A woman living with HIV shows up to her community clinic for antenatal care. The nurses ask why she got pregnant. 

A man living with HIV goes to his dental appointment. He arrives first, but the staff treat him last. 

A young transgender woman learns she is HIV positive. She was already scared about how she would be treated. Now she’s doubly terrified. 

A man living with HIV is hopeful when he applies to a new job. He’s dismayed when they demand an HIV test.

The Thailand Stigma Index 2.0 study was launched in early March to commemorate Zero Discrimination Day. It shows that despite a strong national HIV response, challenges continue to simmer below the surface. 

Sixteen percent of participants reported discrimination in healthcare settings in the past year. Among women, almost one in ten experienced prejudice while accessing health services, including coercion about contraception. Internalized stigma was common, with 39% of participants feeling ashamed of their HIV status. Self-stigma was especially high among key populations and younger people. And 3% of participants reported that they experienced a human rights violation in the past 12 months. 

When compared to the 2009-2010 Stigma Index there has been progress. In that study 20% of participants were denied health services and the same proportion reported discriminatory reactions from health service providers after learning their HIV status. Shockingly, in the 2009-2010 report almost half of respondents (47%) said they experienced violations linked to their HIV status in the last year. 

“For each individual living with HIV who has experienced stigma or discrimination the effects can be long-lasting. Therefore, even the findings that have been experienced by only a few individuals in the new study are of concern,” said UNAIDS Country Director for Thailand, Patchara Benjarattanaporn. “We are serious about the goal of zero discrimination.” 

This was a Stigma Index with a difference. The Task Force ensured all groups were represented including women, young people and key populations. People living with HIV in all the provincial networks were trained to conduct the study. And they added qualitative and gender components to the methodology to deepen the analysis. The study reflects the experiences of more than 2500 respondents across 24 provinces between 2022 and 2023. 

“Addressing stigma and discrimination is key to ending AIDS. At the national and local level there are still issues to be dealt with. Stigma and discrimination lead to people not getting tested, not accessing care and not adhering to treatment,” said Nipakorn Nanta, Chairman of the Thai Women Living with HIV Foundation (TWLHF).

TWLHF led the research exercise, working to ensure the experiences of women were well reflected for the first time. Ms Nanta noted that although Thailand has eliminated mother to child HIV transmission, the emphasis seems entirely on preventing infections in babies. Sometimes women’s agency and confidentiality are sacrificed. 

Mr Sattayu Sithirakarn, Director of the CareMat Foundation noted that young men who have sex with men often have a difficult time handling the double stigma of HIV and their sexual orientation.

“The report lays out the issues around internalized stigma very clearly. It is important because if people living with HIV do not have hope, they don’t have the motivation to take care of themselves and have a future,” he said. 

The Task Force youth focal point, Pete Thitiwatt Sirasejtakorn, shared that this was something he had to overcome. 

“When I was diagnosed, my life went in a very bad direction,” he said. “At age 25 I left my two businesses. I thought I would die soon. It was unacceptable to me to die from an AIDS-related illness. I thought it was better to kill myself before I got sick. My boyfriend got tested and he was HIV-negative, but he still stayed with me. He empowered me and encouraged me to keep going. But I broke up with him because I had very high internal stigma. I felt dirty. I felt dangerous.” 

The game-changer for Mr Sirasejtakorn was knowing about U=U—undetectable equals untransmittable. This refers to the scientific fact that people living with HIV who lower the virus in their blood to an undetectable level through consistent treatment have zero chance of infecting someone they have sex with. 

This is one of the main strategies the report recommends for addressing both self- and social stigma. The report also calls for improved public communication, family and social engagement, enhanced healthcare workforce training, and a focus on human rights in laws and policies for key populations. 

Some of this work is already underway. In December 2024, Thailand hosted a mission to review ten years of efforts to reduce HIV-related stigma and discrimination in healthcare settings. The review found that although 400 hospitals have participated in stigma reduction training, policies must be properly implemented at the provincial and district levels. 

