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

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

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

A cascading crisis 

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

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

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

Impacts on organizations led by people who use drugs 

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

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

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

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

Heightened stigma and structural risks 

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

UNAIDS’ response and coordinated action 

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

A call for urgent action 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Disruptions in the HIV response 

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

Reshaping to deliver in a changing context 

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

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

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

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

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

UNAIDS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Documented impact on services

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

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

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

Human rights, key and vulnerable populations

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

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

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

Government convening, mitigation measures

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

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

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

Civil society impact, resilience and response

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

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

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

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

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

UNAIDS response

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

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

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

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

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