Eswatini, a country once described as the epicentre of the HIV epidemic with nearly 1 in 3 adults living with HIV in 2015 [adult HIV prevalence in 2015 was 31%]. But Eswatini managed to turn around its HIV epidemic, reducing new HIV infections from a peak of 21 000 per year in 2000 to 4 000 in 2023, a remarkable result, achieved with the support of US funding. 

However, the sudden US funding cuts threaten to undo years of progress. We sat down with Nuha Ceesay, UNAIDS Country Director in Eswatini, to discuss the current situation, the impact on HIV services, and the way forward.

Q: How are US funding cuts impacting Eswatini’s HIV response? 

Eswatini’s HIV response has been a success story, by transforming a crisis that once saw extremely high HIV prevalence rates, into a model of resilience and opportunity. But the recent US funding cuts, representing about half of the country’s HIV response budget, have left the people living with and affected by HIV in despair, the government was not notified and left unprepared, and the people working to end AIDS are in total shock. There is real concern that new HIV infections and AIDS-related deaths will rise, reversing years of hard-won progress. The cuts threaten not just HIV treatment and prevention, but also the broader health system improvements, data collection, jobs and empowerment of people living with HIV. 

Q: What disruptions are being seen on the ground? 

The effects are immediate and widespread. HIV testing services, the gateway to treatment, are now limited. With fewer people being tested, many may unknowingly be infected with HIV, missing the chance for early treatment and increasing the risk of further transmission. This could push annual new infections, which are currently around 4 000, even higher, and add pressure to already strained treatment resources. Stockouts of antiretroviral, lab test kits, and condoms are expected within months, and health worker layoffs are affecting service delivery and quality data collection. Primary prevention services, such as medicine to prevent HIV (PrEP), education campaigns, and voluntary medical male circumcision for HIV prevention (which is around 60% effective in preventing HIV) have also been scaled back or suspended. 

We are also seeing a stop of the DREAMS programme which is a major setback for adolescent girls and young women, who are disproportionately affected by HIV in Eswatini. DREAMS provided prevention education, skills, and socio-economic support to young women. Its termination leaves them more vulnerable to infection and strips away resources that have been central to empowering this high-risk group. HIV prevalence among young women and girls aged between 15 and 24 years was 70% higher than among young men in Eswatini in 2023. 

Read more about the impact on UNAIDS website 

Q: How is UNAIDS responding to these challenges? 

UNAIDS is working closely with the government and partners to continue the work of developing and implementing the HIV Sustainability Roadmap. This will help Eswatini’s HIV response to gradually shift from being reliant on international aid to increasing its domestic funding which will lead to the government taking full ownership of its HIV response. The first phase of this roadmap has already been launched, focusing on building resilience and long-term solutions. 

UNAIDS has also worked closely with the Ministry of Health and partners to map the impact of the funding cuts, identify service gaps, and strategize on mitigating disruptions. Collaboration with the Ministry of Health, UN partners, and civil society remains central, but the transition to sustainability is a complex and gradual process. 

Q: What’s your message to the international community? 

The successes that we celebrate in the HIV response are built on mutual accountability and global solidarity. That’s what enabled countries like Eswatini to shift the narrative-from a crisis by leading a response that brought down new HIV infection to 4 000 compared to when new infections were as high as 21 000. 

It is therefore devastating to see all the hard-won gains being reversed at this stage. This is the moment we need to come together in solidarity and in partnership to accelerate our collective efforts. 

Ending the epidemic is like a marathon. We have run the race many miles, but the end is what matters. If we cannot reach that finish line, it means we have not completed, and we cannot afford that. 

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads the global effort to end AIDS as a public health threat by 2030 as part of the Sustainable Development Goals. 

Following the US stop work order in January, UNAIDS is working closely with governments and partners in affected countries to ensure that all people living with or affected by HIV continue to access life-saving services. 

For the latest updates, please visit unaids.org 

Q&A with UNAIDS Country Director in Burundi 

International aid is shrinking, and countries are increasingly burdened by the need to prioritize debt repayment over essential services, including healthcare. This shift has left vulnerable populations more exposed, with the abrupt funding cuts by the United States throwing the HIV response in many countries into chaos. Burundi, unfortunately, is no exception. Across the country, HIV services have faced severe disruptions. Clinics are reducing their services, staff are being laid off, and thousands of people living with HIV are at risk of losing access to critical treatment. 

In this interview, Marie Margarete Molnar, UNAIDS Country Director in Burundi, explains how communities are being affected, how the health system is coping, and what must happen next. 

Q: Can you describe the current funding landscape for Burundi’s HIV response? 

Burundi’s HIV response relies heavily on international aid - 95% of its funding comes from donors, with the US government contributing 51% through PEPFAR. This support sustained 10 major projects covering HIV prevention, treatment, and care for both the general population and vulnerable populations. PEPFAR also provided support to community-led monitoring projects and critical data system information. 

Q: How have the recent US funding cuts affected these programmes? 

