East and Southern Africa

Documented Impact on Services: 

Government Support: HIV programmes are primarily (60%) supported by the government, with public health facilities operating normally. 

Service Disruptions: All key population drop-in centres are closed, limiting access to services. 

Workload and Quality: Increased workload for government staff may hinder adequate monitoring of adherence and retention for clients on treatment. There is a risk of losing trained staff, which could lead to poorer service quality. 

Medium-Term Risks: The quality, efficiency, and sustainability of the national HIV response may be affected due to halted US Government-funded technical assistance in critical areas like the National Sustainability and Transition of TB and HIV roadmap, the development of the National Strategic Framework IV, and HIV estimates for children and breastfeeding women. 

Human Rights, Key and Vulnerable Populations: 

Service Gaps: The pause in U.S. assistance to community programs and drop-in centres means tens of thousands will lose access to critical services such as HIV testing, ART, PrEP, and screenings for tuberculosis and sexually transmitted infections. 

Closure of Drop-In Centres: Most drop-in centres for key populations are closed, with only one in Gaborone partially open. This closure affects safe spaces for key populations, potentially leading to treatment default. 

Government Convening and Mitigation Measures: 

Task Force: A Joint Oversight Committee Task Team - including government, civil society organizations, and other partners co-chaired by UNAIDS - has been established to monitor the impacts of the pause order and develop mitigation measures. 

Referral Systems: The Ministry of Health is working with civil society organizations (CSOs) to ensure clients whose usual drop-in-centers have been closed are informed of where to access services. 

Civil Society Impact, Resilience, and Response: 

CSO Collaboration: Measures are being put in place to ensure that CSO-provided services that have been closed collaborate with government-funded CSOs and refer clients to government facilities. However, demand creation related to vertical transmission and pediatric HIV has been affected. UNAIDS is facilitating regular dialogues of CSOs to assess the situation and collectively decide on mitigating measures. 

AGYW Services: Services for adolescent girls and young women (AGYW) have been closed, with clients referred to Ministry of Health youth-friendly service points. Referral channels for structural and social services for AGYW are still unclear. 

Community-Led Monitoring (CLM): CLM is primarily supported by the Global Fund and domestic funding. The halt in US Government support affects the implementation and monitoring of CLM. 

Politically Relevant Updates 

Government Actions: The government, through the National AIDS and Health Promotion Agency and the Ministry of Health, is actively involved in mitigating the impacts of the pause order and ensuring the continuity of essential services. 

International Support: The involvement of UNAIDS and other development partners highlights the international community's role in supporting Botswana's HIV response. 

Ethiopia has made significant progress in its HIV response in recent years and is on track to reach the UNAIDS 95-95-95 targets with 90% of people living with HIV in the country 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.   

But now, that progress is at risk. The recent pause in United States foreign assistance poses a direct threat to the lives and well-being of thousands of people living with HIV in Ethiopia and millions globally. Critical services are grinding to a halt, leaving people who rely on them facing an uncertain and dangerous future. 

Ethiopia is heavily reliant on external funding for its AIDS response. PEPFAR provides 53% of HIV funding in the country. In 2023, UNAIDS’ estimates show that there were 610 000 people living with HIV in Ethiopia, 510 000 of whom were accessing antiretroviral treatment.  

For women living with HIV, uncertainty is growing. Limited and unclear communication from healthcare providers and policymakers has left them in the dark about treatment changes, medication availability, and service disruptions. With no clear answers, they are forced to rely on rumors, fueling fear and anxiety. 

“We don’t know what’s happening. Are services being cut permanently? Will we still get our medication next month? No one is telling us anything,” one woman shared. 

To make matters worse, case workers and counsellors—once a vital source of medical and emotional support—are disappearing. These professionals were more than healthcare providers; they were trusted confidants who ensured women received care in a stigma-free environment. Their absence is leaving many feeling abandoned. 

“They understood our struggles, checked in on us, and made sure we had what we needed,” another woman explained. “Without them, we feel forgotten.” 

As services become increasingly unreliable, distress and fear are taking hold. 

Shortages and desperate measures  

Funding cuts bring shortages, and for women living with HIV, the fear of running out of medication is overwhelming. Access to antiretroviral therapy (ART) is essential—it keeps people alive. Yet many are already facing supply disruptions, and whispers of medication shortages are spreading panic. 

