Immediate risks and disruptions

1. Loss of PEPFAR support:
   • The community outreach programme is on hold while clinical services continue in the 22 clinics supported by PEPFAR (out of 880 clinics nationally providing ART) across the 4 provinces out of 21 in Angola.
   • Across the country, facilities/service points delivering antiretroviral treatment are working with the same capacity. While stocks of antiretroviral supplies, HIV, viral load and other lab test kits are available, recent reports indicate challenges with distribution.
   • Logistics disruptions have led to facility-level stockouts of HIV commodities, despite stock being available in regional warehouses.
   • The purchase of condoms by INLS and partners, including PEPFAR and the Global Fund, has historically covered only half of the estimated need due to resource limitations. A national condom strategy is currently under development.
   • PEPFAR distributed condoms in the 22 clinics they support and via outreach programmes, which are now on hold.
   • There has been a disruption in the PEPFAR data collection system. Data for Q4 (September-December 2024) is still being collected and analyzed due to a lack of human resources to support DHIS2 (health logistics data) reporting. Eighteen PEPFAR-supported sites are included in the Estimation and Projection Package Spectrum model for calculating HIV incidence; however, PEPFAR antenatal care testing data was not available to serve as a benchmark against the reports submitted in DHIS2.
   • Angola received PEPFAR funding for work on community-led monitoring. This has been terminated.
   • PEPFAR support for stigma, discrimination and enabling legal environments has stopped.
2. Government mitigation measures:
   • The Government has planned mitigation measures for each of the PEPFAR programme components. The plan indicates that the national budget is suggested to cover testing, treatment and laboratory consumables, while it is suggested that community programmes should be supported by public and private institutions.

Documented impact on services

A rapid assessment of the impact of the US funding cuts on service delivery is available. As outlined by the Institute for the Fight Against HIV/AIDS (INLS), the greatest impact of the loss of US support in Angola will be felt in the quality of services, as indicated below: 

1. Peer education for adolescents and youth:
   • In 2024, PEPFAR supported training and mentoring for 467 health professionals creating mutual support groups and peer-to-peer programmes for adolescents and youth.
2. Prevention of vertical transmission of HIV:
   • As of September 2024, 1,163 pregnant women living with HIV were enrolled in a programme to prevent vertical transmission of HIV in 22 health units supported by PEPFAR.
   • Community support programmes for treatment, adherence and psychosocial support are on hold.
3. Early infant diagnosis:
   • In addition to support for early infant diagnosis in the 22 health units covered by PEPFAR, the community component of PEPFAR supported a pilot to collect blood samples in the community, which led to an increase in early infant diagnosis from 36% to 88% in health units supported by PEPFAR. The loss of community outreach undermines these lifesaving efforts.
4. Clinical management for people living with HIV:
   • PEPFAR supports about 6% of HIV tests in the country.
   • As of September 2024, 3,609 people were newly identified as HIV-positive, with 84% enrolled on antiretroviral treatment (ART). Without US funding, lower case identification will occur, increasing the risk of transmission and health complications.
   • By 2024, a total of 26,999 people living with HIV were on treatment at PEPFAR supported sites, representing about 16% of people on ART across the country
   • In addition, active community outreach ensured that out of 1,007 people who interrupted treatment in the third trimester of 2024, 707 (70%) were successfully re-enrolled in treatment;
   • Only in places where there is support from PEPFAR or the Global Fund (Benguela, Bié, Cuanza Sul, Huambo and Lunda Sul), is systematic community engagement effectively implemented (focused on pregnant women, children and high-risk young people); the backing of  mutual support groups of people living with HIV; the provision of psychosocial support for enhanced adherence to HIV treatment, information, education and active communication on HIV prevention, including the distribution of condoms and community based testing and linkage to services.
5. Strengthening the health system:
   • PEPFAR has facilitated training and capacity building for HIV health workers, improving local health systems.
   • Support for data collection and monitoring has reinforced health systems and enabled data-driven decision-making.
   • PEPFAR is the only program that supports the evaluation of the quality of diagnosis, increasing the accuracy, effectiveness and quality of HIV testing services in the country.

