Kenya is at a critical crossroads in its fight against HIV. With key drugs rapidly depleting and several HIV clinics forced to close, the country now urgently requires an additional Sh5.24 billion to sustain its HIV response until June. Over the longer term, Kenya will need Sh13.5 billion for the 2025/2026 fiscal year. This desperate funding call comes in the wake of the US government’s decision to issue a “stop work order” on certain PEPFAR-funded programs, a move that has already disrupted HIV treatment and prevention services across the nation.

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The Urgency of the Crisis

At a high-level consultative forum organized by the National Syndemic Diseases Control Council (NSDCC) in Nairobi on Wednesday, government representatives and development partners gathered to address the unfolding crisis. The forum highlighted that without urgent intervention, Kenya risks a dramatic surge in new HIV infections. Current estimates suggest that 16,752 new infections occur annually. However, experts warn that if disruptions to treatment and prevention continue, this figure could rise sharply—to as many as 58,495 new infections per year.

Approximately 1.3 million Kenyans living with HIV depend on antiretroviral drugs (ARVs) procured through US support. With these life-saving medications in short supply due to funding gaps, millions face the prospect of treatment interruption, which could lead to higher viral loads, increased transmission rates, and a reversal of the hard-won progress made over the past decades.

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The Funding Gap: A Closer Look

The NSDCC, which is mandated to manage not only HIV but also sexually transmitted infections, malaria, leprosy, tuberculosis, and lung disease, has broken down the immediate funding needs as follows:

• Sh4 Billion is required to support healthcare workers who were previously funded directly by US contributions. These workers are on the front lines of the HIV response, providing testing, counseling, and direct patient care.
• Sh1.2 Billion will be allocated for the distribution of ARVs that are currently stored at the Mission for Essential Drugs and Supplies (MEDS) warehouses.
• Sh140 Million is needed to bolster health information systems to ensure efficient tracking and management of HIV services.

Douglas Bosire, head of the NSDCC county support division, explained, “We are seeking about Sh5 billion as a stopgap measure to take us to the end of the [financial] year. For the current financial year 2024-25, our immediate ask is about Sh5.2 billion, and to sustain our response into the year 2025-2026, we require about Sh13.5 billion.”

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Disruption of PEPFAR-Funded Programs

The funding shortfall has been exacerbated by the US government’s recent decision to curtail support for PEPFAR (the President’s Emergency Plan for AIDS Relief) programs in Kenya. PEPFAR, which has been instrumental in reducing HIV-related deaths and new infections across sub-Saharan Africa, was a cornerstone of Kenya’s HIV strategy. The stop work order on certain PEPFAR initiatives means that critical services—from treatment and testing to community outreach—are now at risk.

Health Cabinet Secretary Deborah Barasa, who also attended the forum, urged the Kenyan Parliament to prioritize increased budgetary allocations for HIV programs. “I urge you to advocate for increased budgetary allocations to the health sector, particularly for HIV programs. The time to act is now,” she said. Barasa also emphasized the need to integrate essential HIV commodities into the Social Health Authority (SHA) insurance scheme, thereby reducing the country’s vulnerability to external funding fluctuations.

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A History of Progress and Setbacks

Over the past decades, Kenya has made significant strides in combating HIV. With a high percentage of people living with HIV receiving treatment and achieving viral suppression, the country was once hailed as a success story in the global fight against the epidemic. However, the heavy reliance on external funding—particularly from US-based sources—has long been recognized as a vulnerability. The withdrawal or reduction of such support threatens to undo years of progress.

Kenya’s HIV response is built on a robust framework that includes widespread community testing, access to treatment, and preventive education. Programs supported by PEPFAR have enabled thousands of Kenyans to lead healthy lives and have contributed significantly to reducing HIV transmission rates. Yet, the recent funding cuts have exposed the fragility of this system. As ARV stocks dwindle and healthcare workers face uncertainty regarding their salaries and support, the entire HIV response apparatus is at risk of collapse.

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The Impact on Public Health and Society

The potential collapse of HIV services in Kenya has far-reaching implications. Without consistent access to ARVs and proper treatment facilities, patients may experience treatment interruptions that could lead to drug resistance—a development that would complicate treatment protocols and further burden the healthcare system. Moreover, interrupted treatment increases the likelihood of HIV transmission, potentially triggering a public health crisis that would reverse the gains of the past decades.

The economic and social costs of a surge in new HIV infections are profound. Increased morbidity and mortality would not only strain Kenya’s already limited healthcare resources but also impact the nation’s economic productivity. Families affected by HIV often face significant financial hardships, from loss of income to the burden of medical expenses, which in turn perpetuates cycles of poverty and social inequality.

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The Push for Self-Reliance and Domestic Funding

In light of these challenges, Kenya is making a concerted push towards self-reliance in its HIV response. The Ministry of Health has highlighted the urgent need for increased domestic funding to sustain HIV services. While external support has been critical, the current funding shift by the US government has underscored the importance of building a more resilient and self-sufficient health system.

Efforts to broaden Kenya’s economic base—such as investments in agriculture, trade, and infrastructure—are seen as key components of this strategy. By diversifying its revenue streams, Kenya aims to reduce its dependency on volatile external funding sources. However, transitioning to self-reliance is a complex and gradual process. In the short term, the country must bridge significant funding gaps to ensure that critical health services remain uninterrupted.

