A confusing and evolving situation in Côte d'Ivoire 

The 90-day pause in US foreign assistance has caused a major shock to the national response to AIDS in Côte d’Ivoire. While the US Government released an emergency humanitarian waiver allowing some lifesaving HIV services to move forward during the overall pause, a lack of clarity about what is allowed has led to interruptions in services, even for HIV treatment which is allowed under the waiver.  85% of PLHIV on ART in Cote d’Ivoire are directly supported by the US President’s Emergency Plan for AIDS Relief (PEPAR) programme.  

The US funding pause is creating anxiety and confusion among beneficiaries, service providers and  programme managers. Partners in the AIDS response are reporting a lack of clarity about how to operationalize the waiver —restarting treatment-related activities in line with the waiver is proving much more difficult than stopping all activities. 

For example, government-run clinics and health centres are experiencing staff shortages as some health personnel have had to stop work to comply with the original US President’s Executive Order as PEPFAR tops up their government salaries.   

To assess the situation, UNAIDS has been consulting regularly with national AIDS programme managers, development partners and with civil society and community-led organizations to get a clearer picture of the situation on the ground.   

Both civil society and the national AIDS programme (MoH) have developed plans for the way forward. 

Findings    

The immediate and effective application of the stop-order is creating an alarming situation in terms of the provision and access to services.   

There is a significant communication lag regarding the waiver. Civil society organizations are particularly grappling with how, exactly, to implement the terms of the waiver given considerable budget cuts and given the waiver does not allow for certain complementary support services. This is particularly the case for activities for which US funding complements other sources of funding such as the Global Fund or government resources.  

Main impacts   

On health services:   

•  Immediate large-scale interruption of HIV-related services, including medical examinations and laboratory services   
•  There is a significant risk to adherence to ARV treatment   
• There is a threat to the continued implementation of the Paediatric Action Plan.  
• Tuberculosis programmes have been impacted through the cessation of Stop TB Partnership funding.   

• Critical national strategic planning processes led by the MoH have been interrupted:  2025 spectrum estimates, CIPHIA HIV survey, HIV sustainability roadmap 

On civil society organizations   

• There is a considerable real impact on operational and programmatic activities, including human resources.   

• Widespread temporary and permanent layoffs are reported and associated legal risks related to employee contracts.   

•  An inability to cover operating costs.  
• Co-funded activities and programmes are stopped because critical components are financed by PEPFAR 
• A threat to business continuity and long-term loss of capacity and expertise 

There is a disproportionate impact on vulnerable populations who not only no longer benefit from funding for their prevention, treatment and care activities but may also see their funding from PEPFAR threatened in the long term.   

Solutions and Strategic Recommendations   

Immediate actions:   

• Continued dialogue and joint assessment with the government, civil society and development partners.  
• Strengthen and integrate short and medium-term contingency planning.   
•  Accurately document the interruption of services.  
•  Improve sharing of information with stakeholders and reassure patients and affected populations.   

Resilience strategies :   

• Maintain and accelerate the medium- and long-term sustainability process in this context and ensure that the current situation is considered in this work.   

• Explore new partnerships and mobilise alternative resources    

(private sector, other donors).   

• Optimise the efficiency of programmes.  
• Monitor the impact of the pause on access to services for the most vulnerable, on community structures and their ability to deliver community-led responses.   

Critical points   

• High risk to the continuity of health services.  
• High risk of non-renewal of activities relating to vulnerable populations.  
• Need for a collaborative approach between CSOs, the State and international partners.   

UNAIDS is holding follow up consultations with government, civil society organizations and international partners to analyse needs during the pause and to coordinate efforts to ensure the continuity of HIV services. 