Politically relevant updates

1. Government convening and mitigation measures:
   • The National Institute for the Fight Against AIDS (INLS) has developed a mitigation plan, proposing the national budget cover clinical staff and medical inputs for users of 13 health units supported by PEPFAR.
   • Resource mobilization from public and private institutions is identified to cover community engagement and programmes.
   • INLS is coordinating the mitigation measures with the Ministry of Health and the CCM.
2. Civil society impact:
   • Community Led Monitoring programmes have been terminated.
   • Community outreach programmes, including those for youth, pregnant women, and people living with HIV, are on hold.
   • Civil society organizations are struggling, and while some have alternative funding sources, most organizations are unable to continue their planned work.
3. UN response:
   • UNAIDS has met with networks of people living with HIV and key populations to assess emerging challenges and discuss mitigation measures.
   • In collaboration with Government and civil society, plans to develop national approaches to PEPFAR-supported community-led models are underway.

Immediate risks or disruptions

1. Impact on cooperative agreements:
   • WHO-US CDC cooperative agreement: The WHO-US CDC cooperative agreement has been significantly impacted, particularly in provision of technical assistance to expand point-of-care services, expanding pre-exposure prophylaxis services, strengthening strategic information systems, capacity-building through training, workshops, and seminars, as well as travel and human resources-related costs.
   • Ministry of Health cooperative agreement: The HIV department is partially impacted, with some planned activities not receiving full US Government approval or funding. The US funding cuts have significantly impacted maternal and child health programs, the original $400,000 commitment per year was reduced by more than 50%. This reduction has led to major challenges in capacity-building efforts, limited training opportunities for healthcare providers, and reduced plans for integrating maternal and child health services into point-of-care sites.
   • WHO cooperative agreement: Fully affected, disrupting all planned activities under their Direct Financial Cooperation agreement with the government. This includes efforts to strengthen laboratory service quality, improve strategic data reporting and cover human resource- related costs.
2. Service delivery:
   • Routine HIV services at antiretroviral therapy sites and points of care remain largely unaffected due to the national programme’s continued provision of regular HIV testing and antiretroviral care.
   • However, the US funding cuts have disrupted HIV prevention programmes, particularly those supported by PEPFAR through USAID/FHI 360 and WHO-US CDC. This has led to  delays or disruptions in community-based HIV outreach programmes.
3. Community impact:
   • Eight staff members from the Association of People Living with HIV across 12 operational provinces will lose their jobs, further impacting service delivery and community support efforts.
   • Community-led organizations have experienced a reduction or suspension of services, loss of funding, and loss of staff, reducing their ability to collect and report data and limiting their ability to reach out into the communities to provide HIV prevention services.

Politically relevant updates

1. Government and international response:
   • The Global Fund to Fight AIDS, Tubercuosis and Malaria (Global Fund) and the United Nations have advocated for the government to fully access and optimize the Health and Nutrition Services Access Project (HANSA) grant and loan components to bridge gaps created by the US funding cuts.
   • Communities have approached the French funding mechanism L'Initiative from Expertise France to help close funding gaps.
   • The UN Country Team has mapped the funding gaps and has started quantifying the reduction from the United Nations Sustainable Development Cooperation Framework (CF) as a result of the decrease in overseas development assistance. Eleven of the CF’s 21 outputs have been affected by funding reductions. Programmes affected by funding reductions account for more than a quarter of expected available funding in 2025. Outcome 1 (including Health, Nutrition and Food Security) has the most funding at risk of reduction. Outputs in Outcome 3 (Governance and Rule of Law) see the largest proportional reduction in funding.
   • UNAIDS has supported the government in mapping the gap caused by the US funding cuts and has shared a report with the Global Fund and other development partners.
   • UN Joint Team has mapped the impact on the Joint Programme. While the UNAIDS Cosponsors are looking for stop-gap measures to cover the gaps in the short term, the US funding cuts are expected to significantly reduce the UN’s contribution to the HIV response in Lao PDR. Since the US was the sole donor to UNODC’s health program in Lao PDR, this will result in the suspension of all UNODC health-related activities in the country as of May 1, 2025. 

