By MakanDay Staffer
Zambia stands to lose nearly $400 million (K11.2 billion) in annual U.S. support, a cut that will severely impact the country’s health sector, particularly HIV treatment and monitoring programmes funded by the U.S. government.
Funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) has been critical in ensuring that many Zambians living with HIV receive treatment and maintain their health. According to the U.S. Embassy, Zambia received $390.5 million (K10.9 billion) in 2023 for HIV prevention, treatment, care, and support.
U.S. President Donald Trump announced a pause on foreign aid for an initial 90 days on his first day in office in January as part of a government spending review. Since then, most U.S. Agency for International Development (USAID) programmes have been terminated.
Two weeks after the aid freeze, U.S. Secretary of State Marco Rubio signed an emergency waiver allowing continued assistance in critical areas, offering a temporary reprieve. However, uncertainty remains, especially among people living with HIV.
Jasmine (not her real name), who has been on antiretroviral therapy (ART) for less than a year and remains under medical observation, is worried about the potential impact on her health and that of others on ART.
“I am concerned about my health moving forward because of the growing speculation surrounding the availability of free ARVs in our health institutions,” she said.
Her story reflects the current reality for many people living with HIV who have relied on U.S. foreign aid for years.
According to the 2023 Centre for Infectious Disease Research in Zambia (CIDRZ), approximately 1.8 million people in Zambia live with HIV, with an adult prevalence rate of 11%.
According to the U.S. Embassy website, PEPFAR provides lifesaving HIV medication at no cost to over 1.2 million Zambians.
However, for people like Stella Mubanga, an HIV advocate and person living with HIV, the increasing stigmatization following President Trump’s executive order to freeze funding is deeply distressing.
“This U-turn order has exposed serious stigmatisation against people living with HIV/AIDS in Zambia. Others are making jokes out of a serious issue,” she lamented.
Mubanga warns that if the government does not manage the situation effectively, fear of stigma could lead to more new infections, as people may be reluctant to disclose their HIV status.
Zambia is expected to face significant challenges in its quest to achieve the ambitious goal of eliminating HIV/AIDS as a public health threat by 2023 if USAID funding is not reinstated.
As noted by health experts like Dr. Aaron Mujajati, the withdrawal of USAID funding poses a major challenge to Zambia’s healthcare system.
“However, solutions such as expanding the Zambia Medicines and Medical Supplies Agency (Zammsa) mandate to procure essential drugs could help address this predicament,” Dr. Mujajati advised.
Despite President Hakainde Hichilema’s pledge to secure ARVs using local resources and his call for Africa to strengthen its economies to reduce dependence on foreign aid, Trump’s decision has also caused widespread job insecurity. Employees of U.S.-funded programmes in Zambia faced temporary layoffs, with some being recalled under uncertain conditions.
“We were fortunate to be called back to work after staying home for two weeks without knowing our fate,” said a distressed employee of a U.S.-funded programme. “Previously, we held regular Zoom meetings to discuss the welfare of the people we serve, but all that has stopped. We were told to wait until April for a clear roadmap, and until then, we are just as lost as those who were not called back.”
MakanDay has also established that despite the resumption of work, employees in some U.S.-funded projects have not regained access to certain services, including handling and distributing medicines.
It has further been established that the two-week “Stop Work Order” disrupted the delivery of some services in the Ministry of Health.
According to a Ministry of Health document seen by MakanDay, HIV testing and monitoring were affected due to the unavailability of HIV RT test kits, TB Xpert cartridges, and blood collection tubes.
The document, dated February 12, 2025, and titled “HIV Service Provision, Current Status, Gap Analysis, and Recommendations,” also highlighted the lack of readily available couriers (motorbikes and riders) to transport samples from hub labs to PCR labs, resulting in poor sample quality.
Additionally, it noted a strain on human resources, leading to prolonged turnaround times and inadequate documentation of results in patient files.
The document further revealed that the Ministry of Health emphasised the need to mobilise funds, including from the Constituency Development Fund, to support community-led responses, monitoring efforts, and initiatives to address stigma and discrimination.
The Ministry of Health has not responded to MakanDay’s request for comment, including a query on how the government plans to address the funding gap resulting from the funding freeze.
President Hichilema has issued a rallying call, emphasising the need for Africa to grow its economies through strengthened bilateral relations in order to become self-reliant. He made this statement while addressing a delegation from the Energy Financing Group at State House on Thursday, 6th March,2025.
He also pledged the government’s commitment to ensuring a steady supply of ARVs in health facilities. “We will use our own treasury resources to secure ARVs for our people,” he stated.
The head of UNAids has warned that U.S. funding cuts could result in 2,000 additional HIV infections per day and more than six million deaths over the next four years.
This would mark a sharp reversal in the global fight against HIV, which has seen annual deaths from the disease drop from over two million in 2004 to 600,000 in 2023, the most recent year for which data is available.
UNAIDS Executive Director Winnie Byanyima told the BBC that the U.S. government’s decision to pause foreign aid—including funding for HIV programs—was already having devastating consequences.
The image is AI-generated and is for illustrative purposes only.
This story was written by a fellow in MakanDay’s 2024 training programme.
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