Out of the 10 PEPFAR-funded projects, three were not eligible for the US waiver and had to stop operating. Some of the remaining seven, although eligible, could not resume their activities due to delays and financial uncertainty. As a result and based on an assessment conducted during the first month of the pause, at least 10 000 people living with HIV—who were among the 79 000 currently under treatment—have been directly affected. These individuals risk losing consistent access to medication and support services. In addition, 167 health professionals have lost their positions. These include doctors, nurses, psychologists, lab technicians, and community health workers—many of whom were directly providing HIV services. Financially, the immediate PEPFAR cut represents approximately US$ 6.5 million from the annual PEPFAR envelope of US$ 25 million for HIV in Burundi. 

Q: What does this mean in practical terms for people on the ground?

Burundi had almost reached the 2025 ambitious targets: 95% of people living with HIV who know their HIV status, of whom 95% are on treatment and of the people on treatment 95% are virally suppressed. This was the result of strong collaboration between the government, civil society organizations and partners. The country was even recognized with an award. But now the third 95, on viral suppression, is declining because some people can no longer access viral load testing or follow-up services. If the situation continues, there is a high risk of an increase in new infections and a weakening of the entire HIV response system. 

Q: What steps have the government and partners taken so far to respond to the crisis? 

The government and partners acted quickly. UNAIDS conducted consultations during the first two weeks of February with key stakeholders. These consultations identified the scale of the impact and led to a series of recommendations that were shared with the Government and partners. The Ministry of Health together with UNAIDS and WHO held a two-day workshop with the PEPFAR implementing partners and civil society to understand how the cuts affected budgets, staffing, services, and beneficiaries and to brainstorm on rapid mitigation measures. As instances, it was recommended carrying out field missions to visit treatment sites and assess how services were coping without US support, forming a crisis response group and developing a national contingency plan. The government also began to identify treatment sites facing ARV shortages and organized a drug quantification workshop after PEPFAR-supported partners could no longer lead it. 

Finalizing the HIV Sustainability Roadmap has also become a top priority. The roadmap is intended to guide how Burundi can finance and manage its HIV response without relying so heavily on external donors. We also discussed modeling different scenarios, from best case to worst case, based on whether funding returns or disappears entirely. These models would help us plan, reprioritize, and adapt strategies accordingly. We are also using the UNAIDS Rapid AIDS Financing Tool (RAFT) to get detailed data on how the funding cut is affecting commodities and staffing across the country. 

Q: Is the government prepared to increase its contribution to its national HIV efforts? 

It’s trying. Previously, funding for antiretroviral treatment was split between 76% from the Global Fund, 15% from the government, and 9% from PEPFAR. The government has now committed to covering partially that missing 9%. That shows political will. But it’s not just about medicine. It’s about health workers, community programmes and lab capacity. Burundi will need to restructure its approach by, for instance, integrating HIV into broader health and social protection systems, and significantly increase domestic health funding to reduce dependency, but this is difficult given the country's economic constraints. 

Q: What’s your message to the international community? 

Burundi is a fragile country facing multiple crises—economic instability, fuel shortages, emerging epidemics, and an influx of refugees from neighboring Democratic Republic of Congo. Despite these challenges, the country has made significant progress towards ending HIV, thanks to sustained investment in health including the HIV response. The risk now is losing these gains. Continued support from international partners is essential, not just for health but for the country’s overall development. At the same time, the Burundian government must increase its commitment to health funding. Only through global solidarity and strong political will can Burundi hope to end HIV by 2030. 

The global community must understand that this is more than a budget line. It’s about lives, stability and global health security. 

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads the global effort to end AIDS as a public health threat by 2030 as part of the Sustainable Development Goals. 

Following the US stop work order in January, UNAIDS is working closely with governments and partners in affected countries to ensure that all people living with or affected by HIV continue to access life-saving services. For the latest updates, please visit unaids.org 

Community-led organizations are the backbone of the HIV response in many countries, providing access to HIV services for key populations, advocating for human rights and monitoring the HIV response. However, data collected by community-led organizations shows mass shut-downs of life-saving, peer-led services, significant – or total – budget cuts, staff lay-offs and rising levels of stigma, discrimination and mortality rates.   

Two new key population-led reports, one by Global Black Gay Men Connect (GBGMC) and another by the International Network of People Who Use Drugs (INPUD), document the consequences of the US President’s Executive Order in January 2025 which froze all US foreign assistance. These reports highlight how services led by and for key populations are facing deep uncertainty about their future due to the funding cuts and loss of staff.

In its Frozen Out report, GBGMC found that 36% of partners supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR) shut down within one week of the Executive Order. Another 19% said they could not operate beyond one month without renewed support. Similarly, INPUD’s report The Human Cost of Policy Shifts describes significant disruptions across harm reduction programmes. Nearly half (45%) of the organizations surveyed reported major budget losses, and one in four lost between 75% and 100% of their harm reduction programming. Critical services including peer-led outreach, HIV and hepatitis C testing, opioid agonist therapy, and overdose prevention have been disrupted. 

A cascading crisis 

The GBGMC report states that nearly 93% of key population-serving partners in Kenya reported experiencing full or partial service shutdowns. In Nigeria, every PEPFAR implementing partner providing services to key populations was reportedly affected. Across Kenya, Uganda and Nigeria, an estimated 2.2 million people have lost access to key population-focused HIV prevention services. 