“If I can’t get my medicine, what happens to me?” one woman asked. Women living with HIV who have been healthy for years now fear an uncertain future where their treatment is no longer guaranteed. People living with HIV who do not access antiretroviral therapy will eventually develop AIDS and die. To cope, many have resorted to stockpiling medication, traveling long distances and spending entire days at clinics in hopes of securing extra supplies. While understandable, this survival strategy comes at a heavy cost—disrupting work, family life, and daily routines. No one should have to live in fear of their next refill. The urgent need for stable, uninterrupted HIV treatment cannot be overstated. 

Adding to the crisis, shortages extend beyond medication. The dwindling supply of test kits, including viral load tests, is threatening the future of diagnosis and monitoring. These tests are crucial to ensure that people living with HIV maintain undetectable viral levels, reducing transmission risks and protecting their health.  

Fears have also been expressed around the availability of medications for HIV prevention, particularly for the prevention of vertical transmission of HIV. If the current pause in the supply of medical resources continues, the availability of these vital medications could be severely compromised, putting the lives of women and children at even greater risk.   For women living with HIV who are pregnant, a lack of lifesaving medications for themselves also means their children can be born with HIV even though this is entirely preventable.

Without test kits and prevention measures, undiagnosed and untreated cases could rise dangerously. “We can’t afford to go backward,” one woman said. 

A Plea for Action 

The voices of these women reveal a stark and urgent reality—funding cuts have left people living with HIV in a state of uncertainty, with no clear path forward. 

"Urgent intervention is needed,” stressed Tina Boonto, Country Director for UNAIDS Ethiopia. “UNAIDS is gathering information and developing funding solutions to address the shortfall, with proposals for both the government and external partners to ensure continuity of critical services. We hope Ethiopia's government will step up and lead in covering these essential services. We must act now to safeguard gains that have been made and succeed in securing sustainable support to people living with HIV." 

While the future remains uncertain, one thing is clear: without swift action, the hard-won progress in Ethiopia’s HIV response is at risk. 

There is minimal disruption to HIV services in Malawi. People living with HIV are receiving services. People living with HIV who go to facilities that have been are closed are being referred to government services that are open. Early last week, in response to UNAIDS’ advocacy, the government issued a press release assuring the public that HIV services will continue uninterrupted. Also last week the government developed a contingency plan, which will form Part B of the ongoing work to develop a Sustainability Plan for Malawi. The government issued a circular of the activities it will prioritize going forward. It has redeployed its staff to fill the positions that are vacant because of the stop order. In general services are ongoing. 

Unfortunately, PrEP and long-acting injectables are not part of the package the government will prioritize. Civil Society groups are concerned about the omission of prevention interventions beyond treatment and PrEP for pregnant and breastfeed women. UNAIDS is working with other international partners to see if they would be willing to support PrEP and long-acting injectables.

Staff partner reduction

Non-government organisations such as Partners in Hope, Partners in Health, Baylor College, Lighthouse Trust, Pakachere, CEDEP, EGPFAP, Right to Care, JPPHEIGO, MACRO employ more than 4000 cadre of staff in support of the AIDS response using PEPFAR and CDC resources. These cadre include 180 Doctors, 1640 Health Diagnostic Assistants, and 1870 treatment supporters received stop orders and ceased their activities. Some of these NGOs did not receive the Stop Orders but stopped activities as a precaution. They surrendered the work equipment, including computers and vehicles at the district health offices. Civil society organizations including the Malawi AIDS Services Organisation and the Malawi network of people living with HIV work has been impacted. They have stopped or slowed their community-led monitoring work.

Interruptions to Services at Key Populations Drop-In Centres

The drop-in centers for key population are not staffed because most of the staff are PEPFAR or CDC supported, who are not working. The drop-in centres are open but minimally staffed.  PLHIV are worried about what will happen when the stocks in country – approximately 9-months-worth – run out. Members of civil society are keen to understand how the government will move Malawi’s response to HIV forward, sustainably. They are also concerned about the continuity of prevention and treatment efforts going on in Global Fund Grant Cycle 7 given that the US government provides the bulk of contributions to the GFATM.

The UN Family Responds Together

The UNCT met to discuss the situation. Beyond HIV, the impact of the Stop Order was widespread including on support for the forthcoming elections, maternal and child health and resettlement of refugees. The UNCT agreed on a series of support and advocacy efforts to move forward including reaching out to the government to find out where they need our support and what austerity measures they will take given the freeze on funding.

