UNAIDS is releasing weekly updates to track the impact of US cuts to foreign assistance on HIV testing, treatment and prevention. These reports are based on status reports generated by UNAIDS’ Country Offices.

As of 13 March, at least one status report had been received from UNAIDS’ County Offices in 67 countries, including 84% of all PEPFAR-funded countries and an additional 20 countries that receive US support for their AIDS responses.

Low- and middle-income countries across several regions are building on short-term emergency measures to address cuts in US foreign assistance taking action to sustain their national AIDS responses in the medium and long term.

UNAIDS’ Country Offices are supporting these efforts by working with heads of government, Ministries of Health and national AIDS authorities to assess the full impact of the cuts so countries can ensure continuation of critical HIV services in the medium and long term. 

Many countries have conducted UNAIDS-supported rapid surveys to assess the impact of the cuts on recipients of HIV services. The results from one survey in a high-burden country in East Africa found that 62% of respondents reported difficulty accessing pre-exposure prophylaxis (PrEP), 46% of people living with HIV experienced disruptions in HIV treatment, and 23% of people living with HIV received smaller amounts of antiretroviral medicines (e.g. a three-month supply instead of the usual six-month supply) from local dispensaries. The survey also found that viral load testing, community outreach, condom distribution and TB diagnostic efforts were also significantly impacted.

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Immediate Risks and Disruptions 

1. Distribution Disruptions: 

• According to the policy brief to Parliament prepared by the Uganda AIDS Commission with support from UNAIDS, stocks of ARV supplies, HIV, viral load and other lab test kits are available. However, distribution from district hubs to lower health facilities is disrupted due to reliance on US-funded implementing partners. Facilities have adequate stocks for three months, but the impact will be felt from the second quarter of 2025 if not mitigated. 
• Condom stockouts are anticipated within the next 3-6 months due to challenges with last mile distribution. 

2. Service Capacity: 

• All ART-providing facilities are operating at reduced capacity.   Some community-led, peer-led, NGO-run, and private facilities have stopped services. 
• Reduced adherence to prevention of vertical transmission and early infant diagnosis services due to decreased numbers of expert clients and mentor mothers. 
• HIV prevention services for key populations at drop-in centres, including PrEP access, HIV testing, and antiretroviral treatment adherence counselling  for sex workers, men who have sex with men, transgender persons, people who use drugs, and prisoners, have been disrupted. 

3. Human Resources: 

• It is unclear whether US-funded health workers will be integrated into the government payroll. 
• Data clerks at facilities covered by USAID are not yet back at work, impacting data collection and quality control. 

Politically Relevant Updates 

1. Government Actions: 

• The Ugandan President directed the release of UGX 6 billion for the rollout of electronic medical records (EMR) in government health facilities to improve service delivery. 
• The Ministry of Health issued guidance on improving service delivery, including integrating HIV, TB, and other chronic disease services, training health workers in integrated service delivery, prioritizing recruitment of critical staff, utilization of primary health care funds for disease prevention outreach activities and strengthening accountability for medicines and laboratory supplies. 

2. Mitigation Measures: 

• The government is reallocating domestic resources to priority HIV programs and integrating HIV services into other health services. 
• Civil society partners have conducted rapid assessments to understand the impact of the US Government funding cuts on service delivery. 

3. Human Rights and Key Populations: 

• US funding for stigma, discrimination, and enabling legal environments has stopped, and no alternative funding has been found. 
• Communities are not collecting data on human rights issues, including increased stigma and discrimination. 
• Key populations groups have conducted a rapid assessment on the impact of the US funding cuts. There is also ongoing work to conduct an assessment with people living with HIV and key populations-related services at drop-in centres. 

“In our country we are not the priority,” Daisy Cruz says plainly.

She is surrounded by other women living with HIV who agree. They share stories that are not often told about the epidemic in Asia and the Pacific. In a region where men living with the virus outnumber women roughly two to one, the issues of women and girls are often overlooked. They are all members of the International Community of Women Living with HIV Asia Pacific (ICWAP).

Eva Dewa was diagnosed in Yogyakarta, Indonesia in 2017.

“I came home seeking a safe space to share my sadness. At that time, I believed that my partner would support me. Instead, he blamed me,” she says.

Ms Dewa has survived intimate partner abuse. She knows she isn’t alone: “A lot of women either experience violence and get infected with HIV, or contract HIV and experience violence.”

She gave birth to twins two years before her diagnosis. During her pregnancy she was never screened. Unaware, she went on to breastfeed for a couple years. When she learned her status, it was she rather than healthcare staff who suggested the children be tested. One child was HIV negative. The other wasn’t.

UNAIDS estimates that under two-thirds (64%) of women living with HIV in Asia Pacific receive treatment to prevent transmission to their babies. This is far lower than the global average of 84%. Ms Dewa reflects that while HIV services for pregnant women are expanding, smaller cities and rural areas benefit more slowly.

Cathy Ketepa understands the challenge of reaching remote districts. Every day in her native Papua New Guinea, five infants are born with HIV. The epidemic there has doubled since 2010 with new infections among women increasing by a staggering 67%.

“Only around half of mothers living with HIV receive antiretroviral therapy,” says Ms Katepa . “We must bridge this gap to protect the health and future of our children.”