The report also warns that even short-term interruptions can have life-threatening consequences. Each day, an estimated 200,000 people rely on receiving their HIV treatment through US government-funded sites. Interruptions risk treatment failure, HIV transmission and the emergence of resistance to HIV medicines. Prevention efforts are also at risk, with US government funding supporting nearly 90% of global pre-exposure prophylactic (PrEP) initiatives. 

“The PEPFAR funding freeze has led to the closure of numerous organizations and the disruption of essential HIV prevention services, leaving millions at risk. Immediate action is imperative to restore funding and protect key populations from further harm,” says Micheal Ighodaro, Executive Director of GBGMC 

Impacts on organizations led by people who use drugs 

INPUD’s report, The Human Cost of Policy Shifts, provides a detailed picture of how harm reduction services have been devastated by the US funding cuts. Based on a global rapid assessment of 101 respondents, the report reveals that nearly half lost between 26% and 100% of their harm reduction budgets, and 23% lost more than three-quarters of their funding.  

The most disrupted services included peer-led outreach (41%), legal and human rights support (36%), HIV testing (35%), services for women who use drugs (33%), and overdose prevention (25%). The consequences for individuals and communities have been severe. 47% of organizations reported that people are now going without harm reduction supplies such as sterile syringes and naloxone, and 46% said people are relying on underground or informal networks for access. 30% observed increases in overdose deaths. Additionally, 62% of organizations documented rising stigma and discrimination against people who use drugs. 

The report also highlights a particularly stark impact on women who use drugs. Of the 54 organizations that previously offered tailored services for women, 68% halted outreach, and over a third had to reduce or close services altogether.  

“While increasing overall funding is important, it is equally vital to ensure that organizations led by people who use drugs receive targeted support to run harm reduction services that effectively address their communities’ unique challenges and needs," says Anton Basenko, Executive Director of INPUD 

Heightened stigma and structural risks 

Even before the funding cuts, key populations faced legal and social barriers 
including criminalization, discrimination, and denial of services. According to reports gathered through UNAIDS’ dialogues with global and regional networks, these challenges are now intensifying. Community organizations have documented a rise in harassment, hate speech and healthcare discrimination. In some countries, specialized clinics are being “mainstreamed” into general health systems without adequate training or protections ensuring safe access. 

UNAIDS’ response and coordinated action 

Since February 2025, UNAIDS has been convening biweekly virtual dialogues with global key population networks, civil society advocates and international partners to share updates, raise concerns, and coordinate efforts to protect HIV services. At the regional level, UNAIDS is also convening with networks and joining forces to document the impact of funding disruptions and shape collective responses. These engagements have informed UNAIDS’ advocacy and programming supporting the launch of tools like the Rapid Action Financing Tool, strengthening country-level tracking through the UNAIDS impact portal (launched in early 2025) and amplifying community voices at global forums such as the UN’s Commission on the Status of Women and the Human Rights Council. Through continued collaboration with country teams, regional networks, and civil society, UNAIDS remains committed to co-creating solutions and prioritizing community-led responses. 

A call for urgent action 

GBGMC and INPUD urge governments, donors, and development partners to take immediate steps to: 

• Restore and increase funding for community-led and key population-focused services and establish dedicated funding streams for key population-led organizations   
• Establish pooled emergency funding mechanisms to sustain prevention and harm reduction
• Ensure meaningful community engagement in funding, service design, and legal reform
• Protect peer-led HIV services, which are grounded in principles of dignity, safety, and equitable access 

As the global HIV response faces rising risks, UNAIDS shifts to a leaner, sharper model focused on country impact 

GENEVA, 10 May 2025—In the face of continued high numbers of new HIV infections and declining global funding, the Joint United Nations Programme on HIV/AIDS (UNAIDS) is launching a bold transformation to support countries in ending AIDS as a public health threat by 2030, and to ensure the HIV response remains strong and sustainable into the future. This shift will help governments and communities transition to a sustainable and domestically financed HIV response, grounded in data, equity, and human rights.

“UNAIDS’ transformation is a direct response to a fast-changing landscape, from a shifting geopolitical context to shrinking resources,” said Winnie Byanyima, Executive Director of UNAIDS. “We are reshaping how we work so that we can support inclusive, community led, multisectoral national HIV responses with greater precision and impact.”

UNAIDS restructuring and reform processes are closely aligned with wider UN processes through the UN80 initiative and promote enhanced efficiency, integration, consolidation and coordination.

The restructuring of the UNAIDS Secretariat is informed by the work of a High-Level Panel which has been working since October 2024. The Panel called for transforming the Joint Programme now and through to 2030 and recommended a smaller, sharper focused model for the Secretariat. It called on the Secretariat to focus on four core functions: leadership; convening and coordination; accountability; and community engagement.

Disruptions in the HIV response 

UNAIDS modelling suggests that we are now seeing 2300 additional new HIV infections every day on top of the 3500 infections that were already occurring. These reversals are happening as a result of human rights push backs on women and girls and key populations coupled with disruptions in lifesaving services as international assistance from donor countries stopped. UNAIDS estimates that the funding cuts could lead to an additional 6.6 million new HIV infections and 4.2 million AIDS-related deaths by 2029. A tragedy for people living with and affected by HIV.

Reshaping to deliver in a changing context 

UNAIDS is facing a big transition and is reforming to continue to support the response in the most efficient and cost-effective way. The Secretariat is consolidating its country footprint and will be moving global staff to be closer to the people we serve.