Civil society impact, resilience and response 

• The Community-led monitoring for key populations project, implemented by the Association of People Living with HIV and supported by USAID/FHI 360, operates in Vientiane Capital, Savannakhet, and Champasak provinces. This initiative enhances community engagement among men who have sex with men and transgender individuals, strengthening their capacity to address their own health challenges while fostering trust and collaboration between communities and healthcare providers. This project has significantly improved health outcomes and reduced stigma. However, the suspension of this project is expected to hinder the expansion and scale-up of HIV community led monitoring across all key population services. The loss of eight staff members from the association of people living with HIV across 12 operational provinces will further impact service delivery and community support efforts.
• Despite these challenges, some community-led organizations are managing to sustain efforts through alternative sources of funding, demonstrating resilience and adaptability in the face of funding cuts. However, these measures may not be effective beyond 2025 and will result in weakening the inclusion of community-led efforts in the HIV response. 

Immediate risks or disruptions

1. Vertical transmission services: An impact assessment conducted by the Ministry of Health, supported by UNICEF, confirms:
   • Staffing gaps and shortages: There are significant staffing gaps affecting the availability of counsellors and other essential personnel.
   • Testing disruptions: HIV testing services are disrupted, with specific issues such as a non-operational point-of-care machine in one district.
   • Overcrowding: There is overcrowding in health facilities across all 10 districts due to staff shortages.
   • Data quality issues: Data completion and quality are severely impacted as nurses struggle with using the registers.
   • Resource allocation: The field assessment highlights the need for reprogramming of, and additional, resources.
2. Service restart challenges:
   • Partners who received waivers to restart services are facing difficulties in resuming operations effectively.

Politically relevant updates

1. Government actions:
   • A national resource mapping exercise has been launched by the Ministry of Health to guide reprogramming within the health sector. This exercise aims to provide a detailed understanding of available resources to support broader health sector interventions.

Immediate Risks and Disruptions

• The US waiver allowing the continuation of lifesaving treatment and the court order allowing CDC-led activities to resume resulted in the resumption of the provision of antiretroviral treatment (ART) and prevention of vertical transmission of HIV.
  • Activities for key populations, HIV-prevention, human rights, and community-led monitoring (CLM) have ceased.
  • Contracts providing support to national civil society organizations (CSOs) have been terminated. National implementing partners like Espace Confiance, ASAPSU, and Blety ceased all activities supported by the USAID in March.

Politically Relevant Updates

1. Government actions:
   • The government has requested a rapid analysis of the financial gap following the cessation of US funding (internal report not yet available).
   • The Ministry of Health issued a directive on service continuity, ensuring access to ARV care and other services.
   • An antiretroviral order planning meeting has been held. ARV stocks have been secured for the next 4 months and an order schedule for the remaining part of the year has been agreed.

   • The CIPHIA (Côte d'Ivoire Population-based HIV Impact Assessment) survey has resumed, with final report availability expected by the end of September 2025.

      

2. Civil Society Response:
   • Civil society organizations have launched an advocacy campaign, including a letter to the president, press conferences, and media interviews calling for continued support and funding for HIV programmes, including sustainable financing of civil society and community-led responses

   • Temporary measures have been implemented to maintain services and staff in certain NGOs, including minimal service, part-time contracts, and salary reductions. However, these measures cannot be sustained in the absence of additional funding. CSO are working on developing funding proposals.

