Are women living with HIV/AIDS safe after the funding freeze?

It was in January this year (2025) when the President of the United States of America halted external funding to various countries around the globe. This halt, which took immediate effect following the passage of Executive orders, impacted all countries that were receiving funding from the USA.

As a result, Uganda was among the countries affected by the funding cut, as it relies heavily on external funding for various sectors such as education and research, health and HIV/AIDS services, malaria and infectious disease control, the oil and gas industry among others.

The Executive Orders have significantly affected the HIV community’s access to care and treatment, particularly in adherence services such as mental health support, psychosocial support, and peer-led systems like e-medicines, among others.

However, it is important to note that even before the funding freeze, these communities were already deeply impacted by the law. The Anti-Homosexuality Act (AHA) created widespread stigma and discrimination within the healthcare system, further marginalizing vulnerable populations.

One of the most affected sectors has been communities supporting women living with HIV/AIDS, whose access to healthcare and sexual and reproductive health and rights (SRHR) services has been severely impacted. This is largely because funding for these services constituted a significant portion16.6% of the United States’ total official development assistance (ODA), which was halted under President Trump’s administration.

Women living with HIV/AIDS, including positive women with disabilities, young girls living with HIV, children born with HIV, and other vulnerable groups in Uganda are finding it increasingly difficult to access sexual and reproductive health and rights (SRHR) services.

This lack of access places them at serious risk, including increased chances of HIV transmission, rising new infections, higher mortality due to interrupted antiretroviral (ARV) treatment, greater risk of mother-to-child transmission, a surge in teenage pregnancies, and other related health and social challenges.

Before the funding freeze, by September 2022, approximately 1.3 million people living with HIV in Uganda were receiving treatment an increase from just 26,365 in 2004. Of these, about 60–80% relied directly on external support from PEPFAR and the Global Fund, with PEPFAR alone supporting over 700,000 individuals on lifelong antiretroviral therapy (ART).

However, this progress faced significant setbacks due to funding disruptions in early 2025.
Out of the 1,882,619.57 Ugandan Shilling donated by PEPFAR and the Global fund, between 2023 and 2024, only 12% was contributed from domestic funding which created a funding gap as Uganda largely relied on donor fund, therefore after, the government could not sustain Ugandans with HIV/AIDS treatment with only 12% the freeze. This has prompted goverment to source 480 billion shillings to fund lifesaving services.

Since 90% of people living with HIV in Uganda depended on external donor funding, the funding freeze had a profound impact on patients. The supply of antiretroviral drugs (ARVs) was no longer as consistent or reliable as before, leading to treatment disruptions.

Some patients began missing their hospital visits out of fear of facing unfamiliar health workers who were not adequately trained to care for HIV-positive individuals.

This was largely due to the dismissal of their regular counselors, who were laid off after the funding freeze when the government could no longer afford to retain them. Additionally, the integration of HIV services into general outpatient departments made many patients feel uncomfortable, as they were now forced to share spaces with others, increasing fears of stigma and compromising their sense of privacy and safety.

Following the funding freeze, the International Community of Women Living with HIV in East Africa conducted a regional survey to assess its impact on women and girls across the region. The primary objective was to advocate for urgent policy interventions to restore and sustain life-saving programs.

According to the assessment, one of the most significant consequences of the freeze has been the severe disruption of HIV and TB services as they can no longer be accessed especially at this time when the health centers have been integrated.

Essential interventions including HIV prevention methods such as pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and prevention of mother-to-child transmission were either halted or drastically scaled down. Similarly, critical care and treatment services such as viral load monitoring and access to antiretroviral therapy (ART) were severely affected.

The report further highlights delay in PCR test results a crucial test performed on babies born to HIV-positive mothers to determine whether the infant is infected and should begin antiretroviral treatment, or is uninfected and needs ongoing protection.

These delays have exposed infants to a higher risk of HIV infection, as many mothers, aware of the funding freeze, no longer return to hospitals for their babies’ follow-up assessments. Additionally, other essential services, such as youth-friendly corners, have also been negatively affected.

According to NAFOPHANU, the HIV prevalence rate declined from 7.2% in 2010 to 5.1% in 2023. Over the same period, cases of mother-to-child transmission dropped from 20,000 to 4,000. HIV-related deaths decreased from 53,000 in 2010 to 20,000 in 2023, while new infections fell from 97,000 to 37,000. The significant progress has been achieved in the fight against HIV in Uganda, driven by improved coordination, strong partnerships, and sustained efforts.

