A System on the Brink

NAIROBI – Policies enacted during the administration of former U.S. President Donald Trump (2017-2021) caused catastrophic disruptions to HIV/AIDS prevention and treatment programmes in Kenya, leading to clinic closures, widespread service interruptions, and a reversal of hard-won public health gains. According to a report by the Joint United Nations Programme on HIV/AIDS (UNAIDS), these cuts sent shockwaves through the health systems of low and middle-income countries, with a November 2025 report estimating that the freeze on the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) had already caused 132,933 adult deaths and 14,150 child deaths globally.

The primary policy drivers were the reinstatement and expansion of the Mexico City Policy, also known as the 'Global Gag Rule' (GGR), and a subsequent freeze on foreign aid, including PEPFAR, the cornerstone of the global HIV response. The expanded GGR, reinstated on January 23, 2017, prohibited foreign non-governmental organizations (NGOs) from receiving any U.S. global health assistance if they provided information, referrals, or services for legal abortion, even with non-U.S. funds. This expansion was unprecedented, applying not just to family planning funds but to nearly all U.S. global health assistance, which amounted to an estimated $9.5 billion.

The Impact on Kenya's Frontlines

For Kenya, a nation heavily reliant on international aid for its HIV response, the consequences were swift and severe. A 2025 report by Physicians for Human Rights (PHR) described a health system on the brink of catastrophe, with healthcare workers reporting clinic shutdowns, disruptions to drug supplies, and unpaid salaries in Kenya, Uganda, and Tanzania. In Kenya alone, an estimated 41,500 health workers supported by U.S. funding faced layoffs, representing 18% of the country's total health workforce. A health worker in Nakuru County told PHR, “There was a complete withdrawal of staff, especially nurses and clinical officers, paid by USAID and PEPFAR due to funding cuts. This has affected the accessibility of essential services.”

The funding freeze directly impacted service delivery. Community-led initiatives, including HIV prevention outreach and peer support, were suspended. Key prevention programmes were paused or scaled down, including the DREAMS initiative, which had helped keep 66,000 adolescent girls and young women HIV-free over three years. Data from Kenya's Ministry of Health for the period between January and March 2025 showed a 38% decline in HIV testing compared to the same period in 2024, and a 49% drop in the uptake of Pre-Exposure Prophylaxis (PrEP). UNAIDS reported that globally, roughly 2.5 million people who used PrEP in 2024 lost access to the medicine in 2025 because of donor cuts.

The disruption fragmented the integration of HIV and sexual and reproductive health (SRH) services, a practice long promoted by global health bodies to improve outcomes. Organizations were forced to choose between providing comprehensive SRH services and receiving critical PEPFAR funding for HIV programmes. This led to the closure of clinics run by organizations like Family Health Options Kenya (FHOK) and others, which had provided integrated services including HIV testing, family planning, and post-abortion care.

A Domino Effect on Public Health

The impact extended beyond HIV services. An internal Kenyan Ministry of Health briefing from March 2025 warned of a “domino effect that imperils every link in the healthcare chain,” affecting programmes for malaria, tuberculosis, and childhood immunizations. The U.S. aid freeze also halted the Demographic and Health Survey program, disrupting critical health data collection and hampering disease surveillance. UNAIDS confirmed that the Kenya Health Information System (KHIS), which captures national HIV program data, was down due to the funding cuts, hampering monitoring and reporting.

In response to the unfolding crisis, the Kenyan government took steps to mitigate the damage. In a statement in late January 2025, Dr. Patrick Amoth, the Director General for Health, assured the public of sufficient HIV commodity stocks for six months and stated the ministry was engaging other partners for alternative resources. The Ministry of Health convened high-level meetings to establish a monitoring committee, seek emergency financing, and mobilize county governments to repurpose the health workforce. However, the scale of the shortfall was immense. A UNAIDS report on national HIV spending showed that international partners funded over 80% of Kenya's HIV expenditure between 2016 and 2020, with total spending from these partners dropping from KES 62.7 billion in 2016/17 to KES 46.3 billion in 2019/20.

The Lingering Aftermath and Path Forward

While the most severe funding freezes were eventually lifted, the disruption has had a lasting impact. The crisis exposed the vulnerability of Kenya's heavy reliance on donor funding and accelerated the push towards sustainable domestic financing. The government is now looking to integrate HIV care into the new Social Health Authority (SHA) to ensure long-term stability. The experience serves as a stark reminder of how international policy shifts can directly impact the lives and health of millions of Kenyans, jeopardizing decades of progress in the fight against one of the world's most significant public health challenges.