The physical in-country presence of the Secretariat will be reduced to approximately 35 countries while continuing to be able to support around 60 countries directly. The change is based on a typology of countries with high HIV burden, significant stigma and discrimination against key populations, and heavy reliance on international aid for the HIV response. The restructuring plan includes a 54% reduction in Secretariat staffing strength to ensure UNAIDS is fit for purpose and working within current core resource forecasts.

UNAIDS’ transformation is about supporting countries to protect the critical gains made in stopping new HIV infections and preventing AIDS-related deaths. UNAIDS will continue to support countries in monitoring their epidemics and making strategic investments for HIV prevention and treatment, as well as addressing human rights and policy barriers. It will convene partners, engage communities and stand with people living with and affected by HIV.

“This is a moment for global solidarity,” said Ms Byanyima. “With determination, and partnership, together we can still achieve the goal of ending AIDS as a public health threat by 2030 and ensure sustainable, inclusive, multisectoral national HIV responses into the future.”

In 2025, UNAIDS will shape and deliver a new Global AIDS Strategy to accelerate political, programmatic and financial commitment and sustainability and provide guidance to drive progress towards the goal of ending AIDS as a public health threat by 2030. The Strategy will be adopted by the UNAIDS Programme Coordinating Board in December 2025. It will provide the foundation for a new Political Declaration and 2030 HIV targets, to be adopted by a High-Level Meeting of the UN General Assembly in 2026.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

On the outskirts of Bishkek, the capital of Kyrgyzstan, a small house converted into a shelter welcomes people recently released from prison. The shelter is funded by the Global Fund/UNDP project “Effective Control of HIV Infection and Tuberculosis in the Kyrgyz Republic.”

Madina Toktogulova, head of the public foundation Istikhsan, which supports the shelter, is preparing to welcome her clients.

For 25 years, Madina has worked with people in prison, people who use drugs, and those living with HIV and tuberculosis. As a community representative, she was at the forefront of establishing the country’s first grassroots initiatives, self-help groups, and community-based organizations. She played a key role in developing social support and rehabilitation programmes for people in vulnerable situations.

Together with a group of like-minded colleagues, she established the country’s first peer support groups in correctional facilities. They persuaded prison administrations of the importance of providing HIV prevention services, including harm reduction, to people in prisons; they built relationships with prison health professionals, social workers, and psychologists; implemented HIV prevention projects; and helped people newly released from prison who had no place to stay, clothes, or money to return home.

Dr Gulsara Kukanova, a physician at the FSIN hospital-polyclinic in Kyrgyzstan, stressed how vital organizations like Istikhsan are the moment people are released from prison as some stop taking antiretroviral treatment or relapse into drug use. “We partner with organizations like Istikhsan and witness people rebuilding their lives — finding jobs, reuniting with family. Offering hope to someone who has lost it is invaluable.”

Madina knows that without food, shelter, or ID, HIV treatment is not a priority. That’s why she advocates for a comprehensive approach to reintegration.

“People need more than just medical care. They need psychological support, help finding a job, restoring their documents. Non-governmental organizations, with donor support, play this essential role — helping people rediscover themselves,” she explains.

Istikhsan’s work focuses on supporting incarcerated women. Madina says women are more emotionally vulnerable, more affected by violence – the harsh reality of prisons, trauma, stigma, and self-stigma. They are more likely to give up on therapy and lose hope.

“Society forgives men more easily. Women with a prison history are judged more harshly. Maybe because I’m a woman, I feel their pain more deeply,” she says.

The organization is currently providing support to all women living with HIV in a nearby prison. Thanks to their efforts, more than 20 women have been able to restore their identity documents, dozens are receiving psychological and medical support, starting HIV treatment, reconnecting with children, finding jobs, and reintegrating into society.

But all of this is now at risk. HIV prevention efforts built over years through partnerships with government, civil society, and international institutions face collapse due to shrinking funding from key donors, including PEPFAR and the Global Fund.

According to Madina, a systemic approach to reintegration is impossible without cooperation between government institutions and civil society.

“We have a very good probation law that provides a legal framework for supporting people on the path to resocialization. However, as with any system, there are times when resources and human capacity are not sufficient to reach everyone in need. That’s when civil society can step in — in partnership with the state and within the framework of the existing legislation,” she emphasizes.

While the Kyrgyz government fully covers HIV treatment, there’s a real risk that essential social and prevention services — post-release support, reintegration, temporary housing, documentation help, hygiene kits — will be lost without external aid.

“The loss of funding could dismantle the entire support system for women living with HIV in prison. These programmes are not charity; they’re investments in resilient health and social protection systems that can operate independently. Investing now means building a future where everyone’s right to health is protected,” says Meerim Sarybaeva, UNAIDS Country Director in Kyrgyzstan.

“For the first time, we’ve created a model where probation services, prisons, and NGOs collaborate daily, so no one falls through the cracks,” says Chinara Maatkerimova, Programme Officer at UNODC in Kyrgyzstan.

“If we disappear, who will hear them?” Madina asks. But she’s determined to continue — even if it means starting over — to advocate for sustainable funding and rebuild a system where every person, regardless of their past, has a right to health and a future.