These milestones clearly demonstrate the positive impact of the government, and other organizations such as Uganda AIDS commission, TASO, Uganda cares, Baylor Uganda, Alive Medical Services, UNYPA (Uganda Network of Young People living with HIV & AIDS), among others.

However, the Executive Director at The National Forum of People Living with HIV/AIDS Networks in Uganda (NAFOPHANU) Flavia Kyomukama notes that the timing of the funding freeze is particularly unfortunate, as it coincides with the Church of Uganda’s decision to reclaim the premises that have housed NAFOPHANU’s offices for over 20 years.

As a result, NAFOPHANU is being forced to relocate. This comes at a critical moment when external funding is unavailable, yet the organization urgently needs over 500 million Ugandan shillings to construct a new facility and complete the relocation by December this year. Flavia connects the lack of the necessary support to the funding halt.

However, Dr. Daniel Kyabayinze, Director of Public Health at the Ministry of Health, notes that the integration of health centers has been effective in delivering services to people living with HIV/AIDS, as well as to other patients. He encourages the public to continue collecting their medication as they did prior to the funding freeze.

He further emphasizes that Uganda continues to receive HIV treatment medicines from various sources, including the government, which supports 3,600 clinics, and approximately 7,000 additional clinics funded through American support and the Global Fund (GMS). Dr. Kyabayinze urges the public to keep adapting to the new integrated system and assures them that the government will provide timely updates should any changes occur.

In Tororo, Ayoo Proscovia, the headteacher who resigned due to HIV stigma, notes that misinformation about the funding freeze has severely impacted the lives of women in the community.

Many women fled their homes out of fear of the stigma they might face if their health deteriorated due to lack of medication. She added that in workplaces such as markets, these women were seen as “moving dead,” as people knew that without medicine, they could not survive this perception negatively affected their ability to work.

Proscovia further explains that, even worse, many women who previously worked in health centers to earn a living were laid off due to the funding freeze and are now struggling financially.

However, she appreciates that, so far, the integration system has not been fully implemented in their area, and they are still able to receive their medicines normally from their health centers, since the integration system has been a challenge to many in different parts of the country as they feel uncomfortable being in the same spaces with other people. “We receive our services as usual and things are moving on well, we are not complaining,” she proudly notes.

Sheirat Namayanja, the Youth Country Coordinator of the SRHR Alliance and Uganda’s Representative of the Her Voice Fund Ambassador explains that adolescent mothers, particularly those in rural areas, no longer feel comfortable collecting their medication from health centers following the integration of services.

Many were discouraged after visiting and not finding the teenage peers who previously supported them during hospital visits. Instead, they now face unfamiliar health workers whom they feel they cannot trust with their personal information.

Worse still, many of these new staff members are not adequately trained to handle cases involving people living with HIV. As a result, the lives of these adolescent mothers are at serious risk, as many have stopped collecting their medication from facilities.

Immaculate Owomugisha, Executive Director at the Centre for Women’s Justice, noted that some patients have not yet fully disclosed their HIV status to their partners.

She reported receiving cases of gender-based violence (GBV) resulting from health workers unintentionally disclosing patients’ HIV status within the integrated health system particularly when reminding them about hospital visits. This has led to break down of several relationships especially the discordant couples.

She appreciates the Ministry for implementing the integration system but urges the government to provide training for health workers who attend to HIV patients at these health centers. She emphasizes the need to equip them with the necessary knowledge and skills to effectively manage and support people living with HIV.

This, she explains, will help build trust and encourage patients to open up about their condition. As a result, it would help prevent related conflicts and motivate more patients to continue seeking care at health facilities.

The SRHR lead in Akina Mama Wa Afrika Olabukunola Williams, the funding cuts have reversed much of the progress made in access to HIV medication and in conversations around positive living especially for women living with HIV and those most affected.

Buky mentions that she is frustrated that adolescent girls and women remain at high risk of contracting HIV, and yet much of the progress that had been made is now being lost, thereby calling for urgent discussions on the kind of support needed to address these gaps and how Uganda and all African countries can take ownership in closing them, since some sectors, like health, should not be perpetually dependent on external funding.

“This ties into the ongoing conversation about domestic resource mobilization. It’s critical that we start having these discussions now, sooner rather than later.”Buky emphasises.

The ongoing freeze on external funding has significantly impacted key populations, particularly those who were directly targeted and highly affected.

This has caused widespread fear across the country, especially among beneficiaries in sectors such as education, diversity, equity and inclusion programs, humanitarian aid, and communities of people living with HIV/AIDS, among others.