      

3. UN Involvement:
   • The UN has met with civil society and is in ongoing dialogue with CSOs re the impact and mitigation measures.
   • UNAIDS has produced and shared short videos of interviews with community leaders and beneficiaries; they have garnered more than 4000 views on social networks.
   • Government officials have been informed, sensitized, and mobilized on the impact and the need for a coordinated and systematic response. This included using UNAIDS GOALS impact model on new HIV infections and HIV related deaths in absence of a comprehensive response.
   • An analytical technical note on the impact of the US funding cuts and recommendations for mitigation strategies was produced and shared with government officials.
   • The UNAIDS Rapid AIDS Financing Tool (RAFT) has been shared and promoted with various government offices, including the Directorate General of Health, Directorate of Health Economics, National AIDS Control Program, and the prime minister's office.
   • Resources have been mobilized from various sources to ensure the continuation of critical UNAIDS activities: Expertise France for technical assistance on the sustainability roadmap, reprogramming of CDC cooperation agreement activities for approximately 150,000 USD (Expertise France, BMGF, GF/GC7 grant).

Commodity stock report

The commodity stock report elaborated by the Ghana Health Services/Ministry of Health under the umbrella of the Global Fund Logistics Support Project, provides insights into the national availability of key HIV and other health commodities. The recently released information for the month of February contains the below mentioned information on the availability of antiretroviral treatment and other HIV commodities.

• Antiretroviral treatment:
• Tenofovir/Lamivudine/Dolutegravir (TLD 300/300/50mg): Fully available nationwide with a slight overstock - 12.85 months of stock.
• Dolutegravir 50mg: Fully available with overstock – 18.19 months of stock.
• Tenofovir/Lamivudine (300/300mg): Overstock - 41.62 months of stock
• Lopinavir/Ritonavir (200/50mg): Fully available with overstock - 17.83 months of stock. Nevertheless, there is only 64% availability across regional medical stores, with stockouts in Ashanti, Bono and Bono East regions. Distribution to these regions aims to stabilize supply.
• Dolutegravir 10mg: Adequate stock - 10.85 months of stock with 91% availability at regional medical stores and teaching hospitals. Allocation and distribution measures aim to stabilize supply.
• Abacavir/Lamivudine (120/60mg): Critically low stock levels at 1.22 months of stock with 64% availability at regional medical stores; new shipments are pending clearance.
• Paediatric and syrup formulations: Zidovudine/Lamivudine tablet stock is high (25.27 months of stock). Nevirapine syrup is fully available (6.38 MoS), there are lower stock levels of Zidovudine syrup (3.17 months of stock), with an incoming shipment expected.
• HIV and syphilis diagnostics:
  • OraQuick HIV test kits: Availability improved from 91% in January to 100% in February (4.93 months of stock).
  • HIV first response & syphilis combo test kits: Consistently at 100% availability (6.45 and 9.54 months of stock respectively).
  • Rapid diagnostic tests SD bioline: Stockouts in Ashanti and Bono, with critically low in-country stocks (0.87 months of stock). A shipment of 75,240 kits is expected in April 2025.

Politically relevant updates

• Ghana Medical Trust Fund:  The Government of Ghana has launched the Ghana Medical Trust Fund (Mahama Cares Initiative). This presidential initiative, launched in mid-March, aims to provide financial support for people with chronic diseases. The Ghana AIDS Commission (GAC) and the UNAIDS Country Office have initiated discussions  to potentially include HIV as one of the health conditions to be covered by this mechanism.  This alternative has been also included as part of the options to explore in Ghana’s Sustainability Roadmap document. UNAIDS is providing support to the GAC to amend the terms of reference for the HIV Sustainability Technical Working group to include the documentation of the impact of US funding cuts as part of the mechanisms to streamline the coordination, monitoring and mitigation of the situation.

