How USAID cuts threaten Kenya’s fight against HIV
By Francis Muli, October 10, 2025The looming withdrawal of USAID support from Kenya’s HIV/AIDS programmes has sparked alarm among millions who depend on donor-funded healthcare for survival. Experts warn that without urgent government intervention, the country’s fragile health system could buckle under pressure.
In the crowded settlement of Dandora, Nairobi, 25-year-old Akinyi (not her real name) knows too well what that means. Diagnosed with HIV at just 18, Awuor says the discovery nearly broke her.
“I totally lost hope in life,” she recalls softly. Through counselling and consistent care at Dandora Phase One Hospital, she regained strength, suppressed her viral load, and went on to give birth to a healthy baby girl.
“I finally felt like I could live again,” she smiles.
Grateful for the support she received, Akinyi became a peer educator and joined Positive Young Women Voices, a community group mentoring young women living with HIV. But in February 2025, everything changed.
That month, the US Agency for International Development (USAID) issued a stop-work order, freezing funds to local implementing partners. The ripple effects were immediate and devastating.
“It felt like a death sentence,” says Akinyi. “I received so many calls from friends asking if I’d seen the news. I had to switch off my phone, I couldn’t take it.”
Within days, panic spread among patients. Clinics began rationing antiretroviral (ARV) drugs. “I used to get medication for six months. Now I was given just one,” she explains.
Some facilities ran out completely, forcing desperate patients to buy black-market drugs for up to Sh1,500 a bottle. Even condoms and testing kits vanished from shelves.
Beyond drug shortages, the cuts also halted essential screenings. “As a woman living with HIV, I must get cervical cancer screening every year. I’ve missed mine since February,” she says.
Kenya has made enormous strides against HIV over the past two decades, transforming it from a death sentence into a manageable condition. According to the Ministry of Health, about 1.4 million Kenyans live with HIV, with 1.3 million on treatment.
Supported largely through USAID and the PEPFAR programme, the country has achieved an 83% drop in new infections and a 68% reduction in HIV-related deaths. But these gains are now at risk.
A recent UNAIDS report (April 2025) warns that the suspension of US foreign assistance has disrupted the global HIV response, threatening drug supply chains and patient care in countries like Kenya.
“The USAID freeze exposed how fragile our health system is,” says Nelson Otuoma, CEO of NEPHAK, a national HIV network. “Even basic patient data was stored on USAID-funded systems. Once those went offline, hospitals lost access to records.”
Kilifi
In Kilifi County, one of Kenya’s HIV hotspots, the anxiety is palpable.
At his modest home in Mnarani village, 65-year-old Kisadi (not his real name) recounts his two-decade journey living with HIV. Diagnosed in 2004, he remembers the dark days when stigma killed as many as the virus.
“People were buried in plastic bags,” he says. “I chose life. I took my medication.”
Today, Sadiki is a wood sculptor and a community health volunteer serving over 100 people living with HIV. But he fears the progress made is slipping away. “If programs close, young people will be the first victims,” he warns.
Kilifi’s HIV/STI coordinator Nassim Jahangir confirms that up to 90% of HIV services in the county relied on USAID’s Stawisha Pwani programme—covering treatment, prevention, and gender-based violence care. “We’re already seeing disruptions,” she says.
At Muyeye Health Centre near Malindi, HIV counsellor Selinah Anyango describes a growing crisis. “I have two children patients with very high viral loads,” she says. “They were on a nutrition program that was cut. Now they can’t even afford to come for treatment.”
Balancing act
To fill the gap, the Ministry of Health has begun integrating HIV care into general hospital services. Maria Mulwa, Kilifi’s HIV programme coordinator, says the county is 65% integrated so far. “We’re merging HIV clinics into regular care to sustain services,” she explains.
But not everyone is convinced. Kilifi County preventive health coordinator Amos Nthenge notes that USAID funded over 120 health workers in the county alone. “Losing them will create a huge gap,” he says.
Key populations, such as sex workers and men who have sex with men, are particularly vulnerable as their safe spaces close down. “These groups require tailored care. Once those centers shut, they disappear into the shadows again,” warns Jahangir.
Counting the cost
For health experts, the numbers tell a sobering story. Over 41,000 healthcare workers nationwide are at risk of losing their jobs as donor-funded contracts expire. Clinics may stay open, but the people who make them work could vanish.
“If you invest for 20 years and then pull out, everything collapses,” says Otuoma. “We celebrated 20 years of PEPFAR in 2024—and by 2025, there’s little to show for it.”
Kilifi County’s Director of Health Services, Dr Hassan Leli calls the situation tragic but realistic. “It’s painful, but donors act at their discretion. We must now build sustainable local systems,” he says.
Plea for life
Back in Mnarani, Kisadi’s voice trembles as he sums up what’s at stake. “My life depends on ARVs. Cutting support is like signing our death warrants,” he says, tears welling up. “I have five HIV-free children—they depend on me. If I die, what happens to them?”
In Dandora, Akinyi has chosen to fight back. She has joined a group of young mothers to create podcasts and social media campaigns sensitising others on coping strategies and stigma reduction.
“We can’t sit and wait,” she says with quiet resolve. “We must support each other and push for accountability so that no one is left behind.”
As Kenya stands at the crossroads of donor dependency and self-reliance, one truth remains: the arithmetic of survival cannot be reduced to budgets alone. For millions like Akinyi and Kisadi, hope is counted in pills, and in promises kept.