Zimbabwe and its southern African neighbours are bracing for a severe HIV/AIDS funding shock after the United States abruptly froze its foreign aid programme, including the President’s Emergency Plan for AIDS Relief (PEPFAR). The halt to US assistance, which constituted about 60% of UNAIDS’ budget according to its chief, Winnie Byanyima – has already disrupted lifesaving antiretroviral (ARV) supplies and community outreach services across the region. Health experts warn that if the cuts persist, Zimbabwe and nearby countries could see up to 1.8 million new HIV infections by 2030 due to the breakdown of prevention and treatment programmes. Officials and advocates describe the situation as a looming “funding cliff” that threatens to unravel decades of progress in the fight against HIV/AIDS.
HIV Gains in Jeopardy
Zimbabwe had recently achieved the ambitious UNAIDS “95-95-95” targets – with 95% of people living with HIV knowing their status, 95% of those on treatment, and 95% achieving viral suppression. Over one million Zimbabweans were receiving ARVs through PEPFAR support, and 97% of treated patients had suppressed viral loads, drastically reducing transmission risk. This hard-won progress is now at risk. Clinics that once relied on US funding have shut their doors, and some patients have resorted to rationing medication, taking half-doses or skipping days – to stretch dwindling drug supplies.
“The damage is immediate and severe,” said one advocate, noting that people who depended on US-funded programmes “are suddenly left with nothing”. Health workers funded by PEPFAR have been laid off, and outreach efforts in communities have ground to a halt, imperiling prevention of mother-to-child transmission and other essential services.
Officials fear a resurgence of the epidemic reminiscent of the early 2000s if support is not restored. Zimbabwe’s HIV prevalence remains among the world’s highest at about 11%, with an estimated 1.3 million people living with HIV. “Last year’s success in controlling HIV could be wiped out,” a senior Ministry of Health official warned. Indeed, new modeling studies project that a prolonged aid freeze could cause a surge in infections and deaths: between 2025 and 2030, as many as 1,809,890 additional HIV infections and 720,230 AIDS-related deaths may occur across 26 low- and middle-income countries, Zimbabwe included. UNAIDS has cautioned that the shock reversal of support means global targets to end AIDS by 2030 are now dangerously off-track.
Regional Ripple Effects
Zimbabwe is not alone in this crisis. Neighbouring countries that also benefited from US HIV/AIDS aid are experiencing similar disruptions. Malawi, Mozambique, and Zambia – each with high HIV burdens – have seen critical programmes stalled. Malawi and Mozambique in particular share Zimbabwe’s heavy reliance on PEPFAR: 88.5% of Malawi’s and 81.8% of Mozambique’s HIV prevention funding came from US aid, almost entirely funding their prevention services. In Zimbabwe, an estimated 82.7% of HIV prevention resources were US-supported.
By contrast, wealthier neighbours like South Africa, while also affected, fund a larger share of their response domestically (PEPFAR contributed under 25% of South Africa’s HIV funding). Still, the impacts are profound region-wide – for example, more than 15,000 health workers in South Africa and 21,000 in Mozambique were partially or wholly supported by US programs and now face uncertainty. Regional initiatives such as the DREAMS program (which provided HIV prevention and empowerment services to 2 million adolescent girls across 10 countries) have been halted entirely, and community-led clinics at border trucking stops are closed.
Reports from Zambia, Botswana, and Tanzania likewise indicate retrenched healthcare staff and shortages of test kits and condoms. “We already see young people spacing or sharing ARVs out of panic,” said a healthcare worker from Lusaka. Condom distribution, PrEP roll-out, and HIV testing campaigns – largely funded by PEPFAR – have been scaled back or suspended in many communities.
The resulting service gaps are raising the risk of undetected infections and untreated cases, experts say. Linda-Gail Bekker, a leading HIV researcher in South Africa, warned that the funding withdrawal will “lead to loss of lives, placing the most vulnerable at heightened risk of reinfection and death”. Indeed, across East and Southern Africa, thousands of community health workers have lost salaries, undermining not only HIV care but also maternal health, tuberculosis treatment and routine medical services in hard-hit areas.
