Immediate Risks and Disruptions

• The freeze has exacerbated chronic supply chain challenges, leading to more prominent condom stock-outs.
• Staff Terminations: Some US Government implementing partners have issued termination letters to staff due to cash flow challenges caused by the funding freeze.
• Service Disruptions: HIV prevention programs, especially those targeting key populations, have been disrupted.
• Compromised Surveillance: Data collection continues but with compromised quality control and collation.

Politically Relevant Updates

• Government Response: A formal statement has not been issued. There is no country-level task team to discuss the impact of the US funding freeze.
• Regional AIDS Coordinating Committees (RACOC): These multisectoral committees - comprising community service organizations (CSOs), government ministries, local authorities, and regional leaders from all 14 regions of the country - held a seminar to discuss the decentralized HIV response. Suggested resolutions included enhancing HIV prevention and operationalizing the sustainability roadmap through social contracting and other modalities.
• Given the latest decisions made by the US Government, the Ministry of Health and Social Services has called an urgent meeting of the Sustainability Planning Steering Committee and stakeholders for Friday 07 March 2025, to discuss the operationalization of the Namibia Sustainability Roadmap for HIV, TB, Malaria and Viral Hepatitis. 

Civil Society Impact and Response

• Cash Flow Issues for Community Partners: Despite the US Government’s waiver allowing some lifesaving services to be continued during the freeze, funds for these activities have not been transferred to implementing partners, leading to staff terminations due to cash flow issues.
• Hybrid Meeting: A meeting between CSOs, the Ministry of Health and Social Services (MoHSS), and UNAIDS discussed the implications of the recent freeze of US funding. Participants called for increased networking and collaboration among community leaders and agreed on actionable steps to mitigate adverse effects.
• Namibian Sex Workers Alliance (NAMSWA): The Namibian Sex Workers Alliance convened the African Sex Workers' Alliance (ASWA) to discuss the impact of the reinstatement of the US’ Protecting Life in Global Health Assistance Policy and the implications of the funding freeze.

As of February 2025, the HIV programmes in Ukraine are facing several challenges and risks:

• Potential Stockouts of Antiretroviral Therapy (ART): There are 118,444 Ukrainian people living with HIV (PLHIV) in government-controlled areas receiving ART, with 93,893 (79%) on a TLD (tenofovir disoproxil, lamivudine and dolutegravir)-based regimen. The current TLD stock covers 5.2 months, varying by region. The 28 February Procurement and Supply Management (PSM) working group meeting, hosted by Public Health Centre, highlighted risks to TLD stocks; stockouts pose a direct threat to the continuity of HIV treatment program. The delivery of TLD drugs in the amount of 168,397 packs (15,155,730 tablets), purchased with PEPFAR project funds under COP 23, is on its way from India to Poland. However, there is a potential issue regarding the route from Poland to Ukraine.

• Logistics Issues for Delivery of ART: A PEPFAR-funded batch of TLD was manufactured and handed over to the freight forwarder, Logenics, before the U.S. government suspended aid programs. The shipment is en route to Poland, but Logenics has not received confirmation from Chemonics regarding coverage of logistics costs from Poland to Ukraine. Civil society organization 100% Life is negotiating with a donor to fund transport from the Polish border.

• Pre-exposure Prophylaxis (PrEP): The stock for TDF/FTC for PrEP is sufficient for at least six months, but this also varies by region (2–10+ months). PrEP expansion remains severely constrained. The CAB-LA PrEP pilot remains unchanged. Available stock will sustain the pilot until April 2026, but there are no plans for expansion.
• Funding Gaps: There is a funding gap of USD 1.9 million for procuring 30,000 three-month ART courses needed to sustain treatment through 2025. Ukraine’s Public Health Centre may request a state budget reallocation to close the USD 1.9 million funding gap for ART procurement, though prospects remain uncertain.

Despite ongoing challenges, Ukraine remains committed to the HIV response, supported by a strong coalition including members of Ukraine’s government, civil society, international organizations and donors. UNAIDS, including its Co-sponsors, other UN agencies and UN Member States continue working together to ensure essential services for people living with, and at risk for HIV, including women and key populations.

In Tajikistan, 61% of the national HIV program is funded by external sources. The US Government funding amounts to approximately 20% and is the second largest contribution after Global Fund to fight AIDS, Tuberculosis and Malaria, which represent around 40% of the total resources. Contributions from other donors are negligible. 

The US Government is a key partner in developing national HIV programs and strategies including writing country proposals to the Global Fund, strengthening laboratory services, introducing and informing the population about best practices in HIV prevention, integrating HIV with other services, and collecting and providing statistical data for decision-making. In addition, funding from the US Government is key to the functioning and survival of civil society organizations, communities of people living with HIV, and representatives of key populations in the country. 

