Background

In early 2025, the United States implemented sweeping reforms to its foreign aid program, pausing and then cancelling about $79.5 billion in development aid. This includes $1.1 billion in cuts to the global HIV response in FY24/25 alone. Impact modelling of a similar scenario suggests 70,000 additional new HIV infections and 5000 additional HIV-related deaths across lower-middle income countries.

Countries have issued memos on service modifications considering the cuts. However, little is known about the immediate effects of the funding cuts on clinic-level service provision. An early warning system is needed to inform emergency mitigation actions.

Methods

We analyzed the list of active and terminated USAID awards as of 21 March 2025 to determine the nature and extent of HIV funding cuts in Malawi and South Africa. We then leveraged existing community-led monitoring systems to conduct a rapid early warning exercise on the impact of those cuts in 6 districts: Dedza, Mangochi and Zomba in Malawi, and Ekurhuleni, Mopani and the West Rand in South Africa. In February and March 2025, we conducted 11 focus group discussions with 153 stakeholders, including 30 healthcare workers and 123 people living with HIV and key populations.

This publication was developed with reprogrammed funds from the Citizen Science project,
rapidly responding to the emergency of U.S. funding cuts in early 2025. The existing community systems and relationships with health facilities from Citizen Science were leveraged to form a community-led early warning system on the service-level impacts of the funding cuts.