A confusing and evolving situation in Côte d'Ivoire 

The 90-day pause in US foreign assistance has caused a major shock to the national response to AIDS in Côte d’Ivoire. While the US Government released an emergency humanitarian waiver allowing some lifesaving HIV services to move forward during the overall pause, a lack of clarity about what is allowed has led to interruptions in services, even for HIV treatment which is allowed under the waiver.  85% of PLHIV on ART in Cote d’Ivoire are directly supported by the US President’s Emergency Plan for AIDS Relief (PEPAR) programme.  

The US funding pause is creating anxiety and confusion among beneficiaries, service providers and  programme managers. Partners in the AIDS response are reporting a lack of clarity about how to operationalize the waiver —restarting treatment-related activities in line with the waiver is proving much more difficult than stopping all activities. 

For example, government-run clinics and health centres are experiencing staff shortages as some health personnel have had to stop work to comply with the original US President’s Executive Order as PEPFAR tops up their government salaries.   

To assess the situation, UNAIDS has been consulting regularly with national AIDS programme managers, development partners and with civil society and community-led organizations to get a clearer picture of the situation on the ground.   

Both civil society and the national AIDS programme (MoH) have developed plans for the way forward. 

Findings    

The immediate and effective application of the stop-order is creating an alarming situation in terms of the provision and access to services.   

There is a significant communication lag regarding the waiver. Civil society organizations are particularly grappling with how, exactly, to implement the terms of the waiver given considerable budget cuts and given the waiver does not allow for certain complementary support services. This is particularly the case for activities for which US funding complements other sources of funding such as the Global Fund or government resources.  

Main impacts   

On health services:   

•  Immediate large-scale interruption of HIV-related services, including medical examinations and laboratory services   
•  There is a significant risk to adherence to ARV treatment   
• There is a threat to the continued implementation of the Paediatric Action Plan.  
• Tuberculosis programmes have been impacted through the cessation of Stop TB Partnership funding.   

• Critical national strategic planning processes led by the MoH have been interrupted:  2025 spectrum estimates, CIPHIA HIV survey, HIV sustainability roadmap 

On civil society organizations   

• There is a considerable real impact on operational and programmatic activities, including human resources.   

• Widespread temporary and permanent layoffs are reported and associated legal risks related to employee contracts.   

•  An inability to cover operating costs.  
• Co-funded activities and programmes are stopped because critical components are financed by PEPFAR 
• A threat to business continuity and long-term loss of capacity and expertise 

There is a disproportionate impact on vulnerable populations who not only no longer benefit from funding for their prevention, treatment and care activities but may also see their funding from PEPFAR threatened in the long term.   

Solutions and Strategic Recommendations   

Immediate actions:   

• Continued dialogue and joint assessment with the government, civil society and development partners.  
• Strengthen and integrate short and medium-term contingency planning.   
•  Accurately document the interruption of services.  
•  Improve sharing of information with stakeholders and reassure patients and affected populations.   

Resilience strategies :   

• Maintain and accelerate the medium- and long-term sustainability process in this context and ensure that the current situation is considered in this work.   

• Explore new partnerships and mobilise alternative resources    

(private sector, other donors).   

• Optimise the efficiency of programmes.  
• Monitor the impact of the pause on access to services for the most vulnerable, on community structures and their ability to deliver community-led responses.   

Critical points   

• High risk to the continuity of health services.  
• High risk of non-renewal of activities relating to vulnerable populations.  
• Need for a collaborative approach between CSOs, the State and international partners.   

UNAIDS is holding follow up consultations with government, civil society organizations and international partners to analyse needs during the pause and to coordinate efforts to ensure the continuity of HIV services. 

The HIV programmes in the Dominican Republic are currently facing several challenges and disruptions, primarily due to shifts in US funding and political dynamics. Here are the key points:

PEPFAR-Funded Programmes:

PEPFAR-funded HIV programmes, which were stopped, are now being resumed. For instance, while services for people living with HIV have already been opened, including services offered by civil society, community support, and support for human resources at the government level among others, the opening process has been slow. And while PEPFAR-funded HIV care programmes are resuming, other activities such as PrEP for key populations and Community-Led Monitoring remain on hold.