Last week, the U.S. Ambassador assured the UNAIDS Country Office that PEPFAR-supported services will recommence early next week. She indicated the country needs to complete the sign the Sustainability Plan.

The UCO met the Minister of Health and reached out to other Senior Government Officials and the Sustainability plan has now been cleared by the Minister of Health. The UCO understands the Sustainability plan and the Contingency Plan are  one of the key items that the Minister will share with the President this Friday.  

The UCO will continue to meet with the Minister of Health and Ambassadors from other countries, the NAC, and civil society to understand the flow of services in the districts and see how best we can support.

Overall National Response

A Cabinet memo on the current situation and recommendations for the government of Kenya (GOK) to mitigate the situation has been developed by Ministry of Health and domestic resource allocation is a key recommendation as well as fast-tracking the development of the ongoing HIV sustainability roadmap.

A special national HIV inter coordination committee (ICC) that includes CSOs, communities, private sector, UN Agencies and government stakeholders was convened by UNSDCC on Friday, January 31st to assess the impact and suggest solutions.

Commodity Security

UNAIDS’ Country Office (UCO) has been part of the commodity security meetings.

All requests to distribute PEPFAR-supported products in country through USAID are on hold until further guidance is provided to unfreeze the initial communication.

Products that were to be distributed in January 2025 under USAID/PEPFAR include ARVs (Nevirapine syrup, Dolutegravir 10 mg and 50 mg). For these products, health facilities had a stock balance between 2 to 4 months by 31st December 2025.

The country may start experiencing erratic supply of Nevirapine syrup and Dolutegravir (DTG) 50 mg towards the end of March and May 2025, respectively, if the stop work order is not lifted.

The current stocks at Kenya Medical Supplies Authority (KEMSA) for DTG 10 mg will sustain the country beyond June 2025.

Viral load and EID products are mainly procured through PEPFAR support. This will be adversely affected if the stop order is not lifted as soon as possible as the quantity under the Global Fund is minimal, targeting specific point of care testing sites.

Stop Gap Measures for Commodity Security

GOK will be required to allocate funds for the distribution of these products from Missions for Essential Drugs and Supplies (MEDS) to health facilities. The estimated cost by KEMSA is approximately USD 10 million.

Procurement and delivery of health products will be facilitated by the Global Fund and government counterpart financing. Additionally, discussion to front load commodities under Global Fund year two will be initiated.

If the stop order continues, GOK will be required to allocate funds to cover the deficit.

Discussions to allow Government to distribute HIV commodities under MEDS is to be initiated if the stop work order is not lifted. (To note, as of February 2, 2025, there has been a reprieve with the new circular on waiver for administration costs for procurement and supplies of essential drugs. The circular is however yet to be implemented as it is a new directive)

Human Resources for Health

All PEPFAR-supported medical personnel/health workers have been requested to stop work as per the stop work order effected in PEPFAR supported counties and facilities.

All PEPFAR-supported implementing partners (CSOs, FBOs, UN) and sub-grantees have been requested to stop work and consequently, staff have been requested to proceed on leave for the duration of the stop work order (90 days).

In some of the counties, the county government has recalled all health workers who are on leave to cushion the situation.

UCO programs supported by PEPFAR through COAG (Community led monitoring and Strategic Information) have been halted.

Consequently, the five UCO CLM partners (CSOs, KP led organizations) have stopped work and over 148 staff IP staff have been affected, and service delivery constrained.

Way Forward

UCO to consider supporting a national communities’ meeting to discuss the impact on service delivery and make recommendations to national and county governments.

As mentioned above, as of February 2, 2025, there was a reprieve with the new circular on waiver for administration costs for procurement and supplies of essential drugs, including continued support for human resources. Hopefully, measures will be implemented this coming week to avert potential risks.

Funding for the HIV Response in Botswana

Prior to the U.S pause of foreign assistance, the Government of Botswana funded two thirds of its HIV response (approximately US$ 90 - 95 M). The remaining costs were covered by the U.S. Government (US$ 55 M via the U.S. President’s Emergency Plan for AIDS Relief, PEPFAR, and US$ 12M via the Global Fund to Fight AIDS, Tuberculosis and Malaria).

