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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

CONTINUE READING UNAIDS WEEKLY UPDATE (PDF)

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

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

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