USAID halt on HIV programs: Possible impact on People living with HIV (PLHIV) in Zimbabwe

With the decision made by Trump administration to cut USAID funding in most African countries, this could have a significant impact on the livelihoods of PLHIV as well as national policy and goals in treatment and management of HIV

USAID through PEPFAR was responsible for funding approximately USD $200 million in Zimbabwe for HIV programs in 2024, which makes it the highest funder of HIV programs in the country. Zimbabwe currently has an estimated 1.2 million PLHIV aged between 15-64 years. Zimbabwe had also adopted the 90-90-90 goal which is 90% of people living with HIV would know their status and 90% of people aware of their status would receive ART and 90% of people on ART would have a viral load suppressed

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According to ZIMPHIA report, 72.4% of people with HIV know their status, 86.8% of those that know their status are on ART and 86.5% of those on ART have a viral suppression. Will this sudden change on USAID funding affect the national goals set to manage HIV?

In this newsletter, we will be discussing some of the negative impact of the decision to cut funding on the national goals and on individuals on ART

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Increase in disease progression and mortality

Cutting of funds for HIV programs puts PLHIV at risk of illness from opportunistic infections and even death. On a national level this could undo years of progress made in treating HIV (90-90-90 goal)

Increase in Opportunistic Infections

Opportunistic infections are infections which occur more frequent and severe in individuals with compromised immune system. PLHIV without viral suppression will have compromised immune system which leads to increased risk of being infected by Cryptococcal infections or Tuberculosis. These infections are life threatening, difficult to treat and may cause a financial strain on individuals and the government ?

Disruption of Treatment Access

A halt in funding could affect the supply chain of ARV drugs. PLHIV rely on a consistent supply of their medication to successfully suppress the viral load

Without their medication, there is increased risk of increased viral load, drug resistance and rapid disease progression

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Emergence of Drug Resistance

Currently in Zimbabwe, first line treatment for HIV in adults is Tenofovir/Lamivudine/Dolutegravir. A disruption in supply chain can create shortage which increase viral load. The increased viral load can become resistance to the first line therapy. Drug resistance on an individual level can lead to treatment failure and on national level can result in changing treatment policy which includes changing the first line therapy.

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Economic and Social Impact

Economic impact would be due to more people requiring hospital care for advanced stages of HIV/AIDS. Some of the centers which were responsible for managing HIV patients will be forced to shut down which will overload some of the institutions which would be left open

On individual level, some of the patients will have to use their out-of-pocket money to get their medication. Currently, ARV drugs costs start from USD $15 and above depending on drug combination, this can financially strain such individuals as they will need at least $15/month.

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Socially, due to rapid disease progression, PLHIV might develop visible signs which may create stigma and discrimination within their communities

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Burden on Government

Since the decision was abrupt and unexpected, the government might be forced to mobilize domestic financing, which can strain national budget especially low to middle income country like Zimbabwe

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Afterthought

Although some of these negative impacts might not happen, it is important to factor them when creating a strategy on navigating such a time

National Aids Council recently announced that it has sufficient stock to mitigate the disruption in supply chain, which is good news for PLHIV, but the questions remain: How long can the ARV medication stock last before needing an intervention?

The recent event is a wake-up call for low-middle income countries like Zimbabwe to not rely heavily on external funders on HIV programs. Zimbabwe had adopted the Aids Levy according to the Finance Act which charges 3% on individuals and organizations since the 90s. This money goes to fund HIV programs. Is the AIDS levy sufficient to fill in the $200 million gap which was being provided by USAID, or new initiatives should be put in place?

What's your take on the issue? Let me know in the comments

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