Hanging by a Thread: The Looming Threat of U.S. Pullout from WHO on Kenya’s HIV/AIDS Progress

Ibrahim* steps out of the HIV care clinic at Emusanda Health Center in Kakamega County, holding a brown envelope containing his monthly dose of ARVs. 

For Ibrahim, this monthly trip has been his lifeline since he was diagnosed with HIV in 2018. The medication has kept him healthy, strong, and able to continue his daily hustle without any interference.

However, as he exits the health center, he feels uncertain about the next steps after overhearing the nurses discussing the supply of antiretrovirals (ARVs) in Kenya in light of the 47th president of the U.S. Donald Tramp declaring a withdrawal from World Health Organization funding.

“The antiretrovirals (ARVs)  have really helped me suppress my viral load and live a normal life without health challenges. Without the ARVs, I would have infected my children and my wife. When I was first diagnosed, I was terrified of death, as I saw many affected individuals die of AIDS. But the treatment and counseling I receive have truly saved my life,” said Ibrahim.

Ibrahim is among thousands of Kenyans who have access to ARVs and HIV services, thanks to the support of the United States’ Global Fund and PEPFAR (The U.S. President’s Emergency Plan for AIDS Relief). 

This program has been a savior in the fight against HIV/AIDS, which is one of the three leading causes of death in Kenya and across Africa. The donor ensures a sufficient supply of commodities, including testing kits and antiretroviral (ARV) treatment, as part of the HIV program.

According to data from the National Syndemic Disease Control Council (NSDCC), at least 1.3 million people living with HIV in Kenya have benefited from this support through the provision of ARVs. However, the future of this support has come into question, particularly after the recent announcement by the U.S. to withdraw from WHO funding.

Speaking about the program's impact, Nelson Otwoma, Director of the National Empowerment Network of People Living with HIV/AIDS in Kenya (NEPHAK), notes that although the U.S. has been the leading supporter of HIV programs through PEPFAR since 2024, there has been a gradual reduction in their budgetary allocations for the project.

Otwoma expresses concerns about a highly unpredictable funding environment under Trump’s leadership. 

“Trump’s presidency will impact not just PEPFAR but also UNAIDS, the UN agency for HIV/AIDS, and the Global Fund to fight AIDS, TB, and malaria. His ‘America First’ policy prioritizes domestic interests, which means funding for these global initiatives is likely to decline,” said Dr. Otwoma.

He adds that Trump’s leadership does not seem likely to sustain PEPFAR and Global Fund funding at current levels, which will directly affect Kenya.

“His approach to funding, coupled with Kenya’s issues of corruption and procurement irregularities, puts us in a precarious position. Trump is a businessman who pays attention to such issues, and I do not believe Kenya is in his good books,” Otwoma said.

Recently, the country has reported inconsistencies in the supply of HIV commodities, including ARVs and testing kits. 

Otwoma clarified this by stating, “We do not have a shortage of ARVs at the moment. What has been out of stock since last year is the second-line ARV called Atazanavir/ritonavir (ATV/R).” 

He added that those taking Atazanavir were advised to undergo clinical assessments before being switched to Dolutegravir.

First-line ARVs are used for the initial treatment of HIV. The recommended first-line HIV treatment regimens include ARV drugs that are safe, effective, and convenient for people with HIV who have never taken ARVs before.

The recent decision by the United States to withdraw from the World Health Organization (WHO) has raised concerns in global health diplomacy, with far-reaching implications for public health, particularly in countries like Kenya. 

Over the years, the partnership between the U.S. and the WHO has played a key role in combating and addressing global health threats, including the eradication of malaria, tuberculosis, Ebola, and HIV/AIDS.

The U.S. departure from the WHO creates a significant funding gap, as the U.S. was the largest financial supporter of the organization, providing about 18 percent of its total funding. This disruption could jeopardize critical health initiatives worldwide.

US withdrawal is likely to undermine programs across the organization, especially those related to tuberculosis, the world's leading infectious disease killer, as well as HIV and malaria. PEPFAR has been critical in Kenya’s fight against HIV/AIDS, providing antiretroviral therapy to millions of people.

The Global Fund is among the highest funders of Kenya’s health system. Kenya’s total commodity allocation for HIV services is Sh28.7 billion, of which Sh5.3 billion comes from the Global Fund and Sh3.3 billion from the Kenyan government. 

Of the Sh28.7 billion, the Global Fund allocates Sh4.6 billion for ARVs, while the Kenyan government allocates Sh2.2 billion. However, there is a total shortage of Sh2.4 billion worth of ARVs.

PEPFAR funding for HIV commodities has been declining over the years, from Sh17 billion to Sh11 billion, Sh9 billion, and now down to Sh7.3 billion. 

According to Dr. Gitahi Githinji, CEO of Amref Health Africa, the withdrawal of the US Global Fund and PEPFAR would be disastrous for the fight against HIV/AIDS, potentially reversing the gains made.

“We should be worried. Our governments have relied on foreign funding to make progress against HIV. The withdrawal of PEPFAR would mean losing Sh40 billion a year. Where is Kenya going to find Sh40 billion a year to tackle the HIV problem? Reproductive health is the country’s first social investment and cannot be left to neighbors or friends,” Dr. Githinji remarked.

Githinji stated that the US withdrawal creates a budget shortfall of over $1.2 billion from WHO’s annual budget of approximately $5 billion. Unless this shortfall is offset by increased contributions from other countries and philanthropies, it threatens to weaken global health security, particularly in the most fragile health systems, mainly in Africa.

“We urge the US administration to reconsider its decision and engage with WHO to protect the health and well-being of millions in Africa and around the world. Global cooperation is essential for a safer, healthier future,” Githinji added.

Speaking during a media briefing at the Ministry of Health headquarters, Director-General of Health Dr. Patrick Amoth stated that Kenya aims to strengthen bilateral health partnerships by collaborating with other nations and institutions to address the funding and expertise gaps left by the US withdrawal, ensuring that Kenya’s health priorities remain intact.

“Collaboration with international partners is critical to ensure that our health priorities are not compromised,” Dr. Amoth told journalists. 

He also emphasized the need for Kenya to advocate for multilateral support through the African Union and other global platforms to keep Africa’s health needs on the agenda.

“Strengthening regional partnerships is essential to address cross-border health challenges. We must work together as a region to protect the health of our people,” Dr. Amoth said.

The Director-General also highlighted the need to increase domestic financing for health by mobilizing local resources to support key health programs and reduce dependence on external funding.

He mentioned promoting public-private partnerships (PPPs) to attract investment and emphasized the necessity of engaging with alternative global health partners, including the European Union and the Gates Foundation.

“Shared global responsibility in responding to health emergencies through health diplomacy is vital, and we must call for reforms within WHO to ensure equitable resource allocation,” Dr. Amoth stated.