Experiencing the Fallout: The Felt Impact of US HIV Funding Reductions Across 13 Sub-Saharan African Countries

Abstract To date, there is limited empirical research following the 2025 funding reductions by the US Government. This is the first multi-country qualitative exploratory study to examine the lived consequences of these funding cuts based on 26 semi-structured in-depth interviews with stakeholders at global, national, and sub-national levels across 13 Sub-Saharan African countries. Data were analyzed using rapid qualitative analysis. Participants highlighted disruptions regarding HIV prevention, operational uncertainties in offering pre-exposure prophylaxis and diminished outreach to key populations and adolescents who had to access services at health facilities, with many dropping out. Treatment was rationed in many countries requiring more frequent trips to health facilities. Follow-up services, distribution of health products and monitoring suffered through workforce loss, with restrictive reporting requirements additionally affected monitoring. Adaptive strategies included service integration, prioritization of essential services, and efforts to expand domestic financing with participants highlighting the need for sustainable financing also for prevention.