Zambia Faces HIV Reversal as US Aid Cuts Disrupt Vital Health Services

Lusaka, Zambia – Critical HIV prevention and treatment services in Zambia are facing significant disruption following substantial cuts to U.S. foreign assistance, raising fears of a resurgence of the epidemic. The reduction in funding, primarily from the President’s Emergency Plan for AIDS Relief (PEPFAR), has led to the closure of numerous service centers and placed a strain on the country’s efforts to combat HIV/AIDS.

The United States has been a cornerstone of Zambia’s HIV response for over two decades, providing an estimated 84% of the country’s HIV financing in early 2025. This support has been instrumental in Zambia’s progress toward achieving UNAIDS’ “95-95-95” targets, which aim to ensure that 95% of people living with HIV are diagnosed, 95% of those diagnosed are on antiretroviral therapy, and 95% of those on treatment have suppressed viral loads. In 2024, Zambia had met or exceeded these goals.

However, a withdrawal or significant reduction in U.S. aid has created a precarious situation. A modeling study suggests that unabated disruptions could lead to millions of additional HIV infections and deaths in Zambia. The disruption to services began in January 2025, impacting various facets of HIV care, including prevention services for adolescent girls and young women, and services for marginalized and vulnerable communities. This has resulted in the shutdown of 32 drop-in centers that provided HIV services to over 20,000 key populations living with HIV on antiretroviral therapy across seven provinces. Additionally, U.S. government-supported DREAMS centers for adolescent girls and young women in 21 districts have closed, as have 16 centers offering voluntary medical male circumcision. Nearly half of pre-exposure prophylaxis (PrEP) services in Zambia were also U.S. government-supported.

The cuts also pose a risk to the human resources for HIV service delivery, as the U.S. government supports over 23,000 personnel, including more than 11,500 health workers and community-based volunteers. The Zambian government may face challenges in immediately absorbing these personnel, impacting opportunities for task shifting and service integration.

While antiretroviral drugs (ARVs) have adequate supply for the next 12 months, concerns remain about the availability of HIV rapid test kits, with an estimated supply for only 3.2 months. Other critical supplies, such as tuberculosis x-pert cartridges and viral load testing and early infant diagnosis kits, have even shorter supply chains.

The U.S. government has historically committed substantial funding to Zambia’s HIV response through PEPFAR, with an estimated $6.7 billion provided since 2003. For fiscal year 2023, a planned commitment of $390.5 million was announced for HIV prevention, treatment, care, and health systems strengthening. In January 2024, the U.S. government announced a planned commitment of $761.5 million over two years for Zambia’s national HIV response.

The potential consequences of these aid reductions are severe. Mathematical modeling indicates that a rapid restoration of services within three months could mitigate the worst outcomes. However, unabated disruptions could lead to a quadrupling of HIV prevalence by 2060, with the largest proportional increase anticipated among children. The study estimates that unabated disruptions could result in an additional 1.6 million HIV deaths and 3.3 million HIV acquisitions over the long term. Even a three-month disruption could lead to over 32,550 additional deaths.

In response to these challenges, Zambia has increased its domestic contribution to the AIDS response, aiming to reduce reliance on external funding. The country is also exploring new program designs and financing architectures. The Ministry of Health has defined a minimum package of HIV treatment and prevention services and published a sustainability roadmap, “Vision 2030 and Beyond,” to foster a more resilient AIDS response.

The situation underscores the delicate balance of international health assistance and national efforts in combating major public health crises. The disruptions have highlighted the critical role of sustained funding in maintaining progress against HIV/AIDS and the potential for reversal of hard-won gains when such support is diminished.

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Global Affairs Desk

Global Affairs Desk at The Chenab Times covers international developments, global diplomacy, and foreign policy issues through fact-based reporting, explainers, and analytical pieces. The desk focuses on major geopolitical events, diplomatic engagements, and international trends, with an emphasis on verified information, multiple perspectives, and contextual understanding of global affairs.