But while the women advocate for expanded services to reduce vertical transmission, they are adamant that their dignity, privacy and agency must be respected. The International Community of Women living with HIV (ICW) has conducted a global analysis of the reproductive coercion, mistreatment and abuse experienced by women living with HIV. The study found that across regions, during pregnancy and infant feeding women were most subjected to force.

“There is an issue with coercive practices,” said Sophie Bryon, ICW’s Director of Global Programmes. “We are talking about women being told not to have children, not to have another child, to terminate and being pressured to undergo sterilization. There is still denial of contraception and pressure to use certain kinds of contraception. There are issues ranging from verbal abuse to physical violence.”

There is also stigma. When Ms Cruz went to the hospital in Manila to give birth in 2001, a nurse on the ward loudly asked why she wasn’t breastfeeding.

“All the patients looked at me like there is something different,” she said.

There is a sense from these women that they’ve been ambushed by a threat they didn’t know existed. But having been hit, they will speak up for themselves, and for others.

Christina Montoya didn’t think it was possible for a woman like her to be infected. She was married and only had sex with her husband.

“We must be informed!” she declared. “And all our friends must be informed!”

 11 years of ICWAP 

ICWAP builds the capacity of women and girls living with HIV and women-led organizations in 18 Asia Pacific countries. It provides coaching and mentoring, ensuring women participate in Global Fund processes and are meaningfully engaged in community-led monitoring.

The organization was formed in 2014 to tackle the human rights violations and violence women living with HIV in the region experience, while removing barriers to treatment and care. Sita Shahi, its Regional Coordinator explains that the challenges can’t be tackled from a health angle alone.

“Women face a lot of stigma and discrimination. They also have an economic burden and are responsible for rearing children. There are so many intersecting issues,” she explained.

Now there are new challenges. ICWAP conducted an eleven-country survey on the impact of the United States development aid stop work order. It found that some country networks have either collapsed or scaled back, leaving women without crucial resources, including information about their rights and how to address gender-based violence or discrimination. There is also reduced access for many women who depended on community-based services for HIV or sexual and reproductive healthcare. While treatment is provided by government in most countries, many of the shuttered peer-led services were more accessible and friendly.

Some women who worked for US-supported programmes have lost their jobs, resulting in financial stress. ICWAP itself has been hard hit.

“We lost all funding. The core support we were receiving for managing staff and country interventions is gone. It is a devastating situation for us. There is now no funding to support our sisterhood at country level,” Ms Shahi explained.

UNAIDS has called for countries in Asia Pacific to support community-led HIV work including stigma and discrimination, adherence counselling, social support, monitoring and advocacy.

General Overview

• Funding: Rwanda's HIV program is predominantly donor-funded. In fiscal year 2023-2024, PEPFAR contributed 37.7% of the total HIV expenditure and the Global Fund contributed 50.8%. There is minimal involvement of domestic private contributors in the HIV response.
• Continuity of Services: The Ministry of Health is the principal recipient of PEPFAR funding. During early days of the Stop Work Order by the US Government, the Government of Rwanda through the Ministry of Health ensured the continuity of essential services and effective implementation of the waivers. Furthermore, the Ministry of Health has committed to mobilizing domestic resources to ensure the continuity of HIV services. All facilities/service points providing antiretroviral therapy (ART) are operating at full capacity. Peadiatric HIV treatment services and data collection activities continue without disruption.
• Supplies and Distribution: Stocks of antiretroviral (ARV) supplies, viral load (VL) test kits, and other lab test kits are available with minimal distribution disruptions. No stockouts are expected in the next 3-6 months. The country has a sufficient stock of condoms for the next 12 months.

Immediate Risks or Disruptions

• Community-Led Services: Some community-led or peer-led facilities and services have been suspended. For example, a local NGO has closed its clinic which provided free and friendly key population services, including sexually transmitted infections testing and treatment.

Though some previously USAID supported DREAMS projects targeting adolescent girls and young women and orphan and vulnerable children (3 out of 5) have received notification to resume work, activities have not fully started due to operational challenges. 

• Community-Led Monitoring (CLM): Rwanda received PEPFAR funding for a CLM project to assess the 4As for quality delivery of services including availability, accessibility, acceptability and affordability of services by people living with HIV and key population. That work has now stopped, and communities have suspended data collection on these issues, including stigma and discrimination at service delivery points. 

Politically Relevant Updates

• Government and Partners’ Actions: The government, in collaboration with partners, is conducting a rapid assessment of the impact of shifts in US Government funding, with technical support from UNAIDS.  Civil society organizations (CSOs) are encouraged to document facility level as well as community supported services delivery gaps and coverage for use in advocacy and resource mobilization.
• Press Conference: During a press conference, the Ministry of Health reaffirmed its commitment to mobilize domestic resources to ensure service continuity.
• Civil Society Organizations (CLOs): CLOs involved in service delivery at community level, particularly prevention and support for ensuring continuity have faced significant challenges, including increased demand with fewer resources, anxiety about continuity and future support, loss of staff, and funding cuts.
• Resilience and Response: Despite these challenges, CLOs continue to play a crucial role in the HIV response. Their resilience and adaptability in the face of funding cuts and service disruptions highlight the importance of community-led initiatives in maintaining essential health services.

UN response 

• UNAIDS is supporting the government to assess the overall cost, priority and impact of the stopped interventions to inform actions. UNAIDS is reaching out separately to community networks and NGOs to collect more information about the impact of the US Government cuts.