The impact of AIDS funding cuts on global HIV response.

By Hebert Mugumya

MBARARA: Tomorrow (1^st Dec 2025), Uganda will join the rest of the World to commemorate World AIDS Day.

Uganda has indeed registered tremendous achievements in the fight against HIV/AIDS due to a number of factors and the participation of a number development partners- including the external funding agencies like USAID.

There is however a growing ‘silent concern/worries’ amongst the victims of HIV/AIDS on what next after the withdraw/cuts of several funders in Uganda’s health sector.

Herbert Mugumya a reknown Global Public Health Leader and social Analyst explains the impact of donors withdrawing their support.

World AIDS is annually celebrated globally by each country to remember the heros and victims of the worst global pandemic ever experienced in human history. Every 1^st December, people reflect on the devastating effect of HIV on families and communities, but also on countries’ economic capacity to sustain HIV prevention, care and treatment programs that have positively impacted on HIV response over the decades.

Since 1990, I have been focusing on HIV and reproductive health, and I have actively participated in programs that positively impact humanity from the community,to national and global levels mitigating the horrific effect of HIV. My career has been hugely shaped by global HIV response as I have spent 35 years in HIV response as caregiver, counselor, program manager, policy maker and implementer. Uganda is one of the countries globally that was hit hard by the AIDS pandemic. Without the intervention of development partners like U.S government through agencies like USAID, CDC and others, the AIDS negative impacts could have been very devastating. In partnership with other global funding mechanisms such as PEPFAR, Global Fund for AIDS, TB and malaria, Ugandan government pulled off excellent HIV and AIDS disease prevention, care and treatment interventions. Annually, Uganda has been a recipient of over US$ one billion funding. These funds would directly and indirectly support government efforts to contain the disease by prolonging lives of adults and ensuring that children are born free of HIV even when their mothers are HIV positive.

U.S. Government through its funding mechanism called Presidential Emergency Funding for AIDS Relief (PEPFAR) produced very large, visible socioeconomic and health gains in Uganda. Since 2005, we have seen lower HIV mortality, much higher ART coverage and viral suppression, fewer infant infections, better workforce participation and household resilience. But the recent sudden funding cuts through USAID have already disrupted services in 2025 and if not replaced or mitigated, field reports show the HIV response gains can be reversed quickly. As a country, we need sustainable path of a mix of accelerating domestic financing, integrating HIV care into primary health systems, scaling community-led service delivery, protecting key-population access, and investing in supply-chain and local manufacturing of ARVs.

Let’s break it down!

What has USAID/PEPFAR funding delivered in Uganda? The visible socioeconomic & health gains. Evidence obtained from lancet studies and UNAIDS

1. Large reductions in HIV-related deaths and big increases in people on antiretroviral therapy (ART) and viral suppression. These are gains directly tied to US funding and technical support for testing, ART, PMTCT (prevention of mother-to-child transmission), and community treatment models.
2. Tangible socioeconomic benefits: healthier adults can work, we see lower orphanhood burden, improved school attendance (children of treated parents), and local jobs created through program staffing, labs, supply chains and community health worker networks. (These effects are discussed across global reviews of PEPFAR/USAID impact)
3. Strengthened systems: investments in commodity supply chains, lab networks (viral load testing), data systems, and community cadres (mentor mothers, expert clients) that improved broader primary care resilience.

With U.S.President Trump administration, see what the AIDS funding cuts have done

1. Immediate service disruptions have been reported in Uganda: reduced capacity at some ART sites, interruptions to community-led prevention and support services, and anxiety among marginalized groups when NGO partners stopped activities. Field reports and UNAIDS flagged facility reductions in capacity and gaps in maternal/infant HIV prevention services.
2. Independent analyses and modelling warn that abrupt large cuts would substantially increase new infections and deaths if not mitigated — reversing years of progress. Several papers and WHO/UNAIDS syntheses estimate millions of additional infections/deaths globally if large funding gaps persist. 

Caption: A number of Non Governmental Organisations (NGOs) were funded by agencies like USAID to purchase bicycles to facilitate the fight against HIV/AIDS at the village level. Such interventions are no more due to the withdraw of the funds.

Therefore, the much-hyped gains on HIV and AIDS response are being reversed quickly. This is why! HIV control is a chronic, lifelong program: treatment interruptions raise viral loads, increase transmission risk, and push up drug resistance and mortality. The gains rest on continuous medicines, testing, and community support.What are the best sustainable pathways for containing HIV in Uganda given the donor funding cuts?

1. As we commemorate this day in Bushenyi district, let government negotiate short-term bridging finance and emergency waivers from donors to keep ART and vertical transmission services running while transition plans form.
2. Ring-fence supply chains for ARVs, test kits and maternal drugs; decentralize buffer stocks at district level to avoid single-point failures.
3. Government can adopt a time-bound HIV financing plan that increases domestic budget share for HIV and health, with transparent tracking. Countries using these roadmaps accelerate transitions.
4. Mobilize domestic revenue: earmarked taxes or “solidarity” levies (transport, mobile transactions) tied to health, and incentives for private sector co-financing (employer programs). Evidence shows many African countries must diversify revenue to reduce donor dependence. 
5. Re-shape service delivery for cost-effectiveness and access. Let MOH scale Differentiated Service Delivery (DSD) and community ART models (multi-month dispensing, community groups, fast-track refills). DSD reduces facility burden, retains clients, and lowers per-patient costs while maintaining viral suppression. Uganda has positive evidence for community ART uptake.
6. Integrate HIV into primary health care (NCDs, maternal health) so HIV services are part of routine care. this spreads fixed costs, builds sustainability, and improves patient experience.
7. Put communities and key populations at the centre. Government should fund community-led organizations and peer cadres directly (mentor mothers, expert clients). These actors reach key populations, sustain prevention (Pre exposure prophylaxis and condoms), and support adherence. Evidence shows community models improve retention and outcomes. 
8. Invest in prevention technologies and prioritized interventions. Let the government have targeted, high-impact prevention: PMTCT, PrEP for high-risk groups, voluntary medical male circumcision where efficient, and behaviour programs for young women/men. Prioritize interventions with the highest infections averted per dollar.
9. Support local production/pooled regional procurement of ARVs and diagnostics (reduces price vulnerability) and strengthen national data systems for real-time monitoring of stockouts, adherence and new infections.
10. On social protection & economic strengthening, linkages of HIV clients to social protection, livelihoods and family support (cash transfers, VSLAs, skills programs)should be established. These reduce vulnerability and improve adherence and retention in care.

As I conclude, the bottom line is simple. Yes, USAID/PEPFAR funding materially created health and socioeconomic gains in Uganda (fewer deaths, more people working, fewer infant infections). If major funding gaps continue, those gains are at serious risk of reversal; modelling and field reports show large increases in infections largely in western Uganda and deaths are possible. Immediate mitigation and transition to sustainable finance & service models are essential.  Sustainability strategy should focus on protecting and lifesaving services now plus accelerate domestic finance, community models, prioritize high-impact prevention, strengthen supply chains and local capacity. That combination gives Uganda the best chance to keep the gains and move toward long-term self-reliance. End