One year after the freeze in U.S. funding, the HIV response is faltering

On 20 January 2025, the freeze in U.S. foreign aid funding sent shockwaves through the global HIV response. This decision came alongside a series of political measures taken by Northern countries, restricting both the volume of funding and the conditions under which international solidarity is allocated. One year on, what has been the impact on the ground?

Coalition PLUS and its partners (Sidaction, Frontline AIDS, Aidsfonds) conducted a survey of 79 community-based organisations in 47 countries and are sounding the alarm: the HIV response has been weakened, and essential prevention, support and health services are declining. Women, young people and LGBTQI+ individuals are the most affected.

Beyond the figures, the survey highlights a broader trend described in the report’s conclusion: cuts to international aid are causing widespread and profound damage not only to service delivery, but also to community organisations themselves, to healthcare infrastructure, and to the social and political environment in many countries.

Key findings from the survey

79 community-based organisations responded, across 47 countries.

• 77% report that reductions in international funding have affected service delivery.
• PrEP: in 81% of organisations, access to this preventive treatment is operating at less than 50% of January 2025 levels.
• Supplies: 56% report an impact on the availability of consumables.
• STI treatment: 95% of organisations report that STI treatment products are unavailable or less available.
• Support for people living with HIV: 69% of organisations are operating at less than 50% of capacity.
• Key populations: complete cessation of services for trans people and people who use drugs in 10% of organisations; reduction or suspension of services for men who have sex with men in 85% of organisations, and for sex workers in 82%.
• Staffing: remuneration for 2,275 peer educators and community health workers has been suspended or cut (an average of 45 affected positions per organisation).

Stockouts and shortages: immediate and tangible consequences

The financial shock has translated into stockouts and reduced availability of products: 56% of organisations report an impact on the availability of supplies.

The most affected products include hormone replacement therapies (HRT) and STI treatments (both reported as unavailable or less available by 95% of organisations), as well as harm reduction supplies (93%), opioid substitution treatments (92%), condoms and lubricants (86%), and vaccines (86%).

The survey also highlights a domino effect on costs: when international aid no longer subsidises certain purchases or no longer provides access to pooled procurement mechanisms, some products and medical procedures can become more expensive or even be discontinued in certain contexts (viral load testing, CD4 counts). Ultimately, this leads to increased out-of-pocket costs for affected individuals.

A weakened prevention response, essential services slowed down

The situation is particularly alarming for HIV prevention: in 81% of organisations, access to PrEP is operating at less than half of the level observed in January 2025.

Support services for people living with HIV are also declining, with 69% of organisations reporting that they are operating at less than 50% of capacity.

Community-based organisations play a critical role in reaching those most exposed to HIV and in providing support, retention in care, prevention, referral and non-medical services. Yet the survey indicates that 38% of organisations have completely suspended at least one form of support service, with legal aid and services addressing gender-based violence among the most severely affected.

A crisis affecting the community response itself

Beyond service delivery, organisations’ ability to operate has been undermined: 63% report a direct impact on their operations; 22% have lost at least half of their budget, including 9% that have lost more than 75%.

Human resources have been particularly affected: 65% of organisations report an impact on their teams; in total, 2,275 peer educator and community health worker positions have been affected by the suspension or termination of stipends.

Some organisations report the closure of facilities (centres, outreach points, clinics) or the continuation of activities on an unpaid, volunteer-only basis.

A weakened social and political environment

The effects of funding cuts extend beyond health: weakening of civil society, resurgence of stigma targeting people living with HIV and key populations, and erosion of alliances between stakeholders.
Several respondents link the reduction of community programmes (prevention, dialogue, support, legal aid) to an increase in violence, stigma and discrimination, alongside a growing sense of abandonment among beneficiaries, particularly women, young people and LGBTQI+ individuals.

While 30% of respondents report some form of public authority response (contingency plans, domestic resources), the majority indicate a lack of visibility regarding any structured governmental response.

A roadmap for resource mobilisation

The survey results provide a roadmap for resource mobilisation: they identify the categories of services most severely affected and underscore the urgency of action, as experienced community partners close facilities, reduce staff, and face the risk of disappearing altogether.

As UNAIDS projects 3.3 million additional new HIV infections between 2025 and 2030, Coalition PLUS calls on governments and donors to prioritise the continuity of care and prevention services, particularly PrEP, services for key populations and guarantees of their safety, the availability of essential supplies, and support for the institutional capacity of community-based organisations and their frontline teams.

Survey conducted with the support of AFD and L’Initiative – Expertise France.