Immediate Risks

The pause and stop order will:

1. Undermine Botswana’s ability to fully achieve UNAIDS’ 95-95-95 targets and the efforts to finding the missing 5-2-2 in Botswana. That means reaching an additional five percent of all people living with HIV with testing so they are aware of their HIV status; ensuring that an additional two percent of all people who are living with HIV and are aware on treatment and ensuring an additional two percent of all those aware of their status and on treatment have their viral load suppressed.
2. Take away safe spaces for key populations (KPs) and adolescent girls and young women (AGYW) and increase their vulnerability to HIV-related sigma and discrimination, gender-based violence, mental health problems and other related social ills.
3. Reduce access to early diagnosis and treatment for HIV which leads to health complications and higher default rates for treatment adherence which correlates to a lack of viral suppression.

Impact on Civil Societies and Communities

In Botswana, the impact of the pause on U.S. foreign assistance and related stop order has already affected delivery of HIV prevention and treatment services by civil society organisations (CSOs) and will have implications for the entire system across the national HIV response.

UNAIDS consulted with a significant number of CSOs to establish the impact of the pause and stop order on the provision of services. Additionally, a task force set up by NAHPA and the Ministry of Health and cochaired by UNAIDS met to establish a complete picture of disruptions not just for CSOs but also within MOH and NAHPA where a total of about 207 positions are funded by PEPFAR.

Most of the affected CSOs are those providing some services for key and vulnerable populations (AGYW, MSM, SW, PLWHIV). The government continues to provide services and encourages the affected CSOs to refer and link clients to government facilities. While CSOs have been funded to provide demand creation activities, only three of those consulted have clinics or drop-in centres that were considered safe by the aforementioned population groups. They offer HIV counselling and testing Services, ART dispensing, PrEP dispensing, adherence and psychosocial support, condom distribution and referral and linkages to other services. The stop order has led to the closure of these CSO clinics and drop-in centres and disrupted service delivery.

Government Response

Botswana’s government health facilities continue to operate and provide services. The Ministry of Health issued a press release on 29 January assuring Batswana living with HIV that the pause of U.S. assistance will not affect the availability of ARVs as they are directly procured by the Government of Botswana. This was followed by another press release on 6 February further assuring continuity of services.

Mitigation Measures

Through the Joint Oversight Committee, a task team will be established to monitor developments and ensure that HIV services are not disrupted, clients are referred and linked to care at government facilities and that CSO’s providing services will receive domestic funding.

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 andcCommunity systems responses in Ethiopia.

GENEVA/LUSAKA, 30 January 2025—Zambian football star Racheal Kundananji has been appointed as a UNAIDS Goodwill Ambassador to champion the fight to end AIDS as a public health threat in Zambia.

In her new role, Ms Kundananji will work with UNAIDS to champion HIV prevention, advocate for girls’ education to help reduce new HIV infections and sexually transmitted infections. She will also highlight the importance of preventing teenage pregnancy and advocate for an increase in HIV testing and access to health services for young people. 

“I am so happy to be collaborating with UNAIDS to end AIDS as a public health threat in my country Zambia,” said Ms Kundananji. “Achieving this will require a collective effort, including ensuring that all young people in Zambia, particularly girls, remain in secondary education to reduce their risk of HIV infection and provide them with better economic opportunities.” 

Ms Kundananji is already using her platform to drive change. She founded the Racheal Kundananji Legacy Foundation to harness the power of sport to address gender-based violence, sexual and reproductive health, and child marriage, demonstrating her deep commitment to empowering women and girls and tackling gender inequality.  

“Ms Kundananji shares UNAIDS’ vision of ending AIDS as public health threat in Zambia by 2030,” said Isaac Ahemesah, UNAIDS Country Director for Zambia. “That world is possible. Leaders must ensure that girls stay in school and increase political and financial support to end the AIDS epidemic, by stopping new HIV infections and ensuring that everyone who needs treatment for HIV has access.” 

United Nations Resident Coordinator for Zambia, Ms. Beatrice Mutali, praised Ms Kundananji’s dedication to advancing and promoting HIV awareness, testing, prevention and the  Education Plus Initiative, which promotes girls’ school attendance. She also called for gender equality in sports, emphasizing the need for equal pay for equal work for women and men in all fields.