Furthermore, the new Global Fund grant started in January 2025 has not yet been implemented at the site level.

Service Disruptions:

The PEPFAR program in the country is mainly focusing on the Haitian migrant population and therefore, the suspension of funding has raised concerns regarding Haitian migrants not having access to their treatment programmes.

The absence of USAID-funded staff and the suspension of transportation services that helped patients reach healthcare centers may impact service accessibility.

There have been debates in the media about the need to maintain internationally funded HIV programs, particularly those targeting Haitian immigrants.

The pause of U.S. foreign assistance on Ethiopia will affect many areas of development, however its impact on Ethiopia’s national HIV response is particularly severe.

Ethiopia is on track to reach the global 95-95-95 targets: with 90% of people in Ethiopia living with HIV being aware of their HIV status; 94% of those diagnosed with HIV receiving antiretroviral (ARV) therapy; and 96% of people on ARV therapy achieving viral suppression.  ARV treatment is currently provided to 503,000 people via 1,400 health facilities across the country.   However, with ongoing challenges to the country health system and socio-economic development, Ethiopia remains reliant on external donors for its HIV response. 

SERVICE DISRUPTION: Pause of U.S. assistance to community programs and drop in centres serving women, young girls and priority populations at higher risk of HIV infection means tens of thousands of individuals will no longer be able to access critical services such as HIV testing, antiretroviral treatment, pre-exposure prophylaxis (PrEP) for HIV prevention, and screenings for tuberculosis, sexually transmitted infections and support to address gender-based violence.  The closure of many drop -in centres and the termination of outreach workers’ and peer educators’ contracts will effectively shut off support to vulnerable groups.

Table: Breakdown of Service Disruption in three regions in Ethiopia: Addis Ababa; Oromia and Gambella

SUPPLY CHAIN DISRUPTIONS: The funding freeze has caused critical delays in the supply of essential HIV services, including testing kits and other resources. Notably, PEPFAR is responsible for 100% of the procurement of viral load and Early Infant Diagnosis (EID) reagents. The interruption in funding is limiting the availability of these crucial supplies, undermining the program’s ability to conduct timely viral load and EID testing, which are essential for effective patient monitoring and treatment.

REDUCED CAPACITY FOR HEALTHCARE SUPPORT: The pause threatens to stall efforts to build local healthcare capacity. It impacts the training and support of health workers, slowing progress in Ethiopia’s fight against HIV. This reduction in capacity limits the ability of healthcare professionals to respond effectively to the growing HIV epidemic. The disruption of ICAP’s capacity building, M&E, and clinical mentoring threatens care for advanced HIV patients, putting Ethiopia’s progress at risk. The freeze is also likely to scale back key prevention programs, including outreach, education, and services for key populations, worsening the epidemic

HEALTH INFORMATION SYSTEM DISRUPTION: Ethiopia's Health Information System is severely affected by the stop work order. The termination of 10,000 data clerks, who are essential for entering ART data into the health information management system, is compromising data management, particularly in tracking lost-to-follow-up cases. This disrupts key national activities, such as HIV estimations and studies of key populations. Furthermore, the cessation of the HIV surveys and surveillances, and HIV Estimation Technical Working Group (TWG) which includes CDC, USAID, and PEPFAR undermines the accuracy of HIV data and threatens the continuity of critical HIV data management systems.

HUMAN RESOURCES IMPACT:  Ministry of Health shared that 5,000 public health workers’ contracts funded by U.S. assistance from all regions in Ethiopia have been terminated.  These health workers are supporting Ethiopia’s HIV response – improving regional capacity to accelerate progress towards Ending AIDS.   While the government of Ethiopia will take over the gap, the sudden loss of programmatic experience and the transition period will be rough.