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Policy Recommendations and Strategic Interventions

To address the immediate crisis and lay the foundation for long-term sustainability, experts and policymakers have put forward several key recommendations:

1. Increased Budgetary Allocations for Health

The Kenyan Parliament must prioritize health in its national budget. This includes not only allocating funds to bridge the current shortfall of Sh5.2 billion but also increasing long-term investments in HIV services to the tune of Sh13.5 billion for the 2025/2026 fiscal year. Enhanced funding will ensure that ARVs, diagnostic tools, and healthcare personnel are adequately supported.

2. Integration into the Social Health Authority Insurance Scheme

Integrating essential HIV commodities into the SHA insurance scheme could provide a buffer against future funding disruptions. By embedding HIV services within a broader social health framework, the government can ensure a more stable and predictable funding mechanism, which will benefit millions of Kenyans.

3. Strengthening Health Information Systems

With Sh140 million earmarked for health information systems, there is a clear recognition that data management is critical. Robust health information systems are vital for tracking treatment adherence, monitoring drug supplies, and making evidence-based decisions. Upgrading these systems will enable better resource allocation and more efficient service delivery.

4. Support for Healthcare Workers

Healthcare workers are the backbone of Kenya’s HIV response. The allocation of Sh4 billion to support these workers is crucial. However, beyond immediate financial support, long-term strategies should include capacity building, training, and retention programs to maintain a motivated and skilled workforce.

5. Community Engagement and Preventive Measures

Preventing new HIV infections is as critical as treating those already infected. Community-based programs that promote awareness, testing, and preventive education must be scaled up. These programs not only reduce the incidence of HIV but also empower communities to take charge of their health.

6. Leveraging International Partnerships

While Kenya moves towards self-reliance, international partnerships remain important. Engaging with global health organizations, donor agencies, and multilateral institutions can provide technical assistance and interim funding support. It is essential to maintain these partnerships to ensure a smooth transition during this period of self-reliance.

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Global Context: A Broader Trend in HIV Funding

Kenya is not alone in facing challenges related to the sustainability of HIV services. Many low- and middle-income countries have grappled with the issue of donor dependency. Over the past two decades, international initiatives like PEPFAR and the Global Fund have played transformative roles in the HIV response. However, as donor priorities shift and funding landscapes change, recipient countries must innovate to maintain their progress.

For Kenya, the shift away from heavy external funding is a call to action. It is an opportunity to reassess priorities, streamline operations, and build a health system that is resilient in the face of future shocks—be they economic, political, or environmental. The transition to self-reliance, while challenging, could ultimately lead to a more sustainable and locally owned HIV response.

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Voices from the Field: Personal Stories and Community Impact

Behind the statistics lie the real-life stories of Kenyans whose lives depend on uninterrupted HIV services. In many communities, the provision of ARVs and comprehensive HIV care has been a lifeline. For individuals like Mary, a 38-year-old mother of three from Kisumu, consistent access to treatment means the difference between life and death. “I have been living with HIV for over a decade, and the treatment has given me hope,” Mary shared. “But now, with the drugs running out, I fear for my family’s future.”

Local clinics, once vibrant centers of care and support, are now struggling to operate. Some have been forced to close due to a lack of funds, leaving patients with no alternative but to travel long distances for treatment. These stories underscore the urgent need for a stable funding mechanism that can weather the uncertainties of external donor policies.

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The Way Forward: Urgent Action and Long-Term Vision

The call for Sh5.24 billion until June and Sh13.5 billion for 2025/2026 is more than just a funding request—it is a plea for the survival of Kenya’s HIV response. As the NSDCC and the Ministry of Health rally for increased domestic resources, the government must act swiftly to prevent a full-scale humanitarian crisis.

Immediate measures should focus on:

• Ensuring a steady supply of ARVs to prevent treatment interruptions.
• Supporting healthcare workers to maintain and expand service delivery.
• Strengthening health information systems to better manage resources and track outcomes.

At the same time, there is a need for a long-term strategy that includes economic diversification, enhanced domestic resource mobilization, and the integration of HIV services into broader social health initiatives. Such a comprehensive approach will not only address the current crisis but also build a foundation for sustainable health outcomes in the future.

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Conclusion: A Critical Juncture for Kenya’s HIV Response

Kenya stands at a pivotal moment in its fight against HIV. The loss of US support and the resultant funding gap threaten to reverse decades of progress. With key drugs running out, clinics closing, and the risk of a surge in new infections looming large, urgent intervention is imperative. The call for an additional Sh5.24 billion until June—and Sh13.5 billion for the 2025/2026 fiscal year—is a clarion call for all stakeholders: government, development partners, and the international community must work together to safeguard the health and future of the nation.

The challenges are immense, but so too is the resilience of the Kenyan people and the commitment of health professionals on the front lines. By taking bold, coordinated action now, Kenya can not only avert a humanitarian catastrophe but also pave the way for a more self-reliant and sustainable HIV response. The time to act is now—before the gains of the past decades are irreversibly lost and millions are left to face the devastating consequences of untreated HIV.

In an era where global health dynamics are rapidly evolving, Kenya’s experience serves as a stark reminder of the need for resilient, locally driven health systems. As the country mobilizes for increased domestic funding and redefines its approach to HIV management, the hope remains that with collective effort, the crisis can be turned around. The stakes could not be higher—and the call for urgent action has never been more compelling.

Ultimately, the survival and future well-being of 1.3 million Kenyans living with HIV—and the prevention of an explosion in new infections—depends on decisive action today. With the combined efforts of government, communities, and international partners, there is still a chance to secure a healthier, more hopeful future for all.

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photo source: Google

By: Montel Kamau

Serrari Financial Analyst

14th March, 2025