By: Dann Okoth
[NAIROBI] Milicent Muyoma has been turned away twice from the clinic where she collects her HIV medication in Mathare, an informal settlement in Nairobi, Kenya.
The last time she visited, about a week ago, she was told the medicines had not arrived. When she returned three days later as advised, she found the clinic closed.
She fears missing her medication could have devastating consequences.
“If there is a pandemic in Africa, all of us in the world will be affected. Let us not forget the lesson from COVID.”
Jean Kaseya, director-general, Africa CDC
“I was warned by my doctor not to miss a single dose because that could lead to resistance,” Muyoma told SciDev.Net. “I don’t know what will happen if I don’t secure my medicines soon enough.”
The stockout follows an order from the US State Department on 24 January, which suspended funding for nearly all foreign assistance programmes, including the President’s Emergency Plan for AIDS Relief (PEPFAR), which provides free HIV treatment for millions of people in Sub-Saharan Africa.
Aid programmes worldwide are being put on hold while the administration of President Donald Trump carries out a 90- day review of foreign aid to pursue an “America First” foreign policy.
On 28 January the US administration issued a waiver, exempting “life-saving humanitarian assistance” including “core life-saving medicine” from the pause in funding. This should ensure that HIV treatment dispersed by PEPFAR continues, according to the International AIDS Society.
However, across Sub-Saharan Africa, there is a palpable worry that the treatment of millions of people living with HIV could still face disruptions.
The US order has stopped billions of dollars flowing to US-backed projects worldwide, including initiatives supporting health, education, job training, and anti-corruption efforts.
Women and girls at risk
Gladys Kiio, executive director at African Gender and Media Initiative Trust in Kenya, warns that the disruption will disproportionately affect women and girls.
“Women and girls are already more predisposed to HIV due to their status in society,” Kiio told SciDev.Net.
“The prospect of making HIV treatment and care unavailable or unfordable will double their vulnerability.”
Kiio says successful USAID-funded programmes running in Sub-Saharan Africa include voluntary male circumcision, which reduces HIV infection by up to 50 per cent.
She warns that medication disruptions could have severe repercussions.
Responding to the stories of patients missing their medication, Kiio added: “We hope such reports are unfounded and temporary, because getting large numbers of people missing their doses would exacerbate drug resistance and lead to widespread HIV infection rates and wipe out the gains made in containing the spread of the disease.”
According to UNAIDS, at least 39.9 million people globally were living with HIV in 2023, with two-thirds of them in Sub-Saharan Africa.
Decades of HIV progress threatened
The aid freeze raised alarm among health experts and advocacy groups, who warned it could reverse decades of progress in the fight against HIV/AIDS.
Jean Kaseya, director-general of the Africa Centres for Disease Control and Prevention (Africa CDC), said he was yet to understand the extent of the exemption and will continue to advocate for the full resumption of all US-funded health programmes.
During a virtual press conference last week (30 January), Kaseya warned that the continent could experience an additional two to four million HIV-related deaths per year if the funding freeze continued.
He said this could push an estimated 39 million people deeper into poverty and undo hard-won gains in reducing HIV mortality rates.
“That will be almost comparable to what we had 25 years ago,” Kaseya said. “We can’t afford that because all of these conditions we are putting in place can lead one day to a pandemic in Africa.”
He warned: “If there is a pandemic in Africa, all of us in the world will be affected.
“Let us not forget the lesson from COVID.”
Uncertain future
Despite the waiver, Nelson Otuoma, executive director of the National Empowerment Network of People Living with HIV/AIDS in Kenya, said anxiety was growing within affected communities.
“Nobody at the moment still knows what the end game will be,” Otuoma told SciDev.Net.
He believes the real impact of the Trump directive is yet to be realised.
“Medicines may still be available [but] the challenge will be in the staff dispensing them,” he added as Kenyans directly or indirectly employed by USAID and affiliate NGOs face possible job losses.
A senior official at Kenya’s Ministry of Health, who requested anonymity, told SciDev.Net that some facilities were turning patients away—not necessarily due to shortages but in anticipation of a future supply crisis that could drive up costs.
“Patients are being turned away from some facilities, not because they have run out of the medicines already, but because suppliers anticipate these medicines would be in short supply and therefore costly,” the official said.
HIV stockouts continue
Regan Okech operates a pharmacy on the edges of Nairobi River in downtown Nairobi. His pharmacy dispenses HIV drugs on behalf of an NGO, bankrolled by USAID through PEPFAR.
His shop caters for at least 45 patients coming from the nearby informal settlements of Korogocho, Mathare and Huruma.
However, over the last couple of weeks, Okech says he has not received any medicines or payment from the NGO.
“We have been on stockout for several weeks,” he told SciDev.Net.
“We have not heard from the NGO either so we have been forced to turn away patients.”
Mohga Kamal-Yanni, a senior policy advisor to The People’s Medicine Alliance and senior health policy consultant to UNAIDS, warned that the situation could worsen if urgent action is not taken.
“Cutting aid to developing countries can hit Africa’s health hard,” Kamal-Yanni told SciDev.Net.
“We still do not know what will happen to PEPFAR, which is an essential funding mechanism to get to an AIDS-free Africa and an AIDS-free world.”
She also cautioned that policy changes in the US—such as the removal of price caps on medicines—could embolden pharmaceutical companies to maintain high drug prices, making essential medicines even more inaccessible for people in Africa.
For Otuoma, the crisis underscores the need for African governments to take ownership of HIV treatment programmes and reduce reliance on foreign donors.
“Even if PEPFAR and USAID come back … let them do other work but leave medicines to the government,” Otuoma added.
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.