As of April 1, 2025, Kyrgyzstan has reported 14,609 cases of HIV. Of these, 61.8% were transmitted sexually and 27.8% through injection drug use. HIV is increasingly being detected among people outside of traditional key populations — a sign of the epidemic’s broader spread in the country. 

In April 2025, silence fell over Bahir Dar. Once a lifeline for people living with HIV, key populations, and young people—as the US funding pause began to bite. Funding cuts disrupted services. A few held on without salaries but eventually, even they stopped showing up. Confused and anxious clients arrived to find the gates closed. Some waited. Others turned away.

The crisis quickly spread from Bahir Dar, where key population programmes came to a halt. Outreach workers, who had built trust door by door, were laid off. Fear took hold. Clients asked for extra medication, unsure whether services would return. Peer support groups vanished, and with them, protection against stigma and transmission.

"I often find myself overwhelmed with stress,” said a woman from a women led association. “If the medicine and other services stop coming, where will I go? I simply don’t have the financial means to afford the treatment I need.”

The data collected by the women-led association of people living with HIV is stark. For two months, no new clients have been enrolled in PrEP, the prevention prophylaxis taken orally that protects from HIV infection.

“One of my biggest concerns is the fear of not having access to condoms,” said a case manager from the women led association. “Without them, we know HIV can spread much more easily.”

In the face of this collapse, the UNAIDS Ethiopia team visited Bahir Dar and surrounding towns to document the impact firsthand. They spoke with organizations, youth groups, and people living with HIV. They visited what remained of the services and listened to voices that too often go unheard—adolescents, mothers, peer educators—people still holding the line, even as systems crumbled around them.

“I worry deeply about the spread of HIV,” said a female member. “Will medicine still be available? Will we still have access to viral load testing? If condoms run short, we risk seeing the virus continue to spread, along with other infectious diseases.”

"Without a financial budget, our members are left without the basics they need to survive; no food, medical care, or even hope," said the association manager. "They have families, they have children, and they rely heavily on this support. It would make a huge difference if members could access free medical treatment and hospital services. Today, many can't even afford one meal a day. Their health is deteriorating; their children are suffering. What they need most is dignity, food, and a fighting chance."

“There’s a real fear that if funding ends, everything else will follow—medicines, condoms, even access to medical personnel,” said a member from the women led association. “Without these, proper care becomes almost impossible.”

And yet, even in collapse, communities are refusing to give up.

Young volunteers have stepped in. They have formed informal networks, checked in on peers, and created WhatsApp groups to stay connected. Mothers banded together to support their children’s treatment. Youth collectives used community radio and shared airtime to spread critical information. Where formal systems failed, communities built their own safety nets.

Bahir Dar was both a breaking point and a wake-up call. It laid bare the fragility of systems built around a single funding stream—when the money stopped, so did the services, the trust, and the hope.

This crisis makes clear that resilience must be built in, not left for later. Emergency preparedness must be a core part of national HIV responses. Community-led organizations must be recognized as essential. And youth-led innovation must be scaled up—because it is young people who keep the response alive when everything else falls apart.

"Resilient communities are the backbone of the HIV response," said Tina Boonto, UNAIDS Country Director for Ethiopia. "When systems collapse, it is communities that hold the line. Their leadership, courage, and innovation are not optional—they are essential. Building lasting responses means putting communities first, not as an afterthought but as the foundation of everything we do."

HIV must remain central to humanitarian, development, and recovery agendas. The intertwined challenges of conflict, displacement, gender-based violence, and HIV demand integrated, people-centered solutions. This won’t happen if HIV is treated as an afterthought or reduced to clinical care alone.

The story of Bahir Dar shows what happens when systems fail, and what people do in their absence. It is a testament that resilience is forged in crisis by those most often left behind who still find ways to move forward.

Documented impact on services

Stockouts of HIV medication and condoms are expected in the next 3-6 months.

The antenatal testing of pregnant women, delivery care for women living with HIV, early infant diagnosis and paediatric treatment services are all affected.

Data collection at some facilities/service points continues, but data quality control and data collation are affected

Human rights, key and vulnerable populations

There is disruption to PrEP services for adolescent girls and young women (AGYW), a reduced capacity of service delivery points for HIV prevention and a discontinuation of AGYW-specific outreach programs.

There is a limited availability of HIV testing services for AGYW, reduced availability of HIV prevention education and awareness campaigns, and reduction in the availability of counseling and social support services for AGYW.

All programmes on stigma and discrimination have stopped with key populations, AGYW, young people, people living with HIV and other populations affected.

Government convening, mitigation measures

The Ministry of Health has been convening impact assessment meetings, with a special commission set up for this purpose.

The ministry of justice has been leading an impact assessment on human rights violations and the protection of key populations. There have been consultations between the Ministry and organizations representing key populations.

The Ministry of Family and Child’s gender working group has conducted an assessment and a gender-based contingency plan is available.

Civil society impact, resilience and response

Civil society organizations in Haut-Katanga have conducted a risk assessment. Steps are also being taken to set up a public-private partnership with civil society organizations. Advocacy for the mobilization of local resources is underway.

Community-led organizations are at risk of closure or severe reduction in services.

There is an increased difficulty in accessing government or donor support, loss of funding for monitoring activities and a reduced ability to collect and report data.

