US funding cuts disrupted HIV care in Kenya

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In January of 2025, the US government froze all foreign aid and issued an order to stop work for 90 days. Soon after, USAID was dissolved. In February, PEPFAR received a waiver to continue HIV treatment. 

These abrupt changes disrupted the antiretroviral therapy (ART) supply. Newer, longer-lasting ARTs were not available in Kenya or the rest of sub-Saharan Africa due to cost and lack of support. Without access to treatment, people living with HIV can experience a rebound of the virus that can progress to AIDS.

To understand how these cuts are affecting access to HIV treatment in Kenya, Erica Sedlander, DrPH, and a team of researchers interviewed people living with HIV and the providers who care for them. Co-author Dr. Njeri Wairimu presented the results to local and national stakeholders in Nairobi, highlighting four themes that emerged from the interviews, showing how HIV care has changed.

  1. Rationing ART supply led to more frequent visits to pharmacies, affecting people’s health and quality of life. Instead of receiving drug refills every 3-6 months, people had to go to the pharmacy every 7-14 days. That increased transportation costs and led to missed doses. In some cases, having to make such frequent pharmacy visits caused people to lose their jobs.

“I was told that I would only get them (ARTs) every month. At that time, I was employed and I could not come here every month. So I had to ask for permission, so asking for permission for like two months, it cost me my job. I lost it.” 
Man with HIV, age 37
 

  1. Shutting down HIV-specialty centers and integrating HIV care into primary care impacted confidentiality. Integrating HIV care into primary care settings compromised people’s confidentiality, increased stigma from their communities, and led some to delay or avoid care.

  2. Funding cuts created fears about the future of HIV and calls for the Kenyan government to cover the deficit. Participants expressed fear about future ART affordability, increased HIV transmission, and decreased HIV prevention services. Many encouraged moving toward financial independence from US funding.

“As a country, we should be thinking of manufacturing our own ART. We should stop this overdependence; it cripples us as a nation.” 
Medical doctor
 

  4. Higher cost and lower availability of condoms meant people couldn’t use barrier methods to prevent pregnancy and         sexually transmitted infections. Funding cuts also affected access to condoms and other contraceptives, which were                   previously provided at no cost.  Longer-acting methods like injections were financially out of reach.

“And still there have been no condoms since January, so it became an expense to us as we had to go back to our pockets in this economy. So it affects us a lot.” 
Man with HIV, age 37
 

This study highlights the cascading effects of funding cuts and points to key action steps to respond.

  • Establish a protected HIV treatment budget line within the Ministry of Health. 

  • Implement dedicated service windows, strict privacy protocols, and stigma-reducing care standards to ensure integrated HIV care is confidential.

  • Invest in workforce training and staffing ratios to equip all primary care providers responsible for integrated HIV care and prevent workforce burnout.

  • Restore consistent condom and contraception supply, prioritizing couples in which one person is living with HIV and other key populations.