Government’s Defiant Stand
The Zimbabwean government has reacted with public defiance and a resolve to safeguard its citizens’ health sovereignty. In Parliament last week, Deputy Health Minister Sleiman Kwidini vowed that the nation “would cover the gaps” left by the abrupt US withdrawal. “It is now the mandate of the Ministry and the Government to ensure that these programmes, previously supported by external stakeholders, are now fully managed by us so that we can cover the gap left by the withdrawal of funding,” Deputy Minister Kwidini told lawmakers. He insisted Zimbabwe will not allow its HIV response to collapse, emphasizing that these health programmes originated as government initiatives before donors came on board.
Officials have been quick to formulate contingency strategies. A national emergency HIV funding plan is in the works, which includes reallocating domestic resources and stabilizing the ARV supply. The Ministry of Health has been drawing on the National AIDS Trust Fund, a 3% levy on incomes known as the AIDS Levy, which generated about US$30 million in 2023. However, this amount is only a fraction of the hundreds of millions per year that the US was providing to Zimbabwe’s HIV programmes. Treasury officials are exploring whether budget surpluses from other areas can be diverted to health, and engaging the private sector for support.
“As we speak, our technocrats are working to ensure we cover the gap left by these programme implementers,” Kwidini said, acknowledging the challenges in shoring up human resources and drug procurement.
Neighbouring Malawi’s government has similarly announced emergency measures. It issued assurances that HIV services will continue uninterrupted by redeploying staff to clinics and developing a contingency Sustainability Plan. Malawi’s authorities have prioritised maintaining treatment for people living with HIV by shifting patients to government clinics and reallocating health workers, although some prevention initiatives (like PrEP for populations beyond pregnant women) have been put on hold due to resource constraints. These stop-gap efforts underscore the region’s determination to not “lie down and die,” as one official put it, in the face of the funding shock.
Zimbabwe’s stance has taken a notably nationalist tone. Presidential spokespersons have described the US aid freeze as a betrayal, but stressed that Zimbabwe “will not be found holding a begging bowl.” Instead, the government frames the crisis as an impetus to accelerate self-reliance. “Yes, there is pain, but we refuse to let our people die because someone afar withdrew support,” a Ministry of Health communiqué declared this week. There is also talk of South-South cooperation: Zimbabwe is in discussions with alternative partners like China, Egypt, and the African Union for emergency medical aid. Local media have lauded the establishment of an African Union HIV Solidarity Fund (still in proposal stages) as a bold step towards African countries taking charge of their own health destinies.
Scramble for Funding Alternatives
Non-governmental organisations (NGOs) and health charities in Zimbabwe and neighbouring countries are scrambling to tap alternative funding streams to keep critical HIV services running. Many are pivoting to grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as to special European Union “Health Resilience” funds, to replace lost US dollars. This week, at least five Zimbabwean HIV service NGOs submitted emergency funding requests to the Global Fund and EU delegations. “We are exploring all options – Global Fund, EU, even private philanthropies – just to buy essential medicines and pay health workers,” said Rumbidzai Moyo, director of a Harare-based HIV clinic for adolescents.
The Global Fund has long been a pillar of Zimbabwe’s HIV response, having invested over US$2.3 billion in Zimbabwe since 2003. It recently approved a 3-year, $437 million grant (2024–2026) to support Zimbabwe’s HIV programmes. In fact, even before the current crisis, the Global Fund was financing key commodities – for instance, it had planned to procure over 107 million condoms for Zimbabwe as part of its latest grant cycle. Now the Fund is accelerating disbursements and considering reallocating some resources to plug immediate gaps.