ACTIONS TO ADDRESS THE SITUATION: On 4 February 2025, The Ministry of Health of Ethiopia issued a circular to all regional health bureau to assure regional health offices that the government will step in to manage the work that was performed by the US-funded personnel in order to ensure programme continuity. 

UNAIDS Ethiopia together with WHO will be convening a situation assessment briefing on 11 February 2025 with government, CSOs and development partners to identify solutions to address gaps in the HIV, TB, Malaria and health and Community systems responses in Ethiopia.

Ukraine has been reeling from three years of war since 24 February 2022. One out of two Ukrainians have been affected by the conflict and more than 12 million people need humanitarian assistance and protection while another 6 million have still not been able to return to their homes. 

A war-driven economic crisis has severely impacted healthcare funding, putting access to HIV services at risk. With HIV services entirely dependent on external aid and humanitarian support that is becoming increasingly unstable, the uncertainty of the continuity of U.S. funding has further worsened an already dire situation in Ukraine. In January, the new U.S. Administration froze all foreign assistance for a 90-day period. A waiver to allow life-saving services was subsequently issued allowing support for some HIV services.  

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) contributed US$15.6 million to the HIV response in Ukraine during 2023 and 2024. This includes $11 million for antiretroviral therapy and $2 million for various types of rapid test kits, while the rest was used for laboratory expenses. 

UNAIDS and partners estimate that 92,840 Ukrainian people could see their HIV treatment disrupted if U.S. funding was to be entirely cut – that is 78% of all people living with HIV on treatment.  In addition, stocks of life-saving treatment and HIV prevention drugs are low, with people only getting three versus six months of drug supply.  

The threat of a potential financial void left by the U.S. is forcing Ukraine’s health system to search for alternative sources of funding. From Global Fund reprogramming to private sector donations to bulk medicine offers from pharmaceutical companies. Many options are being explored to patch together a lifeline. However, even collectively these efforts may not be enough to fill the PEPFAR gap should the U.S. permanently withdraw its support. 

There are hopeful signs of recovery like HIV testing increased 23% last year compared to 2023 but obtaining comprehensive epidemiological and clinical data remains difficult. 

This inevitably affects the accuracy of overall assessments due to the ongoing conflict, loss of administrative control in certain regions, missing persons, and mass displacement. 

Despite ongoing challenges, Ukraine remains committed to the HIV response, supported by a strong coalition of government, civil society, international organizations, and donors. The UNAIDS Secretariat, Co-sponsors, UN agencies, and member states continue working together to ensure essential services for women, people living with HIV, and key populations, reinforcing the response's sustainability even in the face of adversity. 

Read full Situation Report on Ukraine

The U.S. decision in January to freeze all funding for U.S. foreign assistance, including for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), has had a critical impact on several countries in Latin America and the Caribbean, exacerbating existing challenges in the HIV response. More than 20 countries in the region rely on these funds to deliver HIV treatment, prevention, and care services, including community-led services focused on the most discriminated and marginalized communities.

Following the decision to freeze all U.S. funding for foreign assistance, the U.S. Government issued a waiver allowing some funding to support lifesaving services. However, confusion about which services may be supported and a lack of support for some services means the situation remains critical, posing a serious risk of setbacks in the AIDS response in the region. While some key treatment services and prevention of vertical transmission have been gradually coming back into operation, most countries have been facing disruptions in their HIV treatment programs.

The lack of funding has led to a significant decrease in community-led HIV prevention efforts, a reduction in treatment adherence, counseling, and social support and monitoring activities. Consequently, there are increased risks of new HIV infections, of higher mortality rates, and a deterioration in the quality of care for people living with HIV, directly impacting their capacity to access treatment and to achieve viral suppression – crucial steps towards the global target of eliminating AIDS as a public health challenge by 2030.