• Human rights steering committee meeting: On 26 March, the Ghana AIDS Commission convened the 7th Human Rights Steering Committee Meeting, chaired by the Acting Director General. The meeting included key national and international partners, including UNAIDS, to advance the human rights agenda within the HIV response. The Committee recommended strategic engagement with the PEPFAR Coordinator to get accurate programmatic and financial information on human rights-related interventions supported by the US.
• Courtesy visit from PEPFAR team to the Ghana AIDS Commission: On 3 April, a PEPFAR team delegation led by the PEPFAR Coordinator for West Africa II Region (Ghana, Liberia, Sierra Leone, and Mali), paid a courtesy visit to the Acting Director of the Ghana AIDS Commission and his team. This was the first official meeting of the PEPFAR Team with the Ghana AIDS Commission since January. Initial discussions on the relevance of PEPFAR’s support to the HIV response in Ghana took place.
• Bilateral Meeting UCD-Ghana and PEPFAR Coordinator for West Africa II: On 4 April, a bilateral meeting was held at the UNAIDS country office between the UNAIDS country director and the PEPFAR Coordinator for West Africa II Region (Ghana, Liberia, Sierra Leone, and Mali).  The iscussion focused on the critical need to maintain US support in Ghana to ensure programmatic sustainability, to achieve the 95-95-95 and 10-10-10 targets, and to continue the collaboration in support of the process led by the Government of Ghana to develop the HIV Sustainability Roadmap. 

• Coordination with Civil Society Organizations and communities.

  On 3 April, UNAIDS Country Office initiated a series of bi-weekly meetings with community-led organizations to assess the impact of the US funding cuts on their work, including their focus on human rights, stigma and discrimination, and HIV prevention. The community-led organizations agreed to design a tool to map out the projects previously funded by the US Government that have stopped and to find alternatives to close the gaps and maximize efficiency in the delivery of programmes.

Low- and middle-income countries across the world continue to adapt to suspensions and terminations of United States support to their national AIDS responses.

In South Africa, for example, a coalition of civil society organizations published an open letter to the government expressing their concerns following the termination of many US-funded HIV projects and demanding transparency in the government’s response to the situation. The same day, Health Minister Aaron Motsoaledi expressed confidence that the country will achieve a new national target to put an additional 1.1 million people living with HIV on treatment. He also revealed that discussions are underway with BRICS countries on how to fill gaps left by cuts in PEPFAR funding. 

In Malawi, the Government’s 2025-26 budget has allocated 23.3 billion Malawian Kwacha (US$13.3 million) to the Ministry of Health and plans to hire 6,000 workers to mitigate the impact of the US funding cuts.

In the Philippines, the government announced that its next budget will include some  expenditures previously supported by US funding. 

Across all countries that received significant US funding for their AIDS programmes, grassroots organizations and community health workers that provide services to vulnerable and marginalized people have been deeply affected by US funding cuts. Among 70 UNAIDS Country Offices that have submitted data on the situation, 40% reported that community-led services had been stopped by the US funding cuts. By comparison, 30% reported that services by international NGOs had been stopped, and 3% reported that government services had been stopped.

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Immediate risks and disruptions

1. Access to Kenya electronic medical records system: There are media reports indicating that aggregate health data are not accessible through the Kenya health information system (DHIS2).
2. Commodity availability: Short-term commodity availability has improved, with HIV commodities now being available at facilities. However, human resources for health remains impacted.
3. Service impact: Services for HIV, TB, malaria, immunization, nutrition, and family planning programmes are still affected. HIV prevention programmes have been paused or scaled down.  

Politically relevant updates

1. Impact of US Government funding cuts: The Kenyan Government released a comprehensive report on 24 March detailing the impact of the US Government funding cuts. Key recommendations include:
   • Immediate actions:
     • Establish an emergency health contingency fund.
     • Mobilize domestic resources and reallocate the national budget.
     • Begin high-level diplomatic negotiations with the United States.
   • Medium-to-long-term actions:
     • Strengthen public-private partnerships.
     • Expand universal health coverage and implement health insurance reforms.
     • Develop local pharmaceutical manufacturing.
     • Set up a donor coordination platform with real-time monitoring and mapping.
     • Create a structured contractual and legal framework to ensure resilience.
2. Government convening and mitigation measures: The National AIDS & STI Control Programme and the National Syndemic Diseases Control Council are planning to take an in-depth account of the situation at the county level on HIV treatment for adults and children.

