Emergency Plan For AIDS Relief (PEPFAR).

The USG pause in foreign assistance has caused significant disruption to HIV services in Zambia, with HIV prevention services being hardest hit. HIV Combination prevention for adolescent girls and young women as well as for other marginalized and vulnerable communities are most impacted.

A total of 32 drop-in centers that provide HIV services to over 20,000 key populations living with HIV on ART in 7 out of 10 provinces have been shut down. Additionally, USG-supported DREAMS centers for adolescent girls and young women in 21 districts have been closed. Further, 16 standalone centers providing voluntary medical male circumcision have also stopped operating. Almost half (49%) of the PrEP services in Zambia are USG supported.

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The United States Government (USG) support to Zambia is estimated at $600 million annually, of which $367 million was committed for the national HIV response for 2025 under the Presidential Emergency Plan For AIDS Relief (PEPFAR).

The USG pause in foreign assistance has caused significant disruption to HIV services in Zambia, with HIV prevention services being hardest hit. HIV Combination prevention for adolescent girls and young women as well as for other marginalized and vulnerable communities are most impacted.

A total of 32 drop-in centers that provide HIV services to over 20,000 key populations living with HIV on ART in 7 out of 10 provinces have been shut down. Additionally, USG-supported DREAMS centers for adolescent girls and young women in 21 districts have been closed. Further, 16 standalone centers providing voluntary medical male circumcision have also stopped operating. Almost half (49%) of the PrEP services in Zambia are USG supported.

Human resources for HIV service delivery are also at risk. The USG supports over 23,000 personnel, with over 11,500 being health workers and community-based volunteers supporting the national AIDS response. The Government may not be able to absorb these health workers immediately. Consequently, opportunities for task shifting and better integration of services are being explored by the Government.

In view of the waiver on service delivery, USG Implementing partners are incrementally resuming services but with a lot of caution. HIV services are at a complete standstill in the six districts of the Northern Province, where Right to Health is the only USG implementing partner.

There is an adequate supply of ARVs for the next 12 months, but without buffer for the period. Available and pipeline HIV rapid test kits are expected to last 3.2 months, with 4 months for tuberculosis x-pert cartridges and a one-month supply for viral load testing and early infant diagnosis.

The Ministry of Health is committed to ensuring the uninterrupted provision of essential HIV, TB and Malaria services across all public health facilities and has issued directions and guidance to this effect. The UN Joint Team on HIV and AIDS has supported the Ministry of Health to establish a high-level steering committee to identify gaps and develop a response plan to mitigate the impact of the “pause orders” for the HIV response. A costed-impact mitigation plan based on the minimum package of HIV services essential for continuity has been developed and presented to the Government and Cooperating Partners. In line with the HIV Response Sustainability Roadmap 2025-2030 that was launched in December 2024, the Joint Team is working with the Ministry of Health and the National AIDS/TB/STI Council (NAC) to explore and implement medium and long-term solutions for sustaining the national AIDS response.

Due to the U.S. Government’s freeze of foreign assistance, 15,374 PEPFAR-funded HIV response staff across national and 27 priority districts have been affected, with an estimated HR cost of ZAR 4.6 billion (~USD 250 million), and approximately 222,000 people living with HIV, including 7,445 children under the age of 15, face disruptions in their daily antiretroviral therapy supplies.

Documented Impact on Services as of 20 February

• PEPFAR-funded Projects: Last week, PEPFAR-funded projects in South Africa received waiver letters, prompting a review of their activities. The CDC has communicated with beneficiary organizations, while USAID-supported partners remain closed.
• Service Disruptions: The closure of the TB/HIV Care clinic in Tshwane, Pretoria, has significantly impacted people living with HIV, particularly the homeless, of whom 70% are drug users.
• The halt in US Government support has led to a pause in the Ritshidze (“Saving Our Lives”) Community-led monitoring project. Established in 2019, the project monitors more than 400 public clinics and community healthcare centers, located in 27 priority districts and 8 provinces of South Africa. The facilities were chosen to cover nearly half of all people living with HIV on treatment in the country, with a focus on sites with large treatment cohorts and where the data show poor linkage and retention rates.