The involvement of community-led organizations in policy design, advocacy, and work on societal enablers has been affected, resulting in a limited ability to advocate for key issues, a shift in focus due to funding constraints, and a reduced participation in policy discussions.

Service delivery by community-led organizations has been affected by the reduction or suspension of services, with an increased demand with fewer resources, loss of staff or funding cuts.

UNAIDS response

The MPox/HIV project for key populations is underway with partners in Kinshasa.

There is support for resource mobilization with a 2-year Department of Health project.

Support is being provided to the Ministry in charge of Gender and the Ministry of Human Development for the organization of a national HIV forum and mobilization of resources.

Advocacy with German and Canadian embassies, African Development Bank, World Bank and the EU to position the HIV response.

Data support is also being provided to assess the impact of the funding cuts on new HIV infections and AIDS-related deaths.

Godfrey Swai is shaken. Since the end of January, the US aid funding cuts have meant that he can only afford for his staff to work a couple of hours twice a week compared to a full five days.

As the Executive Director of an organization called Methadone Family Against Drug Abuse based in Tanzania he has had to scramble. “Despite clinics being partly opened, our outreach in hotspots came to a halt,” he said. “The community is scared.”

In many countries, like Uganda, centres distributing opioid agonist maintenance therapy (OAMT), also known as medically assisted treatment, closed for a month. OAMT is often prescribed as oral medication to alleviate withdrawal symptoms and reduce injecting drug use, which in turn lowers the risk of acquiring HIV. In 2022, the risk of acquiring HIV was 14 times higher for people who inject drugs than for people in the overall adult population.

“We know that disruption to OAMT is a threat to life,” said Catherine Cook, Sustainable Financing Lead at Harm Reduction International (HRI).

Banza Omary Banza, Director of Community Peers for Health and Environment Organization in Tanzania, agrees. “Fearing a stock out of methadone–the OAMT medicine–we have witnessed people returning to heroin use and hitting the black market,” he said.

A setback that has a myriad of repercussions.

According to a recently published survey by International Network of People who Use Drugs (INPUD) there has been large-scale suspension of outreach and harm reduction programmes, including needle and syringe distribution, HIV and hepatitis C testing, overdose prevention and legal support services.

“The hardest hit has really been the peer-led outreach,” said Aditia Taslim, Advocacy lead at INPUD. “Three months later no alternative solutions have been put in place. It’s like we are being erased from the HIV response.”

For harm reduction advocates this crisis isn't just financial, it's profoundly human.

“Peers and peer outreach have been the backbone of the harm reduction response," said Juma Kwame, Director of Tanzania Network of People who Use Drugs (TANPUD). “Without people seeking out their peers you don’t have linkages to treatment to health services or to recovery.”

Team leader at a network of women who use drugs in Dar es Salaam, Grace Mbalawa, said that most people living with HIV who use drugs have little income or a stable home, so the loss of support programmes has upended their lives.

“They no longer have a safe space and many are stretching out their HIV treatment by skipping days in case they can no longer get their medicine,” she said. People living with HIV must take daily treatment to stay healthy and suppress the virus. In addition, when the viral loads of people living with HIV are suppressed, sexual transmission of HIV does not occur.

International donor funding comprised 67% of total harm reduction funding in 2022. Most of the money went towards HIV prevention programmes for people who inject drugs. The US President’s Emergency Plan for AIDS Relief (PEPFAR), a decades-long initiative, supported OAMT to 27 000 people in seven countries (India, Kenya, Kyrgyzstan, South Africa, Tajikistan, Tanzania and Uganda). In many cases these were and are the only services available. They also supported harm reduction programmes in Mozambique, Myanmar and Kazakhstan.

Many fear the loss of funding threatens to undermine human rights and marginalize communities already battling stigma and years of neglect with women bearing a big portion of the impact.

“One in three people who use drugs are women but women only account for one in five people accessing services due to the stigma of being a woman using drugs,” said Ms Cook from HRI. “They risk having to admit drug use and face stigma, arrest, losing custody of their children or even violence from the wider community.” Any services tailored to women like the one Ms Mbalawa works for are key as are all peer-led services.

Ms Cook is concerned that if funding for communities and civil society support dries out, the entire harm reduction response may collapse. INPUD also warns that without immediate and strategic intervention, the world could witness a resurgence of HIV, hepatitis C, and overdose epidemics.

UNAIDS, UNODC and partners have been working with governments to encourage increasing domestic funding and mapping out sustainability plans. Central to these include having organisations led by people from the community participating as well as moving funds away from punitive approaches like criminalising drug use to reduce stigma, and inequalities.

“As countries look at new models for how to integrate specific HIV services tailored to serve the needs of people living with HIV or at risk of HIV, including people who use drugs, into general health services, this must include the integration of harm reduction services ” said Suki Beavers, UNAIDS Director of Equality and Rights for All. “And peer-led outreach is part of that equation.”

Mr Kwame stressed, “We need our voice to be heard so that people who inject drugs are part of the health agenda, and our needs are met.”

The sudden pause and suspension of US Government foreign assistance has resulted in a multifactorial increase in the risks, challenges, and uncertainty related to HIV commodity^[1] availability and management.