In Colombia and Peru, the freeze has severely affected migrants and refugees, who are estimated to have an HIV prevalence two times higher than the general population. Approximately 4,000 migrants and refugees are receiving antiretroviral treatment (ART) in Colombia thanks to the government efforts and cooperation funds, but the withdrawal of such resources is directly impacting this vulnerable group and the country's capacity to include them in the health system. One community-led organization supporting HIV services among migrant and LGBT communities had to end contracts for 40 out of 70 team members, significantly reducing their capacity to provide essential services to reach such populations.

In the Dominican Republic, even though the government guarantees access to antiretroviral treatment, the pause in PEPFAR funding has left thousands without access to essential HIV services. PEPFAR supports around a third of HIV care services, including PrEP services, health human resources, and laboratory networks. The reduction in community assistance has made it difficult for people to access their medications, especially those who live far from care. The quality of services offered by the Comprehensive Care Services (known by the acronym SAI in Spanish) in the Dominican Republic has been highly compromised, with many staff and services entirely dependent on PEPFAR funds.

El Salvador has also been impacted, with PEPFAR projects supporting comprehensive HIV care clinics now suspended. This has caused a slowdown in care, and the opportunity for new diagnoses and early initiations of antiretroviral treatment is likely lost.

In Guatemala, the HIV epidemic is mainly concentrated among key populations such as transgender individuals, gay men and other men who have sex with men, and sex workers. The distribution of PrEP for these groups has been severely disrupted, with many organizations that rely on U.S. Government funding suspending their work. The reduction of personnel, including medical staff as well as outreach workers that were funded through PEPFAR has resulted in people being unable to access HIV prevention and treatment services.

Haiti has seen a significant impact on its HIV response, with PEPFAR covering around 60% of the national response. The stop-to-work order has thrown the response into disarray, causing anxiety for the 127,000 Haitians living with HIV who are on treatment. In the context of the humanitarian crisis and gang violence, more than 1 million people are now internally displaced in Haiti, many of them displaced multiple times– among them women, girls and children. Escalating violence has also led to the closure of 39% of health facilities, including two of the capital’s three major hospitals. Access to healthcare has never been more limited. The quality-of-service delivery of medicines has also been affected, with approximately 5,000 health workers receiving directives to stop working.

In Jamaica, 70% of HIV resources come from external sources – with PEPFAR covering around 50% of services. The pause in funding has raised concerns about the delivery of HIV prevention services for at risk populations delivered via civil society organizations. Civil society groups have reported that their institutional stability and survival are at risk, with many unable to guarantee the continuous employment of their field staff in charge of liaising with the most discriminated and affected populations who need HIV services.

In Panama, the suspension of a study on recent HIV diagnoses and the halt in laboratory sample transportation have further limited essential diagnostic and monitoring services. The country had already been facing significant disruptions, particularly among the indigenous Ngäbe-Buglé population, who are expected to face increased obstacles to accessing HIV services. In 2023, despite representing only 5% of Panama's population, the territory, which is home to approximately 225,000 residents, accounted for 30% of the nation's AIDS-related deaths among individuals aged 29 or younger, as reported by the Panama Ministry of Health.

In Brazil, on the other hand, the Unified Health System (SUS) guarantees uninterrupted universal and free access to health services, including HIV diagnosis, treatment and prevention for all people living in Brazil. The “A hora é agora” project, carried out in five capital cities with PEPFAR resources, worked to provide specific services such as doctors, reception and delivery of antiretroviral drugs and PrEP in addition to public health services, so the national response to HIV was not impacted by the cut in resources.

Latin America is one of the three regions in the world where new HIV infections have increased since 2010, with a rise of 9%, which highlights the urgency of addressing these disruptions. The Caribbean region has made significant progress in reducing new HIV infections and increasing access to treatment. Still, the freeze on PEPFAR funds threatens to reverse these gains and the ongoing process of creating sustainability roadmaps to increase national funding for the HIV response.

UNAIDS continues to work with various  partners to help mitigate the impact and find the best solutions and calls for the continuity of all essential HIV services in the region.

