Download Full Report: Impact of the Pause of U.S. Foreign Aid on HIV&TB services in E.A
ICWEA conducted a rapid assessment using a mixed methods approach employing both quantitative and qualitative methods of data collection and analysis, to assess the immediate impact of the US funding freeze on HIV/AIDS services among women and girls within ICWEA countries of operation, with an urgent need to advocate for policy interventions to restore and sustain life-saving programs. The funding freeze imposed by the U.S.A government on January 24, 2025, as part of a broader foreign aid suspension, has had severe consequences on HIV/AIDS programs globally with severe consequences felt by vulnerable girls and women in Eastern Africa2. The findings revealed significant disruptions in HIV treatment, economic hardships, and increased stigma and discrimination, highlighting an urgent need for policy interventions on healthcare services, employment, and the well-being of people living with HIV (PLHIV).
According to the assessment, a major impact of the funding freeze has been severe disruptions in HIV/TB services. Essential services, such HIV Prevention (i.e., pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and maternal transmission prevention; Care and Treatment (i.e., viral load testing, access to ART were either halted or significantly reduced. Many PEPFAR-funded health facilities reported staff layoffs, resulting in long waiting times and treatment interruptions. Community-led monitoring programs, which play a critical role in advocacy for quality HIV/TB service delivery, were equally affected, exacerbating stigma, misinformation, and discrimination against PLHIV.
Reportedly, the freeze further posed serious economic consequences, particularly for healthcare workers and organizations reliant on PEPFAR funding. Many of the participants reported job losses, income reduction, and financial distress, making it harder to access healthcare services. Women and young professionals were disproportionately affected, as they form a significant portion of the workforce in HIV&AIDS programs. The economic strain extended beyond healthcare workers to PLHIV, with some resorting to rationing their medication due to uncertainty about future treatment availability. In addition, the funding freeze has triggered psychological and social consequences, with many PLHIV experiencing heightened stress, anxiety, and fear. Some participants reported being publicly stigmatized, while others faced discrimination and rejection within their communities. The disruption of peer counseling and mental health support programs further worsened these psychological effects. Women reportedly faced increased rates of gender-based violence (GBV), involuntary disclosure, and intimate partner violence, deepening their vulnerability.
Maternal and child health services were significantly affected, with early infant diagnosis (EID), prevention of mother-to-child transmission (PMTCT), and nutritional support for HIV-positive mothers facing severe disruptions. Many women reported difficulty accessing essential medications for themselves and their children, increasing the risk of HIV-related infant mortality. Additionally, healthcare facilities struggled to maintain adequate supplies of HIV treatment and nutritional support, leaving pregnant and breastfeeding women in a highly vulnerable position.
According to the assessment, immediate restoration of HIV/TB Services is crucial to prevent further deterioration of health outcomes. Governments’ local and international stakeholders must advocate for urgent policy interventions to restore funding for critical HIV programs. Strengthening community-led
To address mental health and psychosocial challenges, HIV programs should strengthen the integration of counseling, peer support, and mental health first aid into service delivery. Healthcare providers should receive training in psychological first aid, and community-based organizations should expand support groups for PLHIV to counter the psychological impact of the funding freeze.
Given the widespread economic distress, there is an urgent need for livelihood support programs targeting healthcare workers and PLHIV. Financial assistance, vocational training, and entrepreneurship support should be introduced to help young women and girls who lost jobs transition into alternative income-generating activities. Governments could also incorporate affected health workers into national payrolls to ensure continuity of HIV service delivery.
To reduce reliance on external donors, governments, local and international development partners must diversify funding sources for HIV programs. This includes strengthening public-private partnerships, increasing domestic budget allocations for HIV services by governments, and exploring regional funding mechanisms. Such measures would enhance financial sustainability and resilience in the face of future funding uncertainties.
Finally, improving communication and advocacy efforts is critical in combating misinformation and stigma surrounding HIV treatment. Governments, civil society organizations, and community groups should increase awareness campaigns to ensure that people living with and affected by HIV and affected communities receive accurate information about service availability. Advocacy efforts should also focus on securing long-term commitments from governments, private sector, anthropologists and international donors to prevent similar funding disruptions in the future.
In conclusion, the funding freeze has posed an immediate crisis for HIV treatment and prevention efforts in Eastern Africa, especially among women and girls, threatening to reverse years of progress in fighting HIV&AIDS and TB programs. Without urgent intervention, millions remain at risk of treatment interruptions, worsening health outcomes, and deepened socio-economic vulnerabilities. Governments and stakeholders must act swiftly to restore funding, integrate mental health services, support affected workers, and build sustainable funding models to protect the lives and dignity of those impacted by the crisis, and most importantly, integration should be implemented in a phased approach with a clear framework, adequate capacity building, and stakeholder consultation an engagement of communities affected.