The analysis below presents findings from 56 countries (including 100% of PEPFAR-supported countries) which reported on the status of their HIV commodity stocks and supply chains between February and April 2025.^[2]

The nature of PEPFAR support is different in all countries, and inclusion in this fact sheet does not necessarily mean that PEPFAR funded HIV commodities or supply chains specifically in that country, nor that all the issues faced are directly attributable to the US funding cuts.

​This fact sheet reflects the situation based on information available as of 28 April 2025. Given the rapidly shifting situation, the information presented could change significantly as the situation evolves.

SUMMARY

• Funding for antiretrovirals often comes from diverse sources and their availability and effective delivery to those who need them depends on well-coordinated stakeholder efforts. Some 14% of countries reported six or less months of stock in at least 1 antiretroviral line.
• The degree of public uncertainty and concern over the continued availability of and access to free antiretroviral treatment has increased significantly. Some 18% of countries flagged public reactions to uncertainty, among others changes in individual behavior related to antiretroviral treatment.
• The most frequent variations in antiretroviral dispensation in countries include reductions in multi-month dispensing periods and in dispensing of emergency supplies, restricted switches to alternative antiretroviral regimens, closures of certain antiretroviral treatment dispensing points, and antiretroviral stock redistribution. Authorities have often sought to preempt or respond to rumors and uncertainty by proactively communicating about antiretroviral availability.
• Global Fund existing (or incoming) antiretroviral stocks are helping some countries ensure HIV commodity availability. National authorities are also securing supplementary domestic budget allocations to ensure HIV commodity availability and management.
• Despite the precarious situation faced by many community-led organizations because of the USG shift, they continue to play a central role in engaging and informing communities, addressing rumors, advocating for mitigation actions, and providing early warning on ARV availability, accessibility and cost.
• Significant disruptions affecting combination prevention commodities have been reported as a result of the USG shift. This is due to the dominant role played by PEPFAR in prevention commodity procurement, distribution or delivery in many countries. Some 23% of countries reported six or less months of condom or PrEP stocks.
• Around 21% of countries reported six or less months of stock in at least 1 HIV testing commodity. Careful monitoring of individualized country situations is necessary to mitigate any possible increase in stockout risks.
• Even when HIV commodities exist in-country, they may not always be reaching health facilities – creating patient-facing shortages that undermine trust in treatment continuity. Some 46% of countries reported supply chain management issues.
• The repercussions of the USG shift on the global HIV commodity markets should not be underestimated in the medium term. Sustained predictability in HIV commodity demand forecasts is essential to guarantee a stable supply, maintain prices, and ensure the availability of affordable generic medicines for national HIV responses.

CONTINUE READING

[1] Commodities include ARVs, HIV tests, VL and other lab tests, early infant diagnosis reagents and supplies, as well as prevention commodities (including PrEP and condoms).

[2] The data analysed comes primarily from three sources: 1) Open-text reporting by UNAIDS country offices through the UNAIDS tool “Monitoring HIV Programmes’ Continuity Amidst US Shifts” for the period 5 February – 28 April 2025; 2) UNAIDS country office ad-hoc email updates for the period 18 -24 March and 16-23 April, and 3) UCO / RST consultations with national and regional PLHIV networks on 18-20 March.

Current implementation and disruptions

Documented impact on services

Due to the suspension of US-funded antiretroviral deliveries, critical gaps in ARV availability are expected as early as Q2 2025 for patients in ABC/3TC regimen.

Abacavir/Lamivudine 600/300 mg (ABC/3TC): The availability of the medication is approaching a critically low level. There are potential risks of a shortage of this medicine. The available supply will cover approximately 3.2 months (as of 01 March 2025), which means a stockout is expected by June 2025. The supply under COP23 that included the delivery of 229 packs was blocked. The delivery date to the country is currently unknown.

Lamivudine oral solution, 10 mg/ml (240 ml) 3TC fl: Delivery of 2,364 bottles for children was suspended, with no national procurement planned for 2026. Considering the expiry date of the majority of the remaining stock (June 2026), the treatment coverage is 16 months. The information is provided without considering the use of the medicine for PMTCT.

Nevirapine oral suspension 50 mg/5 ml (100 ml) NVP fl – the supply of 617 bottles is suspended. The treatment coverage with available stock is 15.4 months.

Raltegravir 100 mg (60 tablets) RAL 100mg – supply of 641 packs suspended. At the end of 2024, part of the ARV supply procured under COP23 with PEPFAR funding—579 packs (34,740 tablets)—was distributed to the oblasts. As patient enrollment and treatment optimization progress, the supply coverage will change. Considering the expiry date of the majority of the remaining stock (November 2026), the current supply coverage is 21 months.

Raltegravir 400 mg (60 tablets) RAL 400mg – the distribution of 3,471 packs to the regions is ongoing but will finish soon. Optimization based on treatment regimens using this ARV is underway, and new patients are also being initiated on therapy. Since the expiry date of most of the remaining ARV stock is set for 30 April 2026, the estimated stock coverage is approximately 14 months.

Tenofovir/Lamivudine/Dolutegravir 300 mg/300 mg/50 mg (90 tablets) TLD – In mid-March 2025, 168,397 packs of ARVs (15,155,730 tablets) procured under COP23 with US funding were delivered to the national logistics warehouse. The medicine is currently undergoing inventory control and is being prepared for distribution to the oblasts. The overall national supply coverage will amount to 9.4 months. A buffer stock of 41,273 packs (3,714,570 tablets) remains at the logistics warehouse.