"United States support through PEPFAR has been a cornerstone of the HIV response in our region, including a key driver for strengthening the sustainability and resilience of national responses. The recent humanitarian waiver reflects the commitment of the American people to save lives and maintain momentum to end AIDS by 2030," says Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean. "UNAIDS will continue to convene communities, civil society organizations, governments, and partners to advocate for continued support and critical HIV services supported by PEPFAR.  It is also time for the governments of the region to play a leadership role in guaranteeing the right to health of their most marginalized populations."

In the past two decades, HIV-related deaths have been reduced by more than half, and millions of people have gained access to life-saving treatment. Scientific breakthroughs, strong political commitment, and community leadership have transformed the HIV response. Yet, despite these remarkable achievements, the path to ending AIDS is still full of challenges. 

Today, the HIV response is at a crossroads. Persistent inequalities, financial constraints, and emerging health threats risk derailing progress. The hard-won gains of recent decades must not only be safeguarded but accelerated. This is why UNAIDS is launching the development of the new Global AIDS Strategy 2026-2031, an ambitious, inclusive, and action-driven plan that will guide the global HIV response for the next five years and help end AIDS as a public health threat. 

"To end AIDS as a public health threat by 2030, we must act with urgency, ambition, and innovation," said Winnie Byanyima, Executive Director of UNAIDS. "This strategy is an opportunity to rethink and strengthen the HIV response by listening to communities, addressing inequalities, applying the science, ensuring equal access to new innovations and leaving no one behind." 

UNAIDS has dedicated 2024 to laying the foundation for this new strategy. A mid-term review of the current Global AIDS Strategy has highlighted the urgent need to accelerate HIV prevention, address societal barriers, and sustain progress in treatment. UNAIDS convened a Global Task Team, composed of experts from governments, civil society, multilateral organizations, and public health, to recommend bold, measurable, and evidence-informed targets for 2030.  

The new strategy will be developed through an open and participatory process that brings together all HIV actors, including governments, civil society, people living with and affected by HIV, donors, UNAIDS co-sponsors, and the private sector. It will build on past successes while tackling the biggest challenges ahead. 

UNAIDS estimates that by 2050, between 29 and 46 million people will still be living with HIV, all of whom will need access to treatment and support to live healthy lives and prevent onward transmission. Closing gaps in treatment, overcoming complacency, and removing structural and societal barriers that prevent people from accessing services will be essential. Countries must have strong and sustainable systems in place to provide adequate care. 

This effort requires a truly multisectoral response bringing together health, finance, justice, education, and social welfare sectors to create a comprehensive approach. Integrating HIV services within broader healthcare systems must be done carefully to ensure high-quality, stigma-free services for everyone who needs them. 

"The challenges are big, but so is our determination," said Ms Byanyima. "We have the knowledge, the tools, and the experience. Now, we must come together with political will, adequate resources, and collective action to end AIDS once and for all." 

The development of the Global AIDS Strategy 2026-2031 is a crucial moment for the HIV response. UNAIDS invites all stakeholders to take part in this journey, share their ideas, and help shape this new strategy, and ensure it reflects diverse voices and experiences. 

Ending AIDS is not just a possibility, it is a choice. The next five years will determine whether we seize this moment or allow progress to stall. The time to act is now." 

On 20 January 2025 the United States announced a 90-day freeze on US foreign aid which has had a devastating impact on people living with and affected by HIV, on the people and organizations supporting them and on the global response to HIV as a whole.  

Community organizations have been particularly impacted by the freeze in funding. Community healthcare workers are losing their jobs, clinics are having to be shut down and, as a result, people in need of HIV testing or prevention or who are living with HIV and dependent on daily antiretroviral medicine are unable to access the life-saving HIV services they need. 