Dr Phongthorn Chanleuan, Chairman of the National Stigma Index Task Force also stressed the importance of community leadership. 

“We need strong networks of not only people living with HIV but also youth, women, and LGBT people working together to address stigma and discrimination as a cross-cutting issue,” he said. 

The significant health progress made over the past decade in Central, Eastern, Southern and West Africa—where many countries were on track to ending their AIDS epidemics—is now at risk of being reversed due to inadequate financing. One of the major causes of the funding shortfall is rising debts.

In 2020, as the Covid-19 pandemic halted economies and overwhelmed emergency rooms, many African countries borrowed from creditors to provide emergency services to their citizens. But four years later, the terms of those loans are forcing governments to make debt payments at the expense of health and other social services. Nearly two thirds of people living with HIV reside in countries that have not received significant debt relief post-Covid.

In West and Central Africa, debt to GDP ratios increased by 9 percent between 2018 and 2023. Countries such as Burkina Faso, Burundi, the Republic of the Congo, Côte d’Ivoire, Ghana, Liberia, Senegal and Sierra Leone have seen significant rises in their debt burden, now reaching at least 15% of GDP. 

In East and Southern Africa, the situation is even more dire: in Angola, Kenya, Malawi, Rwanda, Uganda and Zambia, governments spend over 50 percent of their tax revenues on debt servicing. Many of these debts are from external private creditors seeking unreasonable profits – for example, one creditor in Zambia would make a 110 percent profit if the country paid back its debts. (As context, even highly profitable companies like Apple do not have profits that surpass 48 percent.) 

Despite Zambia successfully reaching a debt restructuring deal with official creditors, effectively getting some debt relief last year, it’s still slated to pay two-thirds of its budget towards debts over the next two years largely due to not yet reaching a deal with private-creditors. On the ground, crises are already proliferating; hospitals lack essential medicines and equipment. Labor unions and health activists have rallied across Lusaka demanding debt cancellation. 

“Countries are facing life and death decisions,” said Charles Birungi, who leads UNAIDS’ work on macroeconomic and fiscal policy. “Do I pay for hospitals, medicines and education – or do I pay my debt? What if paying my debt means that my hospitals go without drugs?”

Two recent UNAIDS reports focusing on Eastern and Southern Africa and on Western and Central Africa outline that the future of funding for the HIV response in many African countries, as well as broader health and social welfare, rests on innovative measures to ensure governments can invest their own tax revenue for citizens. 

“Progress is being made in the fight against HIV in both regions,” said one of the report authors and development finance specialist Gail Hurley. “Of course there were setbacks, including those related to Covid-19, but external funding and strong political commitment has provided a solid foundation to build on. Countries now need partial or even whole scale debt relief in order to achieve global health goals.”

Debt relief is especially critical for countries that want to move away from relying on international donors to finance their HIV responses. In East and Southern Africa, for instance, most HIV financing comes from two donors: the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to fight AIDS, Tuberculosis and Malaria (which is also heavily supported by the US government). But without debt relief, countries cannot invest tax revenue in health systems.

Based on extensive consultation with economists and policy experts, UNAIDS has called for lenders and international institutions to re-negotiate debt payments to comprise at least less than 15 percent of respective countries’ annual budgets. Such a policy for the heavily indebted countries of Angola, Burundi, Ethiopia, Kenya, Madagascar, Malawi, Mozambique, South Sudan, United Republic of Tanzania, Uganda, Zambia and Zimbabwe would free up $41 billion a year for health, education and social welfare. The strategy has a precedent: the Heavily Indebted Poor Countries (HIPC) Initiative, launched in 1996 by the IMF and World Bank, aimed to ensure that states did not struggle under an unmanageable debt burden. It took a similar approach and relieved 37 countries of more than $100 billion in debt.

UNAIDS also recommends that governments increase tax revenue through measures like raising the income tax of the ultra-wealthy, wealth taxes, reducing tax exemptions and clamping down on tax-dodging. Amnesty International estimates that Zambia, for example, loses over USD 4.5 billion annually through tax evasion and tax avoidance. 