Ms Kundananji shattered the global women’s football transfer record, becoming the most expensive player in the history of women’s football. She is the first African footballer - male or female - to break the world transfer record. Now playing for Bay FC, an American professional women's soccer team based in the San Francisco Bay Area, she competes in the prestigious National Women's Soccer League, solidifying her place as a trailblazer on the global football stage. 

Ms Kundananji has represented the Zambian National team since 2018 at the African Cup of Nations, FIFA World Cup Qualifiers and the Olympic qualifiers. Ms Kundananji has also played for Madrid Club de Fútbol Femenino among others.

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.

Progress towards ending AIDS as a public health threat has been strongest in the countries and regions with sufficient investments in their HIV responses, especially in countries from eastern and southern Africa. However, a critical part of this success lies in understanding where resources are being allocated and ensuring that investments are directed towards the most impactful interventions.

“HIV financial data is essential for decision-making”, said Jaime Atienza, Director of Equitable Finance at UNAIDS. “This is especially important when we can see constraints, now and around the corner.”

To reflect on the current use and future potential of HIV financial data, UNAIDS and the Global Fund to Fight AIDS, TB and Malaria brought together representatives from 10 African countries to Cape Town, South Africa. During the event, countries shared how they are using HIV financial data to transform their national HIV responses.

In the case of Kenya, for example, the 2022 National AIDS Spending Assessment (NASA) revealed that approximately 84% of the funds for care and treatment programmes came from external sources. This heavy reliance on external funding prompted the development of a cabinet advisory note on local commodity manufacturing, aimed at addressing commodity security risks. In response, the Office of the Presidency issued a statement on Worlds AIDS day 2022 directing that the government would support the pharmaceutical sector to strengthen its local manufacturing capacity and review relevant regulations and tax policies to create an enabling environment.

In Mozambique another NASA study showed how the country spent 26% less on HIV treatment than the National Strategic Plan required, while still surpassing the antiretroviral (ART) coverage target. ART unit costs have fallen from US$ 208 in 2017 to US$ 137 in 2022—well below most countries in the region. Economies of scale and differentiated service delivery likely contributed to this outcome. “We are using this data to inform multi-sectoral plans and state budgets” said Francisco Mbofana, Executive Secretary of Mozambique's National AIDS Council.  

HIV financial data is also seen by countries as an effective tool for mobilizing resources. Ethiopia’s NASA and National Health Accounts (NHA) informed a Domestic Resource Mobilization Strategy. The Strategy aims to boost domestic investment from US$ 27.9 million in 2020 to US$ 68.5 million by 2025 through government revenues, AIDS fund(s), targeted mainstreaming, community care coalitions, and earmarked taxes. In addition, South Africa demonstrated to the Global Fund that of the US$ 6.3 billion the government committed to invest in HIV from 2022-2025, US$ 6.2 billion (98.99%) is likely to be realized. This, in turn, unlocks the US$ 92.7 million co-financing incentive from the Global Fund grant for 2025-2028.

Financial data has also stressed the major underinvestment in HIV prevention. “The de-prioritization of HIV prevention is among the top sustainability threats,” said Thembisile Xulu, Chief Executive Officer of the South African National AIDS Council. While prevention will require a third (32.8%) of total HIV resources by 2025, NASA data shows current HIV prevention spending is at 9.4% in Kenya, 9% in Namibia, 11% in South Africa, and 13% in Uganda.

Nonetheless, several strategies to boost HIV prevention investments are being developed following evidence provided by HIV financial data. Kenya used its NASA data to develop guidelines for harnessing resources from construction projects to support HIV prevention. Zimbabwe’s resource tracking influenced a new policy to implement social contracting with a least one civil society organization per province, to channel domestic resources to community-led HIV responses. Zimbabwe has committed to invest 21% of domestic funds in HIV prevention, with a focus on key populations.

In the current environment of dwindling resources for HIV—2023 recorded the lowest amount of resources available for HIV in low-and-middle income countries in a decade—strengthening HIV resource tracking is key to ensure effective and sustainable HIV responses. “We need to plan for sustainability,” said Nertila Tavanxhi, Senior Manager for Health Financing Country Support at the Global Fund. “To do this, we really need to understand who is funding what, where and whom. This will show us the gaps, and where we must focus.”

“We are in a time of transformations towards sustainability,” said Mr Azcona. The National HIV Response Sustainability Roadmaps are an essential part of the work that the Global Fund, UNAIDS, PEFPAR and country partners are undergoing in 2024 and 2025. “This makes it even more important to have the right data to make the best possible choices on what these transformations must be.” 

