The United States Government (USG) support to Zambia is estimated at $600 million annually, of which $367 million was committed for the national HIV response for 2025 under the Presidential Emergency Plan For AIDS Relief (PEPFAR).

The USG pause in foreign assistance has caused significant disruption to HIV services in Zambia, with HIV prevention services being hardest hit. HIV Combination prevention for adolescent girls and young women as well as for other marginalized and vulnerable communities are most impacted.

A total of 32 drop-in centers that provide HIV services to over 20,000 key populations living with HIV on ART in 7 out of 10 provinces have been shut down. Additionally, USG-supported DREAMS centers for adolescent girls and young women in 21 districts have been closed. Further, 16 standalone centers providing voluntary medical male circumcision have also stopped operating. Almost half (49%) of the PrEP services in Zambia are USG supported.

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The United States Government (USG) support to Zambia is estimated at $600 million annually, of which $367 million was committed for the national HIV response for 2025 under the Presidential Emergency Plan For AIDS Relief (PEPFAR).

The USG pause in foreign assistance has caused significant disruption to HIV services in Zambia, with HIV prevention services being hardest hit. HIV Combination prevention for adolescent girls and young women as well as for other marginalized and vulnerable communities are most impacted.

A total of 32 drop-in centers that provide HIV services to over 20,000 key populations living with HIV on ART in 7 out of 10 provinces have been shut down. Additionally, USG-supported DREAMS centers for adolescent girls and young women in 21 districts have been closed. Further, 16 standalone centers providing voluntary medical male circumcision have also stopped operating. Almost half (49%) of the PrEP services in Zambia are USG supported.

Human resources for HIV service delivery are also at risk. The USG supports over 23,000 personnel, with over 11,500 being health workers and community-based volunteers supporting the national AIDS response. The Government may not be able to absorb these health workers immediately. Consequently, opportunities for task shifting and better integration of services are being explored by the Government.

In view of the waiver on service delivery, USG Implementing partners are incrementally resuming services but with a lot of caution. HIV services are at a complete standstill in the six districts of the Northern Province, where Right to Health is the only USG implementing partner.

There is an adequate supply of ARVs for the next 12 months, but without buffer for the period. Available and pipeline HIV rapid test kits are expected to last 3.2 months, with 4 months for tuberculosis x-pert cartridges and a one-month supply for viral load testing and early infant diagnosis.

The Ministry of Health is committed to ensuring the uninterrupted provision of essential HIV, TB and Malaria services across all public health facilities and has issued directions and guidance to this effect. The UN Joint Team on HIV and AIDS has supported the Ministry of Health to establish a high-level steering committee to identify gaps and develop a response plan to mitigate the impact of the “pause orders” for the HIV response. A costed-impact mitigation plan based on the minimum package of HIV services essential for continuity has been developed and presented to the Government and Cooperating Partners. In line with the HIV Response Sustainability Roadmap 2025-2030 that was launched in December 2024, the Joint Team is working with the Ministry of Health and the National AIDS/TB/STI Council (NAC) to explore and implement medium and long-term solutions for sustaining the national AIDS response.

Due to the U.S. Government’s freeze of foreign assistance, 15,374 PEPFAR-funded HIV response staff across national and 27 priority districts have been affected, with an estimated HR cost of ZAR 4.6 billion (~USD 250 million), and approximately 222,000 people living with HIV, including 7,445 children under the age of 15, face disruptions in their daily antiretroviral therapy supplies.

Documented Impact on Services as of 20 February

• PEPFAR-funded Projects: Last week, PEPFAR-funded projects in South Africa received waiver letters, prompting a review of their activities. The CDC has communicated with beneficiary organizations, while USAID-supported partners remain closed.
• Service Disruptions: The closure of the TB/HIV Care clinic in Tshwane, Pretoria, has significantly impacted people living with HIV, particularly the homeless, of whom 70% are drug users.
• The halt in US Government support has led to a pause in the Ritshidze (“Saving Our Lives”) Community-led monitoring project. Established in 2019, the project monitors more than 400 public clinics and community healthcare centers, located in 27 priority districts and 8 provinces of South Africa. The facilities were chosen to cover nearly half of all people living with HIV on treatment in the country, with a focus on sites with large treatment cohorts and where the data show poor linkage and retention rates.

