HIV Services Fell Sharply at NGOs After US Aid Cuts, Study Finds
By News

HIV services run by four non-governmental organisations in Uganda and Zimbabwe fell by roughly half to two-thirds after the United States withdrew PEPFAR and USAID funding in 2025, according to a new study published in The Lancet Global Health. Researchers from the London School of Economics and Political Science (LSE) and Duke University found that prevention, testing and treatment had not recovered by March 2026, despite a US humanitarian waiver intended to protect life-saving services. The findings offer some of the first real-world data on how the funding withdrawal has affected people most at risk of HIV, and they carry clear lessons for health NGOs across the continent.

What the study found

The paper, titled “HIV service delivery following the PEPFAR and USAID HIV funding withdrawal in Uganda and Zimbabwe: an interrupted time-series study”, was authored by Dr Henry Cust of the LSE Department of Health Policy and Dr Sungai T Chabata. It used routine monthly and quarterly service data from January 2023 to March 2026, comparing activity after the January 2025 US aid freeze with average levels in 2024.

The four organisations studied serve key populations, including men who have sex with men, female sex workers, people who inject drugs, prisoners and transgender people. Compared with 2024 averages, the LSE reported the following declines:

  • HIV prevention services: down roughly 37% to 63%
  • Pre-exposure prophylaxis (PrEP): down 43% to 72%
  • HIV testing: down 59% to 64%
  • Antiretroviral treatment: down 22% to 32%

Notably, treatment continued to fall even after the humanitarian waiver took effect. The authors suggest that once funding channels had been dismantled, the waiver could not easily restore the staff, commodities and delivery systems needed to keep services running. “The safety net that was supposed to preserve life-saving treatment did not hold,” Dr Cust said, as reported by Bloomberg.

The study also captures the human side of the disruption. Byrone Chingombe, Key Populations Programme Technical Director at CeSHHAR Zimbabwe, is quoted in the LSE release describing how partners were left without notice or support when funding stopped.

Context and limitations

The researchers are careful about the scope of their conclusions. Bloomberg noted that the findings are not representative of national trends in Uganda or Zimbabwe, as the organisations studied had their US funding terminated or sharply reduced and mainly served key populations. Dr Cust has cautioned against extending the findings beyond what the data support, while saying he believes they likely reflect a wider pattern among organisations that depended heavily on USAID contracts.

Wider data point in a similar direction for prevention. According to Bloomberg, Global Fund figures show the number of people receiving PrEP in its investment countries fell by 21% in 2025, even as the number receiving treatment continued to rise.

The US State Department, responding to Bloomberg by email, said it had not verified the report and considered its methodology flawed. It said US-supported HIV treatment reached 20.6 million people as of September 2025, and that the administration is shifting its focus towards outcomes such as reducing new infections and encouraging countries to take greater responsibility for their own health systems. The department also pointed to 35 bilateral health agreements covering USD 14.6 billion in US assistance alongside USD 10.1 billion in recipient-country investment.

What it means for the sector and affected communities

The study’s authors call for protecting HIV services that vulnerable populations rely on and that local health systems are unlikely to replace, strengthening emergency transition funding, and building more inclusive domestic services backed by stable national financing. They also recommend stronger continuity planning.

For community-based and key-population organisations, the findings reinforce several practical priorities: diversifying funding sources, documenting outcomes rigorously, and working more closely with ministries of health as governments take on a bigger share of HIV financing. For communities, reduced access to prevention and testing raises concerns about missed diagnoses and interrupted care, particularly for groups that already face stigma in mainstream health facilities.

What this means for NGO job seekers

The HIV response in Africa is changing shape rather than disappearing. As funding moves towards national systems and bilateral agreements, demand is likely to grow for professionals who can help programmes adapt. Skills worth developing or highlighting include:

  • Monitoring, evaluation and data analysis: the ability to work with routine service data, as this study did, is valuable for showing impact to donors and governments.
  • Health financing and transition planning: understanding domestic budgeting, sustainability planning and government partnerships.
  • Resource mobilisation and grant writing: organisations are seeking to diversify beyond a single major donor.
  • Key population programming: experience delivering stigma-free, rights-based services remains specialised and in demand.
  • Clinical and community health roles: nurses, HIV testing counsellors and peer educators who can work flexibly across facility and community settings.

Job seekers previously employed on US-funded projects should frame their experience around transferable results: patient retention, data quality, community trust and supply-chain management are relevant across health programmes funded by the Global Fund, governments and other donors.

Browse current health and HIV vacancies on our jobs board, including NGO jobs in Uganda and NGO jobs in Zimbabwe, or search by location through NGO jobs by country. Our career resources offer guidance on presenting your experience when moving between programmes and funders.

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