The suspension of USAID funding has had a profound impact on civil society organizations (CSOs) that provide essential HIV services. This has led to:

• Fragmentation of the HIV response: Vulnerable populations are at greater risk of exclusion and neglect without these services.
• Loss of outreach services: Hard-to-reach populations have limited access to HIV prevention, testing, and treatment.
• Impact on adherence support: People living with HIV (PLHIV) are struggling to maintain antiretroviral therapy (ART) regimens, leading to increased viral loads and poorer health outcomes.
• Suspension of peer support programs: PLHIV are deprived of critical emotional and practical support, which is particularly important in a context of prevalent stigma and discrimination.
• Civil society impact, resilience and response: The suspension of USAID funding has led to a decline in community involvement, which will reduce PLHIV representation in policy and programming, making interventions less responsive to their needs. The loss of participation in regional networks will disconnect Tajikistan's HIV response from global and regional best practices, reducing opportunities for knowledge sharing, capacity building, and resource mobilization.

Eleven UNAIDS’ Country Offices submitted new reports on the impact of the freeze of US foreign assistance on their country AIDS responses during the week of 24-28 February. As of 28 February, at least one status report had been received from 59 countries, including 79% of all PEPFAR-funded countries and an additional 15 countries that receive US support for their AIDS responses.

Last week, the U.S. Government issued termination letters for many agreements held by USAID. This decision is expected to significantly alter the situation reported by countries in the coming days. For example, in South Africa dozens of USAID implementing partners received termination letters on 26 February. These decisions will affect a large proportion of the 15,374 PEPFAR-funded staff working on the national HIV response in South Africa. Managers of critical programmes have said they have been given too little time to transition from U.S. funding to other sources of funding.

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New funding for the HIV project implemented by FHI360 – previously supported by U.S. funding - in Mali has been allocated. Once the funds are deployed, the project will be able to resume its activities.

This is significant as the work of associations and NGOs had nearly come to a standstill due to the suspension of U.S. funding. 

Following a report on the impact of the U.S. funding suspension on the community response to HIV, the Malian Government allocated 120 million CFA francs to affected associations to help them continue their activities and mitigate the negative effects of the suspension. This decision was made during a meeting on February 28, organized jointly by the UNAIDS Country Office and the Executive Secretary of the High National Council for the Fight against AIDS.

Despite the reinstatement of funding for the FHI360 project, there are still immediate risks and disruptions to HIV programmes in Mali. The suspension of U.S. funding to PEPFAR has caused disruptions in HIV treatment, testing, and prevention services. This has led to clinic closures and health workers being put on leave, which poses a significant risk to the continuity of HIV services in Mali.

At the 38th Ordinary Session of the African Union Assembly, UNAIDS congratulated H.E. Mahmoud Ali Youssouf on his election as the new Chairperson of the African Union Commission, along with the newly elected Commissioners. UNAIDS looks forward to strengthening the long lasting and fruitful cooperation with the African Union to end AIDS as a public health threat by 2030. 

At the event UNAIDS welcomed the historic adoption of the African Union Convention on Ending Violence Against Women and Girls and the endorsement of the African Union Roadmap on Sustaining AIDS, Strengthening Health Systems and Ensuring Health Security for Africa's Development. These two key policy documents represent a collective commitment to address pressing health and human rights challenges faced by women and girls and vulnerable populations across the continent.  

The African Union Convention on Ending Violence Against Women and Girls is a significant step forward in the response to gender-based violence. It underscores the urgent need for comprehensive strategies to eliminate violence against women and girls and recognizes the systemic inequalities that perpetuate such violence. UNAIDS stands ready to support African Member States in the implementation of this Convention and to ensure that health systems are equipped to provide essential services to survivors of violence.  

“This Convention, Africa’s first dedicated legal instrument to combat all forms of violence, is a strong step toward justice, equality, and protection for every woman and girl on the continent,” said Winnie Byanyima, Executive Director of UNAIDS. 

Similarly, the African Union Roadmap marks a transformative vision for health in Africa, aiming to end HIV as a public health threat by 2030 and to effectively control tuberculosis, malaria, and other communicable diseases. The roadmap is critical to strengthening health systems and achieving universal health coverage, especially for the most marginalized populations. It emphasizes the importance of community empowerment, innovative financing, and global solidarity in addressing current and future health challenges. 

"The adoption of the African Union Roadmap is a great milestone for Africa’s health,” said Winnie Byanyima, UNAIDS Executive Director. “With a bold and ambitious vision to tackle the HIV epidemic and other diseases, this roadmap reflects Africa’s commitment to end AIDS." 

UNAIDS is committed to using the African Union Roadmap as a platform for advocacy at the country and regional levels to ensure that HIV remains a priority on political agendas. This will require a holistic approach that integrates health services, human rights, and gender equality. 

