Zambia’s progress in the fight against HIV/AIDS is at a critical juncture following a pause in foreign assistance from the United States Government (USG). The USG has historically been a major contributor to Zambia’s HIV response, providing an estimated $600 million annually, with $367 million allocated for 2025 under the President’s Emergency Plan for AIDS Relief (PEPFAR). However, the disruption of aid has had profound consequences, particularly for prevention services and vulnerable populations.
The USG aid pause has led to the closure of essential HIV service facilities, significantly affecting key populations. Thirty-two drop-in centers, which previously provided HIV services to over 20,000 individuals on antiretroviral therapy (ART) across seven of Zambia’s ten provinces, have ceased operations. Additionally, the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) centers, which focused on HIV prevention for adolescent girls and young women in 21 districts, have also been shut down.
Furthermore, the suspension has impacted voluntary medical male circumcision programs, with 16 standalone centers halting operations. This is a major setback, as male circumcision has been a key prevention strategy in reducing the risk of HIV transmission. Moreover, the impact extends to PrEP (pre-exposure prophylaxis) services, with nearly half (49%) of Zambia’s PrEP programs being USG-supported. Without immediate interventions, these setbacks could reverse gains made in curbing new infections.
The strain on human resources is another significant concern. The USG supports over 23,000 personnel working in Zambia’s HIV response, including 11,500 healthcare workers and community-based volunteers. The sudden loss of this support poses a challenge for the government, which may struggle to absorb these workers into the public health system. In response, the Ministry of Health is exploring task shifting strategies and integrating services to optimize available resources.
Moreover, in the six districts of the Northern Province where the Right to Health initiative was the sole USG implementing partner, HIV services have come to a complete standstill. While implementing partners are gradually resuming services, progress is slow and marked by uncertainty.
Although Zambia has a sufficient supply of antiretroviral drugs (ARVs) for the next 12 months, there is no buffer stock to mitigate potential shortages. Additionally, critical diagnostic tools are at risk of depletion. The stock of HIV rapid test kits is projected to last only 3.2 months, tuberculosis X-pert cartridges for four months, and viral load testing and early infant diagnosis supplies for just one month. Without urgent intervention, gaps in testing could disrupt efforts to diagnose and treat HIV early, potentially increasing transmission rates.
Despite these challenges, the Zambian government remains committed to ensuring uninterrupted access to essential HIV, tuberculosis, and malaria services in public health facilities. The Ministry of Health, with support from the UN Joint Team on HIV/AIDS, has established a high-level steering committee to address service gaps and develop a response plan.
A costed impact mitigation plan has been formulated, outlining a minimum package of essential HIV services to ensure continuity. This plan has been presented to the government and cooperating partners for support. Additionally, the HIV Response Sustainability Roadmap (2025-2030), launched in December 2024, serves as a strategic framework for long-term sustainability of HIV programs in Zambia.
The pause in USG assistance has underscored the need for Zambia to strengthen the resilience of its HIV response by diversifying funding sources and reinforcing domestic health financing mechanisms. In the short term, mitigating the impact of service disruptions is crucial to prevent a resurgence of HIV infections. In the long term, sustained investment in locally-driven health programs will be key to ensuring Zambia’s HIV response remains effective and resilient.
As the government and stakeholders work toward sustainable solutions, urgent international and domestic support is needed to bridge funding gaps and prevent further setbacks in Zambia’s fight against HIV/AIDS.