Human Rights, Key, and Vulnerable Populations

• People who use drugs: Service disruptions pose a high risk of needle sharing and antiretroviral interruptions due to the lack of referral letters required by some government facilities. This increases the risk of HIV viral rebound and transmission among the estimated 80,000 people who use drugs in the country.
• LGBTQ+ communities: Facilities like Engage Men’s Health, which support gay and bisexual men and men who have sex with men, remain closed. This closure heightens the risk of stigma, discrimination, and potential resurgence of new HIV infections among these marginalized populations.

Government convening and mitigation measures

• ART Dispensation: The Department of Health has implemented a 6-month antiretroviral therapy dispensation for eligible patients to reduce clinic visits and ease the workload on health workers.
• Telemedicine and Digital Health: Efforts are being made to strengthen telemedicine and digital health platforms for HIV prevention and treatment services.
• Private Sector and Civil Society Partnerships: The Department of Health is encouraging partnerships to support key populations' HIV services.
• Diplomatic Discussions: President Ramaphosa has convened a high-level delegation for diplomatic discussions with China and Russia.
• Civil Society Impact, Resilience, and Response
• NGO Closures: NGOs reliant on USAID funding remain closed, affecting community-based programs and outreach services, including HIV testing, in USAID-supported districts.
• Research and Clinical Trials: South African universities and research institutions are concerned about the impact of the funding freeze on research and clinical trials. There is uncertainty about research funding, with fears that NIH-backed projects could be at risk.

Indonesia has had to pause many programmes due to the U.S. funding freeze.  All community led activities funded through USAID have been paused and prevention and linkages to treatment for around 30% of men who have sex with men (MSM) in Jakarta have been affected. In addition, the expansion of PrEP programmes and a test pilot of long-acting HIV pre-exposure prophylaxis (PrEP) have been halted for now.

The HIV epidemic in Indonesia is mostly concentrated among key populations (MSM, sex workers, people who inject drugs and transgender people) except in Tanah Papua, where the epidemic is generalized. There are nearly 80 000 MSM in Indonesia’s capital.

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Documented Impact on Services

Indonesia has had to pause many programmes due to the U.S. funding freeze.  All community led activities funded through USAID have been paused and prevention and linkages to treatment for around 30% of men who have sex with men (MSM) in Jakarta have been affected. In addition, the expansion of PrEP programmes and a test pilot of long-acting HIV pre-exposure prophylaxis (PrEP) have been halted for now.

The HIV epidemic in Indonesia is mostly concentrated among key populations (MSM, sex workers, people who inject drugs and transgender people) except in Tanah Papua, where the epidemic is generalized. There are nearly 80 000 MSM in Indonesia’s capital.

There are an estimated 570,000 people living with HIV in Indonesia.  Addressing the treatment gap is one of the country’s biggest challenges. Only 31% of people living with HIV are accessing treatment and 14% are virally suppressed.

First line HIV treatment is provided for free for PLHIV and is fully funded by the government as are HIV testing kits and CD4 and viral load testing kits.  However, HIV self-testing kits, condoms, clean needles, PrEP and long-acting HIV pre-exposure prophylaxis are procured with the support of the Global Fund.

HIV prevention programmes depend heavily on the Global Fund and USAID, especially regarding community outreach and peer support. The Global Fund investment is focused in 178 HIV priority districts with an allocation of $102 million for three years (2024-2026).  The US government made an annual investment of $11 million for the HIV response in Indonesia in 2024-25. This includes above site technical assistance for the national HIV program implemented through US-based consulting agencies such as JSI/Think Well and through multilateral agencies including UNAIDS; as well as on-site intervention for PLHIV and key populations in the city and greater Jakarta implemented by EPIC/FHI360.

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. 

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

PEPFAR-Funded Programmes:

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

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

Service Disruptions:

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

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

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

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

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

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

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

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

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

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

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

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

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