However, relying on the Global Fund comes with hurdles. Recipient countries must increase their own health spending as part of co-financing requirements. According to Global Fund policy, to unlock full grants, governments must “show progressive expenditure on health” and absorb 15% more of programme costs domestically. For cash-strapped economies like Zimbabwe, Malawi, and Mozambique, finding this co-financing money is a tall order, especially as their budgets are already strained by inflation and other socio-economic pressures. Many NGOs simply lack the matching funds or government guarantees to qualify for large Global Fund or EU grants, creating bureaucratic delays in accessing aid.
The European Union and other bilateral partners are being urged to step up as well. The EU has been a major contributor to health initiatives in Zimbabwe, for example, it has provided over €108 million to a multi-donor Health Development Fund since 2016international-partnerships.ec.europa.eu, focused on maternal and child health. Now, Zimbabwean officials are lobbying Brussels for a dedicated HIV emergency package. UNAIDS has appealed for “remaining international donors, including the Global Fund, the European Union, and bilateral partners, to significantly increase their support for countries like Zimbabwe that lack the fiscal capacity to bridge the funding gap”.
So far, the response from donors has been cautious. EU diplomats in Harare indicated they are considering redirecting some regional Health Resilience funds to HIV, but they also encourage Zimbabwe to present a clear sustainability plan. Global Fund administrators warn that their own resources are under pressure: the Fund’s latest replenishment has fallen short, with key pledges (notably from the US) “below expectations”. “We can reallocate some funds for the emergency, but we cannot replace PEPFAR dollar-for-dollar,” a Global Fund official noted, alluding to the massive scale of US support that is now missing.
“No Going Back” – Calls for Solidarity and Sustainability
The unfolding crisis has ignited debate about the sustainability of Africa’s health responses and overreliance on foreign aid. Winnie Byanyima, the Ugandan-born Executive Director of UNAIDS, did not mince words about the US cuts, calling the situation “a deadly funding crisis” and “a global response knocked totally off course”. Byanyima said she was “shaken and disgusted” by the abrupt halt of PEPFAR, which she noted had been “60% of my budget” for fighting AIDS globally.
She expects worldwide HIV infection rates to soar and deaths to multiply in the next four years as a direct result. “It did so much for people who are so vulnerable. And yet you [the rich world] are spending so much more on wars,” Byanyima lamented of the aid cut. She urged that “health is a human right” and warned that “many people will die” if the freeze continues.
At the same time, African leaders and activists are using this moment to push for new models of solidarity. “African countries are struggling… But they are not lying down and dying, and they are not holding out a begging bowl for more aid,” Byanyima observed, highlighting that “huge efforts are being made to fill the funding gaps in smart ways.” Zimbabwe’s government has echoed this sentiment, with officials saying the crisis underlines the importance of “decolonizing” health financing. They argue that Africa must seize this challenge to demand fairer financing terms, such as relief from debt interest or illicit financial outflows, so that local resources can be freed for health investment. “The aid model cannot stand any more, it’s too unpredictable,” Byanyima said, calling for a shift toward genuine international partnerships rather than charity.
For now, people living with HIV in Zimbabwe and its neighbours face anxious times. Advocacy groups are sounding the alarm that unless the U.S. reverses course or others fill the void, the region may slide backward with rising HIV cases and preventable deaths. Parliamentarians in Harare have urged the Foreign Ministry to engage Washington diplomatically, amid reports some U.S. lawmakers are seeking ways to exempt PEPFAR from the broader freeze. Community organizations continue to do what they can, stretching their last stocks of test kits, encouraging patients to stay adherent to treatment as long as medication is available, and lobbying their governments to allocate any emergency funds possible.
“If these funding cuts move forward, we risk unraveling decades of hard-won progress, leaving millions vulnerable and pushing global HIV goals further out of reach,” warned Dr. Ali Zumla, a prominent infectious disease expert. His words resonate deeply in Zimbabwe, where the spectre of the early AIDS crisis, before ARVs were widely available – still haunts many families. Yet there remains a fierce resolve not to return to that era. As one HIV-positive mother receiving care in Harare put it: “We survived by unity and determination before, and we will do it again if we must. But we hope the world will not abandon us in our hour of need.”
