US Funding Shift Puts Kenya’s HIV Progress at Risk — Duale Warns

Nairobi, Kenya — September 25, 2025

Interior Cabinet Secretary Aden Duale has cautioned that Kenya’s gains in the fight against HIV could stall unless sustainable, long-term resources are secured. He spoke during side meetings at the United Nations General Assembly in New York, where he raised concerns about changes in U.S. health funding priorities. 

The Latest

• Duale highlighted that Kenya has benefited from nearly two decades of strong collaboration with the United States, via programmes like PEPFAR (President’s Emergency Plan for AIDS Relief) and PMI (President’s Malaria Initiative). 

• He warned that decreased U.S. commitment could threaten access to life-saving HIV treatment, prevention, and support services. 

• Duale met with Jeffrey Graham, Acting Global AIDS Coordinator, to discuss how Kenya might navigate the transition and maintain its HIV response momentum. 

Context & Why It Matters

• Kenya’s HIV programmes—diagnosis, antiretrovirals, prevention, and community outreach—are heavily reliant on U.S. donor funds (particularly PEPFAR). 

• Earlier funding disruptions have already strained service delivery. For example, U.S. funding freezes disrupted antiretroviral (ARV) distribution, leaving drugs stuck in warehouses. 

• Health experts predict that cuts could contribute to tens of thousands of excess HIV-related deaths across sub-Saharan Africa over the coming years if care is interrupted. 

• Community-based programmes, drop-in centres, outreach services, and the health workers they employ are often supported in full or in large part by U.S. funding. When funding is cut, those services are among the first to suffer. 

Legal & Programmatic Levers

• Under international health agreements and bilateral memoranda (e.g., Kenya–U.S. health cooperation), donor transitions are supposed to include “transition plans” to help countries absorb key service costs over time.

• Kenya must consider increasing its domestic health budget, particularly for HIV, to reduce donor dependence.

• Strengthening partnerships with multilateral funders (e.g. Global Fund to Fight AIDS, TB and Malaria) is critical for coverage continuity.

Voices & Stakeholders

• Government / Executive: Duale’s statements reflect the urgency from Kenya’s leadership to secure alternative funding and maintain program continuity.

• Health Experts / Civil Society: Many caution that without careful transition planning, decades of progress could be reversed.

• People living with HIV / communities: They are particularly vulnerable to service disruptions—interruptions in ARV provision, loss of support services, or increased stigma could worsen outcomes.

Evidence & Data Highlights

Indicator	Estimate / Note
Number of Kenyans on HIV treatment (via U.S.-supported programmes)	~1.4 million as cited in Duale’s address
Health workforce dependence on U.S. funds	~41,500 workers in Kenya are supported by U.S. funding, about 18% of Kenya’s health worker base
Potential excess HIV deaths (Africa) if PEPFAR cuts persist	Up to 74,000 additional deaths by 2030 projected in scenario studies

Risks, Implications & Scenarios

Risks

• Interrupted ARV supply and adherence breakdowns

• Closure or scaling down of community / outreach programmes

• Loss of morale and layoffs among health workers

• Increase in HIV incidence, mortality, and drug resistance

Implications

• Kenya may be compelled to absorb large portions of program costs, stressing national budgets

• A funding vacuum could lead to inequitable access—rural or marginalized groups may suffer the most

• Political and public backlash if the government fails to sustain services

Scenarios to Watch

1. Managed transition: Kenya and U.S. cooperate to phase down donor dependence gradually, protecting core services

2. Abrupt cut: Rapid withdrawal causes significant service gaps, supply chain breakdowns

3. Hybrid model: Partial donor support continues while Kenya scales domestic funding and leverages new partners

What We Don’t Know Yet

• The exact magnitude and timing of U.S. funding reductions or reallocation

• Kenya’s domestic health budgetary plans to fill any shortfalls

• Which HIV programme components will be prioritized vs deferred

• How local governments and counties will absorb decentralized HIV service burdens

Timeline

• 2003: PEPFAR launched, later expanding substantially to Kenya and other countries 

• 2025 (early)—USAID / U.S. freezes foreign aid including parts of PEPFAR 

• 2025-09-25: Duale issues warning in New York about Kenya’s HIV gains at risk. 

What to Watch

• Official U.S. announcements and budget decisions regarding PEPFAR and global health aid

• Kenya’s 2026/2027 health budget and allocations to HIV treatment, prevention, and human resources

• Statements from Global Fund, WHO, and civil society on bridging any funding gaps

• Reports from clinics or counties about service disruptions, drug stockouts, or funding shortfalls