Current Coverage and Services

• Pre-exposure Prophylaxis (PrEP): According to the National AIDS authority, as of January 31, 2025, there are 210 health facilities nationwide providing PrEP services, with 44,780 people using the service. Of these, 92 facilities with 31,639 clients (70.7%) are funded by PEPFAR in 11 provinces. Antiretrovirals for PrEP committed by PEPFAR in COP 2024-2025 have been delivered by one third. Current stock can cover for PEPFAR-supported PrEP clients until end of May 2025. Relevant medical facilities supported by US CDC have resumed full package service, while those supported by USAID only provide PrEP medicines from available PEPFAR stock but do not cover associated costs, which fall on patients paying out-of-pocket. The development and implementation of the AIDS Information Management System, including PrEP management system, is on hold.
• Antiretroviral Treatment (ART): ART is mainly financed by social health insurance funds and partially by the Global Fund. Technical assistance to the supply chain and treatment information system, mostly through USAID, has been affected.
• HIV Testing and Treatment: Community outreach and lay testing have been heavily affected. All treatment facilities and service points are operating at full capacity. Prevention of vertical transmission and pediatric services are also functioning without disruption.
• Supplies: ARV supplies, HIV tests, viral load tests, and condoms are available with minimal disruption. According to the Viet Nam Administration of Disease Prevention, PEPFAR committed to support about 40,000 PrEP clients in 2025. The Global Fund is supporting 23,000 PrEP clients in 2025 and 25,000 in 2026. 

Immediate Risks and Disruptions

• Funding Freeze: The freeze on PEPFAR funding has significantly impacted the expansion of PrEP coverage. This has led to disruptions in access to PrEP and reduced capacity for HIV prevention services, particularly affecting men who have sex with men, and transgender people.
• Stigma and Discrimination Programs: Almost all PEPFAR supported initiatives addressing stigma and discrimination have been halted and those allowed to continue with support through US CDC are requested to not refer to transgender persons and other key populations, which could exacerbate challenges faced by key populations.
• Civil Society Organizations (CSOs): There has been a reduction or suspension of services provided by CSOs, limiting their ability to participate in essential HIV services, policy discussions, data collection and reporting, and access to government or donor support.

Politically Relevant Updates

• Government Response: The Vietnamese government, through the Viet Nam Administration of Disease Prevention, has formed an informal task team to receive feedback from organizations of people living with HIV and key populations.  
• Precise numbers of the affected CBO community workers are not available. The government is not assuming the costs for the community workers affected by the PEPFAR freeze.
• International Support: The US funding cut has led to the suspension and/or termination of USAID-funded projects, including critical healthcare programs for tuberculosis and HIV prevention and strengthening of systems for health/HIV. Despite these challenges, the Vietnamese government remains committed to prioritizing resources and implementing effective measures for HIV prevention and control.

UNAIDS is releasing weekly updates to track the impact of US cuts to foreign assistance on HIV testing, treatment and prevention. These reports are based on status reports generated by UNAIDS’ Country Offices.

As of 13 March, at least one status report had been received from UNAIDS’ County Offices in 67 countries, including 84% of all PEPFAR-funded countries and an additional 20 countries that receive US support for their AIDS responses.

Low- and middle-income countries across several regions are building on short-term emergency measures to address cuts in US foreign assistance taking action to sustain their national AIDS responses in the medium and long term.

UNAIDS’ Country Offices are supporting these efforts by working with heads of government, Ministries of Health and national AIDS authorities to assess the full impact of the cuts so countries can ensure continuation of critical HIV services in the medium and long term. 

Many countries have conducted UNAIDS-supported rapid surveys to assess the impact of the cuts on recipients of HIV services. The results from one survey in a high-burden country in East Africa found that 62% of respondents reported difficulty accessing pre-exposure prophylaxis (PrEP), 46% of people living with HIV experienced disruptions in HIV treatment, and 23% of people living with HIV received smaller amounts of antiretroviral medicines (e.g. a three-month supply instead of the usual six-month supply) from local dispensaries. The survey also found that viral load testing, community outreach, condom distribution and TB diagnostic efforts were also significantly impacted.

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Immediate Risks and Disruptions 

1. Distribution Disruptions: 

• According to the policy brief to Parliament prepared by the Uganda AIDS Commission with support from UNAIDS, stocks of ARV supplies, HIV, viral load and other lab test kits are available. However, distribution from district hubs to lower health facilities is disrupted due to reliance on US-funded implementing partners. Facilities have adequate stocks for three months, but the impact will be felt from the second quarter of 2025 if not mitigated. 
• Condom stockouts are anticipated within the next 3-6 months due to challenges with last mile distribution. 

2. Service Capacity: 

• All ART-providing facilities are operating at reduced capacity.   Some community-led, peer-led, NGO-run, and private facilities have stopped services. 
• Reduced adherence to prevention of vertical transmission and early infant diagnosis services due to decreased numbers of expert clients and mentor mothers. 
• HIV prevention services for key populations at drop-in centres, including PrEP access, HIV testing, and antiretroviral treatment adherence counselling  for sex workers, men who have sex with men, transgender persons, people who use drugs, and prisoners, have been disrupted. 

3. Human Resources: 

• It is unclear whether US-funded health workers will be integrated into the government payroll. 
• Data clerks at facilities covered by USAID are not yet back at work, impacting data collection and quality control. 

