What's happened
Funding for HIV programmes has fallen sharply, risking decades of progress. New reports show disbursements dropped to $6.2bn in 2025 from $8.3bn in 2024, with enforcement of the America First Global Health Strategy prompting clinic closures and job losses. MOUs are shifting the burden to domestic finance as the US signals continued leadership alongside cutbacks.
What's behind the headline?
Market dynamics and policy shifts
- The US reorients HIV aid through five-year MOUs, demanding greater domestic financing while preserving frontline services during transitions. This moves risk from donors to recipient governments and local partners.
- Mozambique and other African health systems are integrating HIV services into government systems, which could improve sustainability if funding commitments hold.
- The exodus of international funding risks broad disruptions to testing, prevention, and peer support, potentially reversing gains in ART coverage.
What to watch
- Will recipient countries accelerate domestic investment enough to sustain treatment and prevention programs?
- How will MOUs affect access for key populations and marginalized groups?
- Can global health governance establish clearer exit frameworks to protect patient care during donor disengagement?
How we got here
The US has reduced foreign aid under its America First Global Health Strategy, dismantling USAID and cutting thousands of overseas aid awards. Donor funding remains volatile, with other donors also pulling back since 2011, pressuring African health systems that rely on external support for HIV treatment and prevention.
Our analysis
Independent reports from The Independent and All Africa quote researchers and policymakers warning of service closures, job losses, and reduced prevention. Direct quotes include Elise Lankiewicz of amfAR and Jeff Graham of PEPFAR, illustrating concerns over donor withdrawal and transition strategies.
Go deeper
- What new funding commitments have governments announced to compensate for cuts?
- How are clinics adapting to MOUs in the short term?
- Which regions are most at risk of service reductions?
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