US Aid Freeze Triggers Sharp HIV Service Declines in Uganda, Zimbabwe

In January 2025, the United States froze its foreign aid apparatus. The machinery that had sustained HIV prevention and treatment programs across Africa simply stopped. Now, nearly eighteen months later, researchers at the London School of Economics and Duke University have documented what that stoppage actually meant on the ground—and the picture is stark.

The study, published in The Lancet Global Health and led by Dr. Henry Cust, an LSE Fellow in the Department of Health Policy, is the first peer-reviewed examination of service delivery impacts using real data from organizations whose funding was cut and never restored. The researchers tracked four non-governmental organizations in Uganda and Zimbabwe, watching what happened to their HIV programs after the PEPFAR and USAID stop-work orders took effect. What they found was not a temporary disruption but a sustained collapse across three critical service areas: HIV prevention (predominantly through PrEP, the preventive medication), HIV testing, and antiretroviral therapy—the drugs that keep people with HIV alive.

All three service categories fell sharply in the months following the aid freeze. By March 2026, more than a year after the cuts began, none had recovered. This persistence matters. The U.S. government had issued a humanitarian waiver intended to shield life-saving services from the broader aid suspension, but the data suggests that protection did not reach these organizations or did not reach them in time to prevent the damage.

The significance of this research lies partly in what it measures and partly in what it proves. Previous reporting on the aid freeze relied on projections, policy analysis, or anecdotal accounts. This study is different. Cust and his team worked directly with organizations that experienced the cuts, examining their actual service delivery records—the number of people tested, the number started on prevention or treatment, the number retained in care. These are not estimates or extrapolations. They are the operational reality of four NGOs trying to sustain HIV programs without the funding that had made those programs possible.

Uganda and Zimbabwe were not random choices. Both countries have significant HIV burdens and have relied heavily on U.S. funding to support their national responses. The populations served by these four organizations are among the most vulnerable: people living with HIV who depend on antiretroviral therapy to survive, people at high risk of infection who need prevention services, and communities where testing infrastructure is fragile. When funding stopped, the ability to reach these populations stopped with it.

The humanitarian waiver was meant to be a safety valve—a mechanism to ensure that even as broader foreign aid was suspended, the programs that literally keep people alive would continue. The fact that HIV services at these four organizations did not recover despite the waiver raises hard questions about how the exemption was implemented, whether it reached the organizations that needed it, or whether the damage was simply too rapid for any waiver to prevent. The research does not answer those questions directly, but it makes clear that the protection, whatever its intent, was insufficient.

What happens next remains uncertain. The study documents the decline through March 2026, but does not extend beyond that point. Whether services have begun to recover since then, whether alternative funding has materialized, or whether these organizations have had to scale back their work permanently is not addressed in the published research. What is clear is that vulnerable populations in two countries lost access to prevention, testing, and treatment services for a sustained period, and the health consequences of that loss will unfold over months and years to come.