The United States Government (USG) has long been a pivotal partner in Zambia’s fight against HIV, contributing an estimated $600 million annually towards the country’s national HIV response. Of this, $367 million was allocated under the Presidential Emergency Plan for AIDS Relief (PEPFAR) for the 2025 HIV response. However, recent disruptions to US foreign assistance have caused significant disruption to Zambia’s HIV services, particularly impacting HIV prevention efforts, which have borne the brunt of the funding pause.
One of the most alarming consequences of the funding cut is the closure of 32 drop-in centers across 7 out of 10 provinces, which provided critical services to over 20,000 individuals living with HIV and on antiretroviral therapy (ART). In addition, USG-supported DREAMS centers, which focus on adolescent girls and young women, have been shut down in 21 districts. The suspension of 16 standalone centers providing voluntary medical male circumcision services has further compounded the situation. Moreover, nearly half of Zambia’s pre-exposure prophylaxis (PrEP) services, which are funded by the USG, have also been halted.
The suspension of funding is also threatening the health workforce dedicated to HIV service delivery. USG support extends to over 23,000 personnel, including more than 11,500 health workers and community-based volunteers, who have been crucial to Zambia’s national AIDS response. With the abrupt loss of this support, the Government of Zambia faces difficulties in absorbing these health workers in a timely manner. Efforts are underway to explore alternatives, such as task shifting and better integration of services, to mitigate the negative impact on service delivery.
In certain regions, such as the six districts in Northern Province, HIV services have come to a complete standstill, where Right to Health is the only USG implementing partner. Despite a secured supply of antiretrovirals (ARVs) for the next 12 months, there is no buffer for the period beyond that. Other essential supplies, including HIV rapid test kits, tuberculosis x-pert cartridges, and materials for viral load testing and early infant diagnosis, are rapidly depleting, with stock levels expected to last only a few months.
In response, the Ministry of Health has reiterated its commitment to ensuring that essential HIV, tuberculosis (TB), and malaria services continue across public health facilities. The UN Joint Team on HIV and AIDS has been assisting the Ministry by establishing a high-level steering committee aimed at identifying gaps and developing a response plan to address the impact of the funding pause. The Government, in collaboration with cooperating partners, has presented a costed-impact mitigation plan to ensure the continuation of essential HIV services, even amidst funding challenges.
Additionally, the Joint Team is collaborating with the Ministry of Health and the National AIDS/TB/STI Council (NAC) to explore and implement both medium and long-term strategies to sustain Zambia’s national AIDS response. These efforts align with the HIV Response Sustainability Roadmap 2025-2030, which was launched in December 2024.
As Zambia navigates this critical period, the priority remains to minimize the disruption to HIV services and safeguard the progress made in reducing the burden of HIV in the country.