The recent US cuts to foreign assistance pose a direct threat to the lives and well-being of thousands of people living with HIV in Ethiopia. Critical services are grinding to a halt, leaving people who rely on them facing an uncertain future. Ethiopia is heavily reliant on external funding for its AIDS response; the US Government provides 53% of HIV funding in the country.

Prior to the US cuts, Ethiopia was on track to reaching the “95-95-95" targets, with 90% of all people living with HIV knowing their status, 94% of those aware of their status accessing treatment and 96 % of those on treatment being virally suppressed. However, there are fears that the funding crisis will reverse the gains made by Ethiopia and that the country will see a resurgence in the annual number of new HIV infections.

Impact on Services:

• ART Services: All facilities and service points providing antiretroviral therapy (ART) are operating at a reduced capacity. However, there are no changes in the capacity for providing prevention of vertical transmission and early infant diagnosis (EID) services.
• Data Collection: Data collection continues at some facilities, but data quality control and collation are affected.
• Supply Chain: Stocks of antiretroviral (ARV) supplies, HIV viral load (VL) and other lab test kits are available, but distribution is disrupted. There is sufficient stock of condoms for the next 12 months, although many aspects of condom supply and distribution have been impacted.

Primary HIV Prevention Services:

• Disruptions: Distribution of condoms and other prevention commodities is disrupted. Availability of pre-exposure prophylaxis (PrEP) services is reduced. HIV prevention education and awareness campaigns are suspended or reduced. Access to HIV testing and counselling services for key populations is decreased. Voluntary medical male circumcision services are limited or suspended. Access to safe and effective HIV prevention services for adolescent girls and young women (AGYW) is disrupted.

Services for Key Populations:

• Sex Workers, PWID, and Prisoners: HIV prevention services for sex workers, people who inject drugs (PWID), and prisoners are impacted. Access to PrEP services is reduced. HIV testing services are discontinued. Availability of HIV counselling and testing is reduced. Access to ART services is disrupted. Opioid agonist therapy and other harm reduction services for PWID are unavailable. HIV prevention services in prisons are decreased.
• Human rights, key and vulnerable populations Ethiopia received PEPFAR funding for work on stigma, discrimination and enabling legal environments. As a result of the USG stop-work order, all programmes on stigma and discrimination have stopped, affecting key populations, AGYW, PLHIV and young people.
• Communities are not collecting data on human rights issues, including increased stigma and discrimination. 

Politically Relevant Updates

Government Actions:

• Staff Replacement: The state minister for health sent out a circular to regional health bureaus informing them that government staff would take over from the US-funded staff affected by the US Government stop-work order. This affects more than 5,000 contracts of staff working on HIV.
• International Discussions: Health Ministers of African member states discussed the issue at the WHO Executive Board Meeting.

Civil society impact, resilience and response Community-led or peer-led facilities and services (including drop-in centers), as well as services provided by international NGOs have been affected as a result of the US Government funding cuts. As a result, CLOs have reduced or suspended their services, shifted service priorities, lost staff or faced funding cuts. CLOs have now reduced ability to collect and report data. While CLOs may have some alternative funding sources, they are struggling.