Shortly after the United States froze foreign assistance in early 2025, programmes delivering critical HIV services in Uganda and Zimbabwe experienced large, sustained declines, an analysis published this month in The Lancet reports.
Immediate impact on treatment and prevention
Researchers used service-delivery data from four non-governmental organisations (NGOs) in Uganda and Zimbabwe that received funding through the President's Emergency Plan for AIDS Relief (PEPFAR). The study found a 31.5% drop in the number of people receiving antiretroviral therapy (ART). Prevention services — including distribution of condoms and lubricants — fell by 62.7%, and HIV testing declined by 63.8%. Among the three NGOs reporting on pre-exposure prophylaxis (PrEP), initiation and continuation of PrEP fell by 71.6%.
"Severe, immediate, and sustained reductions in service delivery," the Lancet analysis concluded.
The pause followed the return to office of President Donald Trump in January 2025, when the administration temporarily halted all existing foreign assistance awards to reassess whether aid aligned with its "America First Global Health Strategy," according to the paper. PEPFAR, established in 2003, is the largest external funder of HIV services globally; the interruption of its funding therefore has broad implications for programmes that serve key populations and high-risk groups.
Who was affected and how
The NGOs in the analysis provided services to groups that face higher HIV risk and barriers to care: men who have sex with men, female sex workers, transgender people and people who inject drugs. The reductions in ART and other services threaten individual health and undermine the public-health benefit of preventing onward transmission.
The study weighted results by the number of ART clients each NGO served in 2024. Because ART both prevents AIDS-related illness and reduces the risk of transmission, interruptions in treatment can lead to worse outcomes for patients and an increase in community transmission if not promptly restored.
Funding shifts, bilateral deals and national responses
The Lancet analysis notes that the US has since resumed public-health aid to some countries through bilateral agreements that attach conditions such as access to mineral rights and patient data. Uganda is among countries said to be resuming US public-health aid under bilateral arrangements, while Zimbabwe reportedly turned down offers it judged to infringe on national sovereignty.
Such changes in aid architecture can shift how services are delivered and to whom, with possible consequences for population-level coverage and for marginalised groups that often rely on NGO-led programmes for access.
Regional implications and expert concerns
Although the study covers two countries, its findings carry lessons for southern Africa, where HIV burden remains high and external funding continues to support substantial parts of the prevention and treatment cascades. Interruptions to donor funding or abrupt changes in funding models risk undoing gains in testing, prevention and viral suppression.
- ART coverage fell by 31.5% in the NGOs analysed.
- Prevention services declined by 62.7% (condoms, lubricants and related outreach).
- HIV testing declined by 63.8%.
- PrEP initiation and continuation dropped by 71.6% among reporting NGOs.
| Service | Change reported |
|---|---|
| ART | −31.5% |
| Prevention services | −62.7% |
| HIV testing | −63.8% |
| PrEP | −71.6% |
Researchers warn that reductions of this magnitude are likely to have both immediate clinical consequences and longer-term effects on epidemic control unless funding and services are rapidly restored and access secured for vulnerable populations.
Health programmes and governments that depend on external funding may need to consider contingency planning, diversification of funding sources and strengthened national health financing to shield essential services from geopolitical shifts. The analysis also raises questions about the ethics and practicality of tying health aid to non-health conditions.
Patients and community members who are concerned about interruptions to HIV services should contact their local clinic, health department or accredited NGO for information on continuing treatment, testing and prevention options. Always consult a healthcare professional rather than self-adjusting medication.
This report is based on an analysis published in The Lancet that used data from four NGOs in Uganda and Zimbabwe and examined service delivery changes following the US foreign aid pause in early 2025.
