Date:
Author: Toby Le, PhD Candidate in Medical Microbiology, University of Manitoba
Original article: https://theconversation.com/u-s-cuts-to-hiv-aids-funding-will-be-detrimental-for-vulnerable-groups-in-kenya-250001
On his first day in office, U.S. President Donald Trump signed an executive order to freeze foreign aid funding. This was followed by a stop-work order for dozens of life-saving humanitarian programs.
One of the programs affected by this announcement is the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). This program has invested more than US$100 billion in the global HIV/AIDS response since it was founded in 2003. This makes the U.S. the largest funder of HIV/AIDS programs worldwide.
Although a 90-day waiver has since been issued which temporarily allows life-saving HIV drugs to continue being delivered, the impact of this executive order is already being felt across the globe — including in Africa, where PEPFAR funding has been integral in controlling the HIV/AIDS epidemic.
If PEPFAR funding ends when the waiver expires — or resumes but doesn’t allow funding for services to all key populations — this will have severe impacts on those in the continent living with HIV or at high-risk of infection.
HIV/ AIDS research
For 45 years, the University of Manitoba has been part of an important initiative in Nairobi, Kenya — partnering with the Sex Worker Outreach Program (SWOP and local agency Partners for Health and Development in Africa (PHDA) to develop effective strategies against HIV that can be employed in the region and communities worldwide. The approach, developed in 1985 by Elizabeth Ngugi, a public health nurse, and Francis Plummer, a University of Manitoba researcher, has empowered the community to share knowledge and to advocate for their rights. It has been vital in reducing HIV prevalence.
This partnership between the University of Manitoba and SWOP has been funded by PEPFAR since 2003. It receives an average of US$1.5 million annually to deliver reproductive health, tuberculosis, sexually transmitted infection and HIV services to key populations. Currently, this funding allows the program to operate nine clinics in Kenya, which annually provide services to over 40,000 female sex workers, 12,000 men who have sex with men and 1,400 transgender people.
The program offers safe spaces and tailors services to address the specific needs of each group and reduces health-care barriers. Our research team assessed gaps and refined approaches so that this partnership could serve the most vulnerable — transforming engagement with key groups.
Groundbreaking research findings have also emerged because of this partnership. University of Manitoba research conducted with the SWOP community was among the first to show that STIs increase the risk of HIV infection, that breastfeeding heightens the risk of transmitting HIV to babies, that male circumcision helps prevent HIV and that some people exposed to HIV have a natural immunity to the virus.
These findings have informed global prevention strategies and highlight the partnership’s significant impact.
Critical funding
If PEPFAR funding does indeed end in April once the temporary waiver expires, it would have a serious impact on the HIV/AIDS programs being delivered not only in Kenya but around the globe.
AP Photo
SWOP clinics have been instrumental in curbing HIV infections among sex workers. HIV prevalence among female sex workers accessing SWOP clinics declined from 44 per cent in 2008 to 12 per cent in 2017. This 67 per cent reduction can be attributed to an increase in HIV testing, community education and STI treatment. The program also highlighted the prevalence of HPV anal lesions in men who have sex with men and the importance of early detection. The cessation of PEPFAR funding will jeopardize STI and HIV services.
After much advocating, the SWOP clinics servicing female sex workers were able to resume some of their activities last week (Feb. 12, 2025). However, the waiver specified that PEPFAR-funded HIV care and treatment services could only be offered to certain groups. This meant we were unable to resume HIV prevention services for all key groups.
Without a strong contingency plan, the abrupt end to PEPFAR funding will have devastating consequences. It would mean an immediate end to SWOP activities. This would mean no more HIV testing, preventive treatment and anti-retroviral therapy — which would increase the risk of transmission, leading to an increase in cases and even a greater number of deaths in people living with HIV.
Key groups accessing SWOP are among the most marginalized in Kenya. Without access to dedicated clinics, the majority will avoid seeking care due to fear of stigma, discrimination and harassment in clinics designed for the general public.
SWOP partners with local agencies to provide empowerment, legal support and counselling. Closing these clinics could leave the communities they serve more vulnerable to violence, exploitation and human rights abuse.
On the research front, funding cuts would mean ongoing projects would be halted and new ones couldn’t be started. Three already-funded University of Manitoba studies are planned to start this year. These aim to further investigate the impact of HIV on women living in the region and understand how women’s health can be improved not only in Kenya but worldwide.
But without SWOP’s infrastructure (such as their clinics and outreach team) we won’t be able to start these new studies. Furthermore, the implementation of research-based programs that aim to prevent HPV-related cancers would be stopped.
Cuts to HIV/AIDS funding could threaten the 40 years of work that has gone into ending the AIDS epidemic — potentially putting the lives of millions of people at risk.
The PEPFAR program has saved over 25 million lives since its beginning in 2003. Ending the PEPFAR program would have serious impacts on services for key populations and the LGBTQ+ communities. If the funding does end after the waiver expires in April, it will be necessary for Canada’s provincial and federal governments to step in and become leaders in global health and the fight against HIV.