Another option not included in the reports but recommended by UNAIDS’s partner WHO is a ‘health tax’ on products that lead to or exacerbate health issues, including sugary beverages, tobacco and alcohol. In 2023, WHO called on all countries to increase taxes on alcohol and sugary drinks (and has previously suggested taxes on tobacco). These monies could then be re-invested in health systems. 

But UNAIDS cautions that even raising tax revenue will not be enough to address funding gaps unless it goes hand in hand with debt reduction. Without swift changes to enable African governments to invest in health, Birungi fears what the future could hold. “What happens if we wake up tomorrow and the donors are gone?” he asked. “Will we go back to the 80s and 90s when people were dying in massive numbers?”

In 2025, for the first time, the G20 is chaired by an African nation: South Africa. President Cyril Ramaphosa has set debt as one of the priorities for action of the G20 Ministers of Finance. Former South African Finance Minister Trevor Manuel has been appointed to chair the newly established G20 Africa Expert Panel, an international commission of experts to advance proposals. UNAIDS will join efforts with other UN agencies and experts such as Nobel Prize laureate Joseph Stiglitz, co-chair of UNAIDS sponsored “Global Council on Inequality, AIDS and Pandemics”, to advocate for fair financing and debt resolution mechanisms to be advanced in the G20 this year.

Government and CSO Operations

• Government institutions continue to function, but two community support centers run by civil society organization partners have closed.
• Human resources affected include 32 community health workers, 15 doctors, 15 technical staff and management, and 16 CSO staff. Neither government nor partners are covering their salaries. According to the most conservative estimations, about 1700 key populations have been lost from the social support program, over 2000 clients were not tested for HIV, and about 100 new cases were not detected. Due to the closure, dozens of clients didn’t receive specialized medical services provided in those community centers. 

Service Provision

• ART Services: All facilities/service points are operating at full capacity with minimal disruption in ARV supplies, HIV test kits, viral load test kits, other lab test kits, and condoms. Condom stocks are sufficient for the next 12 months.
• Prevention of vertical transmission and Pediatric Services: All facilities are functioning at full capacity.
• HIV Prevention: There are disruptions in the distribution of condoms and other prevention commodities, suspension or reduction of HIV prevention education and awareness campaigns, and delays or disruptions in community-based HIV prevention outreach programs.
• Data Collection: Continues at all facilities, including data quality control and collation.

Immediate Risks or Disruptions

Human Rights and Key Populations

• PrEP Services: Disruption in access for sex workers, men who have sex with men (MSM) and gay men, people who use drugs – due to the disruptions in outreach work.
• HIV Prevention Services: Reduced capacity for sex workers, MSM and gay men, people who use drugs – due to the disruptions in outreach work by CSOs.
• HIV Testing Services: No discontinuation for key populations, but reduced availability of counseling and testing - due to the disruptions in outreach work by CSOs.
• ART Services: Disruption in access for sex workers, MSM and gay men, people who use drugs - due to the disruptions in outreach work by CSOs.
• Stigma and Discrimination: All PEPFAR-funded work has stopped, affecting key populations, adolescent girls and young women, and people living with HIV.
• Adolescent girls and young women (AGYW) HIV Prevention due to the disruptions in outreach work by CSOs.
• Outreach Programs: Discontinuation of AGYW-specific outreach programs.
• Education and Awareness: Reduced availability.
• Mental Health Support: Inability to provide support in HIV prevention programs.
• Counseling and Social Support: Reduction in availability.

Civil Society Impact

• Community-led organizations (CLOs): Reduction/suspension of services, loss of staff, or funding cuts.
• Community-Led Monitoring: Lack of funds to conduct CLM.
• Policy Discussions: Reduced participation due to funding constraints.
• Advocacy: Limited ability to advocate for key issues.
• Policy Design and Societal Enablers: Reduced ability to collect and report data, loss of funding for monitoring activities, increased difficulty in accessing government or donor support.