Ethiopia faces a triple crisis of conflict, climate change, and displacement that impedes the capacity to provide essential health and other humanitarian assistance to those in need, including people living with HIV.

With support from 2Gether 4 SRHR, UNAIDS and partners recently organised a joint mission to learn about the humanitarian response and to identify the challenges that persist. The findings of the mission will help update the guidelines on Addressing HIV in Humanitarian Settings, a crucial resource for all actors working on HIV in emergency settings, providing evidence-based recommendations for integrating HIV into the different sectors of humanitarian responses.

Ethiopia hosts more than 1 million refugees, predominantly from South Sudan, Somalia, Eritrea and Sudan, the majority of whom live in 24 refugee camps established across five regional states, and 80,000 of whom reside in the capital Addis Ababa. In addition, the country has 4.4 million internally displaced persons (IDPs) and over 1.5 million IDP returnees.

The team visited two of the regions hardest hit by humanitarian crises, grappling with rising HIV rates: Tigray and Gambella. In Tigray, just 5 kilometers from the capital Mekelle, lies Seba Kare (70 Kare) IDP camp—a settlement hosting over 20,000 people displaced by the conflicts in the western and eastern parts of the region. Seba Kare represents both the resilience of its inhabitants and the dire challenges of prolonged displacement. The camp, initially intended as temporary shelter for six months, has now housed many families for over four years. Cramped conditions, insufficient food, limited access to education, and inadequate healthcare services are daily realities for residents. Despite the tireless efforts of humanitarian partners on the ground, the growing needs of the displaced population far exceed the resources available.  

Among the most pressing gaps is the lack of comprehensive healthcare, particularly for people living with HIV. In humanitarian crises, critical services for HIV and sexual and reproductive health are often sidelined, overshadowed by the urgent need for food, shelter, and disease control. Healthcare is restricted to primary services. Care for chronic conditions, such as HIV, is referred to government hospitals. This means that all patients, IDP or not, must pay for transportation as well as services and purchase vital medical supplies on their own—an impossible burden for many.

Despite the continuous advocacy efforts in support of the decentralization of services and outreach interventions at camp-level, government-owned facilities outside the camp remain the only viable option for IDPs in need of health services.

The refugee camp of Jewi—in the western province of Gambella which has the highest HIV burden across Ethiopia—is equipped with its own antiretroviral therapy center. However, like in Tigray, Gambella faces significant challenges in providing HIV testing and treatment. Limited mobility within and beyond the camps, due to the costs of transport for clients and a shortage of ambulances in medical emergencies, combined with resource constraints at health centres, often results in treatment interruptions and high rates of loss to follow-up.

Adding to the crisis, the recent reduction in donor funding has severely impacted the quality of health services in the camps. The gender-based violence (GBV) center run by International Medical Corps will soon close due to funding cuts, leaving no other GBV services available outside of health services.

The situation for women and youth in Gambella is especially concerning. Limited educational and employment opportunities, compounded by rising HIV infections, put them at higher risk of infection due to the adoption of negative coping mechanisms, including substance abuse. The high rates of new HIV infections exacerbate these existing challenges, underscoring the urgent need for sustained interventions to improve health services, livelihoods, and social inclusion for refugees and host communities in the region.  “There are many young and vulnerable people who need protection, shelter, food, income, education – and HIV prevention, testing, treatment and care. We must make sure to rebuild health and social services and fill the current resources gap,” said Tina Boonto, UNAIDS Ethiopia Country Director.
 
As international organisations step up their efforts to address HIV in humanitarian settings, there is a coordinated push in Ethiopia, at both the federal and regional levels, to ensure that the health needs of people living with HIV are met, even in the most challenging circumstances. The Ministry of Health, with support from UNAIDS, is developing an HIV Baseline Survey in Humanitarian Settings and a comprehensive National HIV/Sexual and Reproductive Health Guiding Document. This initiative is a substantial step towards safeguarding the rights and well-being of people living with HIV across the country.

"Ethiopia's progress in addressing HIV is inspiring,” said Maheswari P Murugayia, Public Health Officer and Global HIV Focal Point at UNHCR. “Tackling HIV in humanitarian settings is not just a priority— it’s a necessity for ensuring the health and well-being of displaced populations.”