On 10 February, UNAIDS convened an emergency meeting with community organizations to monitor the impact of the unfolding crisis. Community groups reported that HIV services around the world are facing serious challenges. Some are grinding to a halt. Supplies of antiretroviral medication, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP) and condoms have been disrupted, leaving many without essential tools of HIV treatment and prevention.  

HIV testing kits are increasingly scarce and outreach services – essential for connecting people in need of HIV testing – are being suspended. As a result, HIV and sexually transmitted infection testing are disrupted, threatening detection and prevention efforts. 

“The damage is immediate and severe,” said one advocate. “People who rely on [U.S.-funded] programmes for [safety and] survival are suddenly left with nothing.”  

The US pause in administering foreign assistance while it reviews recipients is not just a bureaucratic delay; it is a direct threat to continued progress against AIDS and will quickly erode decades of hard-won gains in the global HIV response. It will destroy many community organizations without which the world cannot close the gaps in HIV testing, prevention and treatment. 

The US Government has invested more than US$ 100 billion to date in the global fight against AIDS with the US accounting for around 73% of donor funding for HIV worldwide; millions of people at risk for and living with HIV rely on US funded clinics to stay healthy in the face of HIV.

Community-led data reveals community organizations are bearing the brunt of the pause

A survey conducted by the Uganda Key Populations Consortium found that 97% of respondents reported negative effects on their HIV service due to the freeze on US foreign assistance. A staggering 43% of organizations supporting key populations surveyed said they relied on US funding for at least 76% of their budgets. 

Another joint survey by Aidsfonds, the Global Network of People Living with HIV (GNP+), and the Robert Carr Fund found similarly worrying results. Of 564 organizations surveyed across 25 countries, 95% reported direct impacts from the US funding freeze. 43% of programmes have paused implementation, while 35% have fully suspended operations. 

“The results are alarming,” said Mark Vermeulen, Director of Aidsfonds. “More than half (57%) of the organizations estimate that this crisis will impact more than a million people. The longer these disruptions persist, the greater the risk of a new generation of preventable HIV infections. This threatens to undo the hard-earned progress in reducing new infections among children.” (New HIV infections among children had been reduced by 62% from 2010 to 2023, largely thanks to investment and commitment from the US Government). 

It’s not just people living with or at risk for HIV that face an existential threat 

The financial void left by the US aid freeze of its foreign assistance is forcing community groups to fire employees and/or to close up shop entirely. Many community organizations do not have sufficient funding reserves to stay afloat through the 90-day (or perhaps longer) period of no US funding. 

“The leadership of national networks of people living with HIV have been forced to let go of community cadre staff- peer educators, adherence counselors, community health facilitators, and mentor mothers,” said Florence Anam, Co-executive Director of GNP+.   

GNP+ recently convened with leaders from national and regional networks of people living with HIV and released a statement with the main concerns. 

“These organizations are not a luxury – they are critical for ending AIDS,” said Christine Stegling, Deputy Executive Director, UNAIDS. “Serving as advocates, peer educators, care providers and watchdogs, community-led organizations ensure that lifesaving HIV testing, prevention and treatment reaches those most in need.”  

Many organizations have spent years garnering the trust of the communities they serve. If these organizations disappear, even if others replace them one day, it will take years to reestablish the bonds of trust that allow them to be so instrumental in encouraging people to seek HIV care.  

In a joint survey by Aidsfonds, GNP+ and the Robert Carr Fund 22% of organizations reported increased experiences of discrimination, including reports of discrimination within healthcare settings, where people faced barriers to accessing care. 

LGBTQ+ communities in need of HIV testing, prevention and treatment fear increased risks of violence and discrimination as funding for protective services – led by HIV community groups –  disappear. 

Since the earliest days of the AIDS pandemic, communities and community-led services have been instrumental in ensuring equitable, accessible HIV testing, prevention and treatment – as well as the supportive services that make all three possible. 