Immediate Risk: Starting from April–May 2025, 193 patients out of 117473 patients on Abacavir/Lamivudine 600/300 mg (ABC/3TC) regime may face treatment interruption.

Collapse of PrEP Scale-Up and Discontinuation of Pilot CAB-LA Programs: In 2025, the PrEP program is at high risk due to halted procurement. The total stock of Tenofovir Disoproxil Fumarate 300 mg / Emtricitabine 200 mg, (TDF/FTC), across Ukraine amounts to 792,240 tablets. Based on the average monthly consumption of 150,346 tablets, the estimated supply coverage of TDF/FTC for PrEP is approximately 5.3 months. A request was submitted for 140,850 packs of TDF/FTC to be funded by the US. However, due to the suspension of US funding, this procurement is currently in question. An urgent procurement of the quantity requested using Global Fund resources is being considered.

CAB-LA: The injectable form of PrEP, CAB-LA, is supplied to two pilot regions: Kyiv and Lviv. The estimated supply coverage is approximately 14.5 months. Immediate Risk: Starting from Q2 2025, the country will likely face inability to initiate new PrEP users among key populations and a disruption in the continuity of prevention for over 13 thousand people already enrolled in the programme.

Breakdown of HIV rapid diagnostics: There is uncertainty about timely delivery of rapid diagnostics tests. Stock balance – 14,823 tests (including 470 tests expiring on 05 June 2025 and 14,353 tests expiring on 08 October 2025). The current stock is expected to last until August 2025. A delivery of 8,480 tests is expected in June 2025.

As of April 2025, the U.S. Government has suspended humanitarian assistance programs, including those funded by PEPFAR, which previously provided essential HIV-related commodities. This suspension has: 1) Blocked planned shipments of antiretroviral medications (ARVs), including major components of pre-exposure prophylaxis (PrEP), 2) Left pending orders under the COP24 procurement cycle in limbo — notably 140,850 packs of TDF/FTC for PrEP, which were to be funded by PEPFAR.

Direct Impact on Service Availability

Disruption of PrEP Services: The uncertainty with procurement for 140,850 packs of Tenofovir Disoproxil Fumarate / Emtricitabine (TDF/FTC) under PEPFAR funding has placed the national PrEP program at risk. The current supply is expected to be exhausted by mid-August 2025, based on average monthly consumption.

No confirmed delivery timeline is available, jeopardizing PrEP continuity for individuals at high risk of HIV infection, PWID, SW, MSM, serodiscordant couples.

Risk of ARV Shortages: Delays linked to the waiver’s absence are contributing to projected shortages of several essential ARVs, particularly:

Abacavir/Lamivudine (ABC/3TC) – with a stockout expected as early as June 2025.

Some ARVs are at risk of expiring before use, due to supply overlaps and administrative uncertainty (e.g., 4,450 packs of ABC/3TC and 8,300 packs of Ritonavir).

Risk to Diagnostics: The current stock of rapid diagnostic HIV tests is expected to last until August 2025.

Government convening, mitigation measures

The Ministry of Health (MoH), through the Public Health Center (PHC), is conducting rapid assessments of ARV, diagnostic, and PrEP stock levels to identify urgent supply gaps. Efforts are underway to reallocate existing stocks from regions with surplus to high-need areas, prioritizing children, pregnant women, and patients on second-line regimens.

The Government of Ukraine, in consultation with partners, is exploring the use of unspent budget lines and Global Fund reprogramming to cover immediate gaps.

The Global Fund Country Coordinating Mechanism (CCM) is actively reviewing budget flexibility for 2025–2026 to prioritize life-saving commodities. UNAIDS to support technically an immediate application by Ukraine to be submitted to the Pandemic Fund for which Ukraine would qualify. WHO and UNAIDS are in dialogue with partners to map regional lab capacity and support logistics to shift patient samples for central testing if needed.

This crisis has accelerated dialogue on transition and sustainability planning, including an appeal to pharmaceutical companies and medical goods manufacturers to explore the possibility of receiving commodities as free humanitarian or charitable assistance.

Civil society impact, resilience and response 
In response to diagnostic test shortages, civil society organizations (CSOs) and local healthcare facilities have initiated internal redistribution of rapid HIV test kits purchased with local and regional budgets, as well as other budgetary programs.

Civil society platforms actively pushed for government and international donor action by: Submitting urgent appeals to donors for temporary humanitarian shipments of ARVs and PrEP, Coordinating with Global Fund implementers (e.g., 100% Life, Alliance for Public Health) to track deliveries rapid HIV test kits and PrEP supplies.

UN response

Advocacy for emergency procurement and resource mobilization: UNAIDS and UN partners are supporting national counterparts, including the Ministry of Health (MoH) and Public Health Center (PHC), in engaging international donors to mitigate disruptions in ARV and PrEP supplies.

UNAIDS is working with the MoH and other stakeholders to develop longer-term strategies for transition and sustainability, including Diversification of procurement sources, Programmatic optimization to prioritize high-impact interventions amid constrained resources.