UN Response

• Consultations: UNAIDS conducted informal consultations with government and civil society partners. The situation is being monitored; regular updates are collected from partners. While testing, ART, and prevention services are available, outreach work is suspended, making most of the hard-to-reach groups inaccessible.

Current Funding and Impact

There has been no direct US Government funding for HIV-related programs in Uzbekistan. However, other crucial initiatives such as civic space development, human rights, education, and advocacy efforts relied on US funding. With the closure of these programs, organizations working on HIV-related legal reforms, anti-discrimination efforts, and rights-based healthcare access will face increased challenges in advocating for policy change

Alternative Funding Sources

UN agencies in Uzbekistan have started mobilizing alternative funding sources to ensure the continuation of key initiatives previously supported by the US Government funds. Negotiations are ongoing with embassies, the European Union (EU), and the Government of Uzbekistan to secure financial support.

Immediate Risks and Disruptions

The cessation of US funding has led to the stoppage of programs focused on stigma and discrimination, affecting key populations and people living with HIV. Communities have collected data on human rights issues, including stigma and discrimination. Additionally, the funding cuts have impacted the ability of civil society organizations to  advocate for HIV-related issues. 

Civil society impact, resilience and response 

The National Association of NGOs in Uzbekistan (NaNNO UZ) has stepped forward to support organizations that have been affected by the funding cuts. Through NaNNO UZ, the Government of Uzbekistan is exploring ways to compensate for the financial gaps created by these funding shifts. One of the key measures being considered is increasing allocations to the national grant-making mechanism and expand government contracting. 

Politically Relevant Updates

The Government of Uzbekistan is actively working to mobilize additional financial resources to support ongoing development projects and mitigate the impact of recent funding cuts. Efforts are focused on securing new funding streams to sustain progress in various sectors, including economic development, social welfare, human rights, and civic engagement. 

Current Situation

Prevention of HIV and other sexually transmitted infections among key populations in Latin America and the Caribbean is heavily reliant on US funding. Recent decisions by the United States Government indicate that efforts to support prevention among key populations will not receive funding resources. This has led to significant disruptions in and challenges for HIV services in the region.

Immediate risks and disruptions

1. Humanitarian assistance: Transnational projects aimed at migrant populations have been suspended. Despite a waiver announced on February 1 allowing continued provision of some HIV services, resumption of humanitarian services has been hindered due to the absence of PEPFAR and USAID staff.
2. Service delivery: The suspension of US funding has affected the delivery of various HIV services, including those provided by civil society organizations, government entities, and United Nations agencies. NGOs are particularly vulnerable to the US funding cuts.
3. Impact on key populations: The US funding cuts have led to stress, depression, anxiety, and uncertainty among people living with HIV and key populations. There is a significant concern about the risk of being left without antiretroviral treatment, access to PrEP, and other essential services.
4. Funds allocated for non-contingency humanitarian assistance were primarily focused on the humanitarian crises in Haiti and Venezuela, Colombia's post-conflict challenges, and the Northern Triangle crisis (Guatemala, Honduras, El Salvador). Although these funds were not intended for a direct response to HIV, their absence deepens the structural vulnerability of migrant and other vulnerable populations—including people affected by conflict in Colombia—and puts them at risk of exploitation, human trafficking and survival sex, all of which increase vulnerability to HIV. 

Politically relevant updates

1. Emergence of extreme positions: In many countries in the region, outbursts of homophobia, transphobia and discrimination against people living with HIV have intensified. Many parliamentarians in the region have taken advantage of the situation to gain political leverage by attacking key populations.
2. Media Representation: Actions targeting societal enablers are being shown in the media as examples of waste of money and corruption.