Communities have been at the forefront, driving the delivery of comprehensive care, life-saving treatment and offering regular monitoring and prevention services and psychosocial support. Their unwavering dedication has not only saved millions of lives but also reshaped the trajectory of the AIDS pandemic. Their leadership and work on HIV are a model for all other responses to communicable diseases.  

By paralyzing frontline response efforts led by community groups, the US decision to freeze funding is weakening health systems across the Global South. The freeze not only jeopardizes precious gains made to date against HIV – it also threatens to usher in a new wave of entirely preventable HIV infections and AIDS-related deaths. 

The community groups stressed that this crisis extends beyond HIV treatment. The funding cuts impact efforts to provide clean water, basic education and to prevent human trafficking of girls. The loss of funding is dismantling the fragile safety net that has been built over decades around the world 

“We are deeply concerned about the sustainability of the HIV response, particularly support for key populations, HIV prevention, human rights and community led responses. We are re-orienting our own efforts to support the communities and organizations that are both bearing the brunt of the loss of funding and facing targeted attacks on their rights and their very lives,” said John Plastow, Executive Director of Frontline AIDS, a global partnership, headquartered in the UK and South Africa, that works with 60 partners across 100 countries around the world.  Over 20 of their partners have said they are affected by the US foreign aid freeze. 

Since the US funding freeze on foreign assistance was announced, UNAIDS has conducted daily assessments led by its regional and country teams to track disruptions and to relay urgent needs to donors and to governments of affected countries. At country and regional levels, UNAIDS has also been convening people living with HIV and other affected communities to assess the impact and discuss mitigation measures. For the latest updates: Impact of recent U.S. shifts on the global HIV response - The global impact of PEPFAR to date | UNAIDS

UNAIDS stands in solidarity with community leaders calling on the US, other donors and governments of affected countries to step in before irreversible damage is done. UNAIDS and communities call on the US to maintain its global leadership on, and unparalleled support for the global response to AIDS. Without immediate intervention, decades of progress in the global HIV response will be undone, leaving the world on the precipice of a public health disaster that we have the power and tools to avert.

As of 17 February 2024, UNAIDS had received at least one status report from 52 countries (39 PEPFAR-funded and 13 countries that receive some US support). The 39 countries represent 71% of all PEPFAR-funded countries. 

Collectively, these status reports reveal a range of significant impacts resulting from the US Government’s decision to freeze and review all US foreign assistance (see the chart below). The situation continues to evolve rapidly as waivers are requested, issued and implemented.

UNAIDS is also working at the country level to understand exactly which HIV services are not operational, and which populations are not being reached. It is essential to maintain high-impact HIV testing, treatment and prevention programmes and community-led services.

People in highly reliant countries are at particular risk

UNAIDS’ Equitable Financing team analysed HIV funding and spending data from recent years and produced estimates of PEPFAR funding as a percentage of total funding for the AIDS response in various countries (see box, below). More detailed analyses focused on specific programmatic areas (e.g. ARV procurement) are also available.

UNAIDS is offering its funding data and data on health system capacity to triage support to countries as they adapt to disruptions. For countries that are highly reliant on external assistance, particularly from the United States, there may be large numbers of health workers and other critical personnel (e.g. data managers) affected by the stop-work order. The chart below shows that nearly 20,000 health care providers supporting HIV services in Mozambique have received stop-work orders.

This situation is happening elsewhere. For example:

• In South Africa, 15,374 PEPFAR-funded HIV response staff, allocated at national level and across 27 priority districts, have been affected by the stop-work order.
• In Cameroon, 2,332 critical staff, including 258 doctors and nurses, have been affected by the stop-work order.
• In Lesotho, 1,258 health workers working in HIV treatment and providing strategic information to implementing partners received the stop-work order.

UNAIDS Country Offices are working with partners to determine whether waivers (issued after the stop-work order) or the reallocation of national/non-US donor funding have allowed some, or all, of these essential staff to resume work.

CONTINUE READING UNAIDS WEEKLY UPDATE (PDF)