This weekly update summarizes reports on the impact of US funding cuts on national AIDS responses from 20 UNAIDS Country Offices received during the week of 3-7 March 2025. These reports show that an increasing number of US-funded implementing partners—including in Botswana, South Africa and Zambia—have received notices that their funding awards have been terminated. In some cases, these notices have led to the closure of HIV services that had previously been allowed to operate under terms of waivers.

Many national AIDS responses impacted by the freezing or termination of US funding are prioritizing the continuation of antiretroviral therapy for people living with HIV, including the procurement of life-saving antiretroviral medicines (ARVs). Despite these measures, there have been reports of panic and hoarding of medication among people living with HIV who fear that their governments and remaining partners may struggle to maintain these services – and that stockouts will occur. Multiple countries have reported significant impacts to human resources for health supported in part or in full by US funding. This includes 1,952 doctors, 1,234 nurses, and 918 technical and management staff in Kenya; 8,600 healthcare providers and community workers in Côte d’Ivoire; 423 medical and technical staff in Namibia; and about 250 health professionals that provided technical assistance to the HIV program in Angola. The previous week South Africa reported that more than 15,374 HIV response staff at national level and across 27 priority districts were impacted by US funding cuts.

HIV prevention, testing and support services for populations at high risk of infection, as well as community services and structural enablers work, have been hard hit by funding cuts. Many US-funded drop-in centres and other safe spaces for highly stigmatized key populations and adolescent girls and young women have been closed, and US funding for the provision of pre-exposure prophylaxis (PrEP) to these populations has been largely halted. US support to community-led monitoring programmes has been frozen or terminated, and community-led organizations in Kenya and other countries have lost funding to engage in advocacy and policy design.

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1. CDC-Funded Programs:
   • CDC-funded programs continue operations with ICAP as the implementer, applying the conditions of the Temporary Restricting Order (TRO) and the Limited Waiver to Pause focusing on health system strengthening, laboratory support, and medical worker capacity-building.
2. USAID-Funded Activities:
   • Status: Remain paused as the waiver related to USAID funding has not been operationalized.
3. Global Fund (GF):
   • The Global Fund is considering using savings to maintain the national electronic register as an immediate mitigation measure, with the National Center taking ownership and transitioning it to national hosting.
4. Reduction in Services:
   • HIV Testing and Outreach: 90% reduction for key populations, affecting four HIV-servicing NGOs in two regions. These regions account for 20% of the population of people who use drugs and 9% of the population of men who have sex with men (MSM).
   • Impact: Expected to affect national targets on new case detection, treatment adherence, and PrEP scale-up.

Politically Relevant Updates

1. Government Mitigation Measures:
   • Domestic Funding: There is a commitment to use domestic funding to cover outreach work gaps in two regions, allowing AIDS centers to contract outreach workers, given that the funding pause will lead to termination after the 90-day freeze.
2. Civil Society Response:
   • Mitigation Strategies: Some of the mitigation strategies and innovations by civil society (including community) include maintaining services through volunteering, applying for social contracting, shifting outreach workers to AIDS center contracts, transitioning to web outreach, reviewing plans with mid- and long-term scenarios, and engaging in dialogue with the Global Fund on the uptake of some service funding after the 90-day pause and once there is more clarity on the final decision.
   • National Consultation: Convened by UNAIDS with national partners to assess risks and possible scenarios.
   • Joint UN Team Meeting: Conducted to assess the potential impact on cooperation, technical assistance, and partnerships.
   • Community Engagement: Civil society and community representatives actively involved in maintaining services and planning for mid- and long-term scenarios.

UN Response:

• National Consultation: Convened by UNAIDS with national partners to assess risks and possible scenarios.
• Joint UN Team Meeting: Conducted to assess the potential impact on cooperation, technical assistance, and partnerships.
• Community Engagement: Civil society and community representatives actively involved in maintaining services and planning for mid- and long-term scenarios.

Immediate Risks and Disruptions

• Total Pause of HIV Prevention Programming: There is almost complete halt of HIV Prevention interventions that were fully funded by PEPFAR. This includes DREAMS programme targeting vulnerable adolescent girls and young women, orphans and vulnerable children and voluntary medical male circumcision. In addition, there is significant impact to other HIV prevention interventions that were largely supported by PEPFAR including PrEP for at risk populations (key populations). There is the risk of wastage of commodities related to prevention. 

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Immediate Risks and Disruptions

• Total Pause of HIV Prevention Programming: There is almost complete halt of HIV Prevention interventions that were fully funded by PEPFAR. This includes DREAMS programme targeting vulnerable adolescent girls and young women, orphans and vulnerable children and voluntary medical male circumcision. In addition, there is significant impact to other HIV prevention interventions that were largely supported by PEPFAR including PrEP for at risk populations (key populations). There is the risk of wastage of commodities related to prevention.
• Fear of Service Interruption: There is severe and widespread fear of service stoppage, leading to reports of hoarding antiretroviral (ARV) drugs and patients dropping out of care due to the risk of treatment interruption. There was disruption of samples transportation for testing. Implementing partners with waivers are not fully operational due to slow payment systems among other reasons, thereby affecting efficiency of services.
• ARV Stock: The current ARV stock is expected to last for the next four months and shipments are on their way that will ensure commodity security until the end of 2025. The forecast for 2026 is not clear. Close monitoring is required as the pause in programming might impact the demand and implementation of lab services.
• Technical Support: Technical support to regions, councils, and health facilities has been paused.

Politically Relevant Updates

• Government Actions: The Tanzania AIDS Commission plans to conduct a detailed assessment of the impact of the US funding pause. There are discussions in parliament regarding future budgetary allocations by the government for the purchase of antiretroviral therapy (ART). The government has reassured that there will be no disruption of ARV medications with commitment to allocate adequate funds to purchase and distribute ARVs free of charge.
• Global Fund Discussions: The Global Fund Principal Recipient (PR1) is in discussions regarding the possibility to reinvest savings from the Global Fund HIV grant into HIV commodities to ensure security.
• UN Engagement: UNAIDS and WHO have engaged with the Tanzania AIDS Commission to assess the impact and discuss fundraising modalities to continue ongoing activities.
• Civil Society Response: Civil society organizations are calling for expansion on the implementation capacity of the Global Fund grant to mitigate the impact of the pause.
• Government Mitigation Measures: Strategies are being implemented to absorb the human resources for health (HRH) to ensure continuity in care. The government is in the final stage of launching a web-based Care and Treatment Centre (CTC) database that will mitigate absence of data clerks who were USAID supported; the health care workers will be able to directly feed the database which is integrated to DHIS-2; this will be linked with all the electronic medical records in both private and public facilities. The government will continue to carry out storage and distribution by the Medical Stores Department (MSD) of the Ministry of Health. Plans are also in place to use government postal services for the transportation of lab samples.