Civil society impact and resilience:

• Survey Findings: A survey conducted by the civil society organization "Corresponsales Clave" (Key Correspondents) with 49 organizations from various countries in the region revealed that US funding cuts have led to significant disruption of services for key populations and emotional distress among people living with HIV and key populations.
• Community Response: Despite the challenges, civil society organizations and community leaders are working to ensure the sustainability of the HIV response by optimizing health services.
• UN Response: The offices of the UN Resident Coordinators are intensifying the search for non-traditional donors and making bilateral approaches with embassies to identify funding opportunities. UNAIDS and PAHO are working together to deliver technical assistance to optimize health services in three areas: integration of HIV services in primary health care, optimization of service delivery models, and facilitation of community response to HIV.
• UNAIDS is carrying out joint analyses with the Global Fund to align the resources of national grants destined to the strengthening and resilience of health e-services with the principles mentioned above. 

Additional Insights

• Regional Progress: The Caribbean has made substantial progress against HIV since 2010, with a 22% decrease in new HIV infections and a 57% decrease in AIDS-related deaths. Latin America is the most autonomous region of the Global South in terms of national funding for HIV treatment, but there are still major gaps in prevention and social enablers. Therefore, continued funding is a necessary strategy for a smooth transition towards full sustainability of the HIV response in the region.
• Funding Challenges: The critical impact of the US funding cuts has exacerbated existing challenges in the HIV response across Latin America and the Caribbean.

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.

General Overview

• Funding: Rwanda's HIV program is predominantly donor-funded. In fiscal year 2023-2024, PEPFAR contributed 37.7% of the total HIV expenditure and the Global Fund contributed 50.8%. There is minimal involvement of domestic private contributors in the HIV response.
• Continuity of Services: The Ministry of Health is the principal recipient of PEPFAR funding. During early days of the Stop Work Order by the US Government, the Government of Rwanda through the Ministry of Health ensured the continuity of essential services and effective implementation of the waivers. Furthermore, the Ministry of Health has committed to mobilizing domestic resources to ensure the continuity of HIV services. All facilities/service points providing antiretroviral therapy (ART) are operating at full capacity. Peadiatric HIV treatment services and data collection activities continue without disruption.
• Supplies and Distribution: Stocks of antiretroviral (ARV) supplies, viral load (VL) test kits, and other lab test kits are available with minimal distribution disruptions. No stockouts are expected in the next 3-6 months. The country has a sufficient stock of condoms for the next 12 months.

Immediate Risks or Disruptions

• Community-Led Services: Some community-led or peer-led facilities and services have been suspended. For example, a local NGO has closed its clinic which provided free and friendly key population services, including sexually transmitted infections testing and treatment.

Though some previously USAID supported DREAMS projects targeting adolescent girls and young women and orphan and vulnerable children (3 out of 5) have received notification to resume work, activities have not fully started due to operational challenges. 

• Community-Led Monitoring (CLM): Rwanda received PEPFAR funding for a CLM project to assess the 4As for quality delivery of services including availability, accessibility, acceptability and affordability of services by people living with HIV and key population. That work has now stopped, and communities have suspended data collection on these issues, including stigma and discrimination at service delivery points. 

Politically Relevant Updates

• Government and Partners’ Actions: The government, in collaboration with partners, is conducting a rapid assessment of the impact of shifts in US Government funding, with technical support from UNAIDS.  Civil society organizations (CSOs) are encouraged to document facility level as well as community supported services delivery gaps and coverage for use in advocacy and resource mobilization.
• Press Conference: During a press conference, the Ministry of Health reaffirmed its commitment to mobilize domestic resources to ensure service continuity.
• Civil Society Organizations (CLOs): CLOs involved in service delivery at community level, particularly prevention and support for ensuring continuity have faced significant challenges, including increased demand with fewer resources, anxiety about continuity and future support, loss of staff, and funding cuts.
• Resilience and Response: Despite these challenges, CLOs continue to play a crucial role in the HIV response. Their resilience and adaptability in the face of funding cuts and service disruptions highlight the importance of community-led initiatives in maintaining essential health services.

UN response 

• UNAIDS is supporting the government to assess the overall cost, priority and impact of the stopped interventions to inform actions. UNAIDS is reaching out separately to community networks and NGOs to collect more information about the impact of the US Government cuts.