The adoption of these frameworks not only sets a bold agenda for health and human rights but also reaffirms the commitment of African Union Member States to the principles of Agenda 2063 and the Sustainable Development Goals. Together, we can build resilient health systems that uphold the dignity, rights, and health of all people, especially women and girls in Africa. 

UNAIDS calls on all stakeholders, governments, civil society, and international partners—to unite in implementing these critical agreements for a future free from violence and free from HIV, where women and girls can prosper. 

Adrian Lindayag, a Philippines actor, learned he was living with HIV in 2017. But even before then, he’d felt the weight of the disease.

“I’ve lost friends to AIDS, and that is because of the shame and stigma surrounding the virus… the lack of education because they were afraid to get tested. Or, if they did get tested, they just gave up on their dreams, gave up on their lives.”

At first, he only discussed his diagnosis with his family and medical team. But last year he made the decision to go public, becoming a LoveYourself U=U Ambassador.

U=U is short for Undetectable = Untransmittable. It means that when a person living with HIV, adheres to effective antiretroviral treatment, the virus in their blood reduces to a level that is undectable, bringing the chance of passing the virus on to zero.

“I honestly didn't know about the concept of U=U before learning about my HIV status. It was my doctor who told me about it, and it changed my life radically. It gave me hope that I'll be able to still live a normal and healthy life,” Mr. Lindayag explained.

Dr. Jakkrapatara Fair Boonruang is a research physician at the Institute of HIV Research and Innovation (IHRI) in Bangkok, Thailand. He reflects that U=U has transformed the way he counsels newly diagnosed patients.

“U=U changed my clients’ lives,” he said. “Before, providers would advise them that antiretroviral treatment will keep them alive and healthy. But there was no sense of returning to who they were before the infections. U=U actually changes that. It means they can fully enjoy sexual intimacy, and mothers can deliver their babies without the fear of transmitting the virus. It has been a mantle of hope and empowerment.”

In 2014, Thai researchers joined peers in Australia and Brazil for the Opposites Attract Study. That research tracked couples in which one person was HIV-negative and the other was living with HIV but had achieved an undetectable viral load through successful treatment.  It confirmed that after two years of unprotected sex, there were no cases of HIV transmission between more than 300 couples. 

Although the U=U concept has been established as scientific fact for over a decade, the word has not gotten out to the wider world. Even some people living with HIV weren’t informed during counselling. Bella Aubree, an Indonesian activist, is one of them. When she learned her HIV status at age 16, she wondered whether she would die soon. She learned about U=U online and the message gave her hope.

“At the time I felt bored with taking ARVs (antiretroviral therapy) every day. But my motivation came from knowing at some point I will be undetectable, which means untransmittable,” she explained.

For Shan Ali, a Dostana Society peer counsellor from Pakistan, while the U=U concept has transformed his health and outlook, the knowledge hasn’t shifted attitudes among his family members.

“In Pakistan right now there are only two sets of people who know about U=U. One is the service providers and the other is people living with HIV. The general public has no idea,” Mr Ali explained. “I have tried bringing my family in for counseling, but they still discriminate towards me. They even make me eat with separate utensils. I feel very isolated and stigmatized. But in my work with community, I feel a sense of purpose.”

Karun Lama, a communications specialist for the Seven Alliance, is HIV-negative but lost both her parents to AIDS. For her, U=U holds the promise of a regular life and family with her boyfriend who is living with HIV.

“In India, where family and relatives' consent is very important, it was very difficult for us at first to make them understand because my partner's family and relatives were scared and concerned for me. They thought that my partner is putting my life at risk and he should get married to a person living with HIV only. But we've sensitized them about U=U and they have begun to understand that we can also live a life together happily and he won't transmit HIV if his viral load is undetectable,” Ms Lama said.

Eamonn Murphy, Regional Director of UNAIDS Asia Pacific and Eastern Europe Central Asia, saluted the courage of these and other community leaders working to raise awareness about the power of the U=U concept.

“Treatment saves lives. But it can also prevent new infections and transform the way we think about people living with HIV and how they see themselves,” said Mr Murphy. “This Zero Discrimination Day, we recognize the critical role of communities in spreading awareness, supporting adherence and challenging stigma and discrimination. We must ensure this essential work is facilitated and financed.”

With support from communities, researchers and UNAIDS Goodwill Ambassador for Asia and the Pacific, Miss Universe 2015, Pia Alonzo Wurtzbach, UNAIDS is leveraging the U=U message to help end HIV stigma and discrimination. On Zero Discrimination Day (1 March). UNAIDS welcomes everyone to join by sharing these messages and joining the U=U song and dance challenge on social media. #UequalsUDance #EndHIVstigma

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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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.