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.