Impact highlights

1. Civil society impact: Kenyan civil societies, led by the Kenya Legal and Ethical Issues Network, have demanded clarification from the Office of Data Protection Commission on measures taken to safeguard health data and ensure compliance with relevant data protection laws.
2. Community-led initiatives: ISHTAR, a key populations-led organization, received funding from other donors to continue with community-led monitoring work until the end of March.
3. UN response: The UNAIDS country office, in partnership with the National AIDS & STI Control Programme and the National Syndemic Diseases Control Council is developing a proposal to mobilize resources from the China International Development Cooperation Agency for HIV and other sexually transmitted infections prevention activities.

Documented impact on services

All facilities/service points providing antiretroviral treatment are working at a reduced capacity. The UNAIDS country office has received reports from the field that HIV commodities are now available at the facilities. The country has currently adequate HIV commodities and those that were running low at health facility level were flagged on 14 March 2025 by the Cabinet Secretary Ministry of Health for distribution by the US supported procurement agency. No stockouts are foreseen in the next 3-6 months. However, human resources for health remains impacted. 

Immediate risks and disruptions 

1. Documented impact on services:

• Reduced availability of PrEP; suspension of HIV prevention education and awareness campaigns, and decreased access to HIV testing and counselling services for key populations.
• Disruption of the distribution of condoms, lubricating gel, antiretroviral drugs.
• All programmes on stigma and discrimination funded by the US Government have stopped. 

2. Disruption of HIV data collection:

• Cessation of data entry at PEPFAR sites, leading to a disruption in HIV data collection.

3. Decrease in viral load testing:

• Viral load testing has decreased due to the slowdown in services at PEPFAR-funded sites.

4. Stock concerns:

• Concerns about stock-out of HIV test kits within 3-6 months.
• Condom stocks are sufficient for 1-3 months; but there is a need for 800,000 condoms per month, with funding for procurement being a concern.

5. International NGO-run services:

• All services run by international NGOs funded by US Government/PEPFAR have stopped. 

Politically relevant updates 

1. Government actions:

• The National Programme for the Fight against HIV/AIDS and Sexually Transmitted Infections has conducted an analysis of service provision, commodity availability, and human resources.
• The National Council for the Fight against AIDS sent an information note to the President and the Ministry of Health.
• Advocacy efforts with other technical and financial partners to mobilize resources to fill gaps.
• Integration of HIV services into other health services is being worked on by the government.
• The government is funding 55 operational sites and 142 mediators.

2. Civil society impact:

• Civil society has assessed financial, programmatic, and human resources gaps.
• Consultation meetings with the National Program for the Fight against HIV/AIDS and Sexually Transmitted Infections and implementation of a roadmap. 

Impact 

1. Impact of USAID funding suspension:

• 11,000 people living with HIV will lose access to antiretroviral treatment.
• 24,769 people living with HIV will no longer have access to viral load testing.
• 10,000 individuals, including pregnant women and their children, will miss out on testing.
• 203 project staff are facing technical unemployment since January 2025.

2. Current financial gaps:

• Togo faces a financial gap of 2.1 billion FCFA (West African CFA franc) for 2025, with 1.6 billion FCFA needed for antiretroviral medications and reagents.

3. Proposed solutions:

• Increase the state budget line for health from 2.5 billion FCFA to 5 billion FCFA.
• Include HIV as a chronic disease in the universal health insurance mechanism to ensure sustainable domestic funding. 

UN response 

• The UNAIDS Country Office is meeting with networks of people living with HIV and key populations, and a country-level task team is in place, including representatives from people living with HIV and key population networks.