Mozambique, on the east coast of Africa, has the world’s 8th highest prevalence of HIV. Antiretroviral therapy has been available at 97% of health facilities, serving around 2.1 million of the country’s 2.4 million people living with HIV. Mozambique relies heavily on external funds to provide HIV services, with the United States having covered around 93% of the country’s expenses, mainly through PEPFAR. However, in January 2025, the US government issued an executive order suspending almost all foreign aid programs for 90 days.
Study authors investigated the impact of the executive order on HIV services and predicted the impact of potential funding interruption on the HIV epidemic in Mozambique.
Using the country’s district health information system, the investigators compared selected health service indicators in February 2024 and February 2025 to analyze the absolute variation and relative change in ART initiation and viral load cascade performance at the two time points.
To predict the impact on the HIV epidemic, the authors utilized a published dynamic HIV transmission and disease progression model (Optima), which they calibrated to Mozambique data. They compared the trend before January 2025 to a counterfactual scenario with funding interruption, assuming a scenario of stagnation in February 2025. They simulated the impact of funding interruption on HIV incidence and HIV-related mortality until 2030.
- Comparing February 2024 to 2025 among people 15 years of age and older, ART initiation decreased by 25%, from 22,865 to 17,105.
- Among those on treatment, viral load tests performed declined by 38% (37,010), test results received dropped 37% (27,656), and viral suppression dropped 33% (22,043).
- Children younger than 15 years of age were disproportionately affected, with a 44% decline in viral load tests performed, a 71% decrease in test results received, and a 43% decrease in viral suppression.
- By 2030, the funding interruption is estimated to cumulatively increase new HIV infections by 90,522 (23% more than the status quo) and HIV-related deaths by 28,631 (33%).
The results demonstrate the immediate negative impacts of the US funding freeze on HIV service outcomes and the potential alarming effect of a sustained freeze on the HIV epidemic. To mitigate these harms, funding is urgently needed.
Reference
Uetela DM, et al. IAS 2025. Program number OAS0102LB.