Politically Relevant Updates 

1. Government Actions: 

• The Ugandan President directed the release of UGX 6 billion for the rollout of electronic medical records (EMR) in government health facilities to improve service delivery. 
• The Ministry of Health issued guidance on improving service delivery, including integrating HIV, TB, and other chronic disease services, training health workers in integrated service delivery, prioritizing recruitment of critical staff, utilization of primary health care funds for disease prevention outreach activities and strengthening accountability for medicines and laboratory supplies. 

2. Mitigation Measures: 

• The government is reallocating domestic resources to priority HIV programs and integrating HIV services into other health services. 
• Civil society partners have conducted rapid assessments to understand the impact of the US Government funding cuts on service delivery. 

3. Human Rights and Key Populations: 

• US funding for stigma, discrimination, and enabling legal environments has stopped, and no alternative funding has been found. 
• Communities are not collecting data on human rights issues, including increased stigma and discrimination. 
• Key populations groups have conducted a rapid assessment on the impact of the US funding cuts. There is also ongoing work to conduct an assessment with people living with HIV and key populations-related services at drop-in centres. 

“In our country we are not the priority,” Daisy Cruz says plainly.

She is surrounded by other women living with HIV who agree. They share stories that are not often told about the epidemic in Asia and the Pacific. In a region where men living with the virus outnumber women roughly two to one, the issues of women and girls are often overlooked. They are all members of the International Community of Women Living with HIV Asia Pacific (ICWAP).

Eva Dewa was diagnosed in Yogyakarta, Indonesia in 2017.

“I came home seeking a safe space to share my sadness. At that time, I believed that my partner would support me. Instead, he blamed me,” she says.

Ms Dewa has survived intimate partner abuse. She knows she isn’t alone: “A lot of women either experience violence and get infected with HIV, or contract HIV and experience violence.”

She gave birth to twins two years before her diagnosis. During her pregnancy she was never screened. Unaware, she went on to breastfeed for a couple years. When she learned her status, it was she rather than healthcare staff who suggested the children be tested. One child was HIV negative. The other wasn’t.

UNAIDS estimates that under two-thirds (64%) of women living with HIV in Asia Pacific receive treatment to prevent transmission to their babies. This is far lower than the global average of 84%. Ms Dewa reflects that while HIV services for pregnant women are expanding, smaller cities and rural areas benefit more slowly.

Cathy Ketepa understands the challenge of reaching remote districts. Every day in her native Papua New Guinea, five infants are born with HIV. The epidemic there has doubled since 2010 with new infections among women increasing by a staggering 67%.

“Only around half of mothers living with HIV receive antiretroviral therapy,” says Ms Katepa . “We must bridge this gap to protect the health and future of our children.”

But while the women advocate for expanded services to reduce vertical transmission, they are adamant that their dignity, privacy and agency must be respected. The International Community of Women living with HIV (ICW) has conducted a global analysis of the reproductive coercion, mistreatment and abuse experienced by women living with HIV. The study found that across regions, during pregnancy and infant feeding women were most subjected to force.

“There is an issue with coercive practices,” said Sophie Bryon, ICW’s Director of Global Programmes. “We are talking about women being told not to have children, not to have another child, to terminate and being pressured to undergo sterilization. There is still denial of contraception and pressure to use certain kinds of contraception. There are issues ranging from verbal abuse to physical violence.”

There is also stigma. When Ms Cruz went to the hospital in Manila to give birth in 2001, a nurse on the ward loudly asked why she wasn’t breastfeeding.

“All the patients looked at me like there is something different,” she said.

There is a sense from these women that they’ve been ambushed by a threat they didn’t know existed. But having been hit, they will speak up for themselves, and for others.

Christina Montoya didn’t think it was possible for a woman like her to be infected. She was married and only had sex with her husband.

“We must be informed!” she declared. “And all our friends must be informed!”

 11 years of ICWAP 

ICWAP builds the capacity of women and girls living with HIV and women-led organizations in 18 Asia Pacific countries. It provides coaching and mentoring, ensuring women participate in Global Fund processes and are meaningfully engaged in community-led monitoring.

The organization was formed in 2014 to tackle the human rights violations and violence women living with HIV in the region experience, while removing barriers to treatment and care. Sita Shahi, its Regional Coordinator explains that the challenges can’t be tackled from a health angle alone.

“Women face a lot of stigma and discrimination. They also have an economic burden and are responsible for rearing children. There are so many intersecting issues,” she explained.

Now there are new challenges. ICWAP conducted an eleven-country survey on the impact of the United States development aid stop work order. It found that some country networks have either collapsed or scaled back, leaving women without crucial resources, including information about their rights and how to address gender-based violence or discrimination. There is also reduced access for many women who depended on community-based services for HIV or sexual and reproductive healthcare. While treatment is provided by government in most countries, many of the shuttered peer-led services were more accessible and friendly.

Some women who worked for US-supported programmes have lost their jobs, resulting in financial stress. ICWAP itself has been hard hit.

“We lost all funding. The core support we were receiving for managing staff and country interventions is gone. It is a devastating situation for us. There is now no funding to support our sisterhood at country level,” Ms Shahi explained.

UNAIDS has called for countries in Asia Pacific to support community-led HIV work including stigma and discrimination, adherence counselling, social support, monitoring and advocacy.