By Health Correspondent
HIV prevention, testing and treatment services in Zimbabwe have suffered sharp declines following the Trump administration’s suspension of US foreign assistance, according to a new study published in The Lancet.
Uganda has also been hard hit.
The analysis found that the number of people receiving antiretroviral therapy (ART) through four non-governmental organisations in the two countries fell by 31.5%, while HIV testing declined by 63.8% and prevention services dropped by 62.7%.
The findings raise concerns about the impact of Washington’s decision to freeze foreign aid in January 2025, including funding under the President’s Emergency Plan for AIDS Relief (PEPFAR), a major international source of financing for HIV programmes.
The study examined service delivery by organisations working with populations at heightened risk of HIV infection, including men who have sex with men, female sex workers, transgender people and people who inject drugs.
Among the three organisations that provided data on pre-exposure prophylaxis (PrEP), the initiation and continuation of the preventive medication fell by 71.6%.
PrEP substantially reduces the risk of acquiring HIV when taken as prescribed.
The research found that the interruption of US funding resulted in severe, immediate and sustained reductions in HIV service delivery, highlighting the vulnerability of programmes dependent on external assistance.
PEPFAR was established in 2003 under former US president George W Bush and has since become the world’s largest external funder of HIV services.
Soon after returning to office in January 2025, President Donald Trump ordered a pause on existing foreign assistance awards as his administration reviewed programmes against its “America First Global Health Strategy”.
The policy shift disrupted funding for organisations providing prevention, testing and treatment services, particularly those serving marginalised communities that may struggle to access mainstream healthcare.
Lead researcher Henry Cust, a health economist specialising in HIV risk at the London School of Economics, warned that withdrawing services from these groups could have consequences beyond the communities directly affected.
People who use drugs, engage in sex work or have sex with sex workers also have partners and families, meaning reduced access to prevention and treatment could contribute to wider HIV transmission.
Although the study did not measure subsequent changes in HIV infections, Cust warned that declining prevention and treatment services could set in motion a chain of events leading to increased transmission, including mother-to-child transmission.
The findings also raise questions about the future of US-funded health programmes as Washington seeks new bilateral agreements with recipient countries.
The Trump administration has resumed public health assistance to some countries, including Uganda, through agreements that have raised concerns over conditions relating to patient data and other national interests.
Zimbabwe, however, has rejected the proposed US health assistance arrangement, with the government raising concerns about national sovereignty and the terms attached to the funding.
The United States subsequently moved to end its health assistance to Zimbabwe following the collapse of negotiations, putting programmes that have relied on American support under further pressure.
The funding dispute comes at a critical time for HIV prevention and treatment efforts, with health organisations warning that disruptions to essential services could undermine progress made in controlling the epidemic.
The study’s findings underscore the risks of abrupt funding withdrawals, particularly for community-based organisations that provide services to populations often excluded from conventional healthcare systems.