Human Rights, Key, and Vulnerable Populations

• People who use drugs: Service disruptions pose a high risk of needle sharing and antiretroviral interruptions due to the lack of referral letters required by some government facilities. This increases the risk of HIV viral rebound and transmission among the estimated 80,000 people who use drugs in the country.
• LGBTQ+ communities: Facilities like Engage Men’s Health, which support gay and bisexual men and men who have sex with men, remain closed. This closure heightens the risk of stigma, discrimination, and potential resurgence of new HIV infections among these marginalized populations.

Government convening and mitigation measures

• ART Dispensation: The Department of Health has implemented a 6-month antiretroviral therapy dispensation for eligible patients to reduce clinic visits and ease the workload on health workers.
• Telemedicine and Digital Health: Efforts are being made to strengthen telemedicine and digital health platforms for HIV prevention and treatment services.
• Private Sector and Civil Society Partnerships: The Department of Health is encouraging partnerships to support key populations' HIV services.
• Diplomatic Discussions: President Ramaphosa has convened a high-level delegation for diplomatic discussions with China and Russia.
• Civil Society Impact, Resilience, and Response
• NGO Closures: NGOs reliant on USAID funding remain closed, affecting community-based programs and outreach services, including HIV testing, in USAID-supported districts.
• Research and Clinical Trials: South African universities and research institutions are concerned about the impact of the funding freeze on research and clinical trials. There is uncertainty about research funding, with fears that NIH-backed projects could be at risk.

Indonesia has had to pause many programmes due to the U.S. funding freeze.  All community led activities funded through USAID have been paused and prevention and linkages to treatment for around 30% of men who have sex with men (MSM) in Jakarta have been affected. In addition, the expansion of PrEP programmes and a test pilot of long-acting HIV pre-exposure prophylaxis (PrEP) have been halted for now.

The HIV epidemic in Indonesia is mostly concentrated among key populations (MSM, sex workers, people who inject drugs and transgender people) except in Tanah Papua, where the epidemic is generalized. There are nearly 80 000 MSM in Indonesia’s capital.

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Documented Impact on Services

Indonesia has had to pause many programmes due to the U.S. funding freeze.  All community led activities funded through USAID have been paused and prevention and linkages to treatment for around 30% of men who have sex with men (MSM) in Jakarta have been affected. In addition, the expansion of PrEP programmes and a test pilot of long-acting HIV pre-exposure prophylaxis (PrEP) have been halted for now.

The HIV epidemic in Indonesia is mostly concentrated among key populations (MSM, sex workers, people who inject drugs and transgender people) except in Tanah Papua, where the epidemic is generalized. There are nearly 80 000 MSM in Indonesia’s capital.

There are an estimated 570,000 people living with HIV in Indonesia.  Addressing the treatment gap is one of the country’s biggest challenges. Only 31% of people living with HIV are accessing treatment and 14% are virally suppressed.

First line HIV treatment is provided for free for PLHIV and is fully funded by the government as are HIV testing kits and CD4 and viral load testing kits.  However, HIV self-testing kits, condoms, clean needles, PrEP and long-acting HIV pre-exposure prophylaxis are procured with the support of the Global Fund.

HIV prevention programmes depend heavily on the Global Fund and USAID, especially regarding community outreach and peer support. The Global Fund investment is focused in 178 HIV priority districts with an allocation of $102 million for three years (2024-2026).  The US government made an annual investment of $11 million for the HIV response in Indonesia in 2024-25. This includes above site technical assistance for the national HIV program implemented through US-based consulting agencies such as JSI/Think Well and through multilateral agencies including UNAIDS; as well as on-site intervention for PLHIV and key populations in the city and greater Jakarta implemented by EPIC/FHI360.