Funding cuts impact HIV care for communities in Kenya

For years, community health workers in Western Kenya have helped families affected by HIV navigate challenges beyond hospitals, following up on children who miss appointments, supporting caregivers and helping patients adhere to treatment.

For female sex workers and other key populations, dedicated drop-in centers provided confidential access to HIV prevention, testing, treatment and other health services.

But funding cuts by donors have disrupted these community-based services, forcing some programs to scale back or close and shifting clients to public health facilities, where stigma, confidentiality concerns and additional costs may discourage them from seeking care.

The disruptions followed a major shift in foreign assistance policy. In January last year, the United States froze foreign aid and issued stop-work orders affecting programs funded through the President's Emergency Plan for AIDS Relief, or PEPFAR, including those implemented by the US Agency for International Development, or USAID, and the Centers for Disease Control and Prevention.

Kenya and the US subsequently signed a five-year Health Cooperation Framework on Dec 4, 2025, under which Washington pledged up to $1.6 billion in health support. In July 2026, the two governments signed a Strategic Objective Grant Agreement to guide implementation.

But for people who relied on community-based services, the transition has brought significant challenges.

At Oruba Dip Dispensary in Migori County, Peter Omollo, a member of a key population, remembers the time when he could access services at a dedicated drop-in center.

"Initially, we were confined in one place where we could meet all services under one roof with a lot of confidentiality, with a lot of positive approaches, with a lot of care," he said.

Omollo, who had received services through a drop-in center since 2010, said some clients were reluctant to seek care after the services were integrated into a public facility, fearing relatives and other community members might discover their HIV status or sexual orientation.

"The integration has increased stigma among peers," he said.

He said some clients who previously received free services now face charges for consultations, tests and treatment for other conditions.

These costs can be particularly difficult for people without stable incomes, identification documents or working phone numbers needed to register with the Social Health Authority system.

Diana Ross Ouma, director of Faraja Women Initiative, a Migori-based nonprofit organization supporting female sex workers and other key populations, said the uptake of prevention services had declined following the integration of services into public facilities.

The organization previously worked with a dedicated drop-in center offering HIV prevention, pre-exposure prophylaxis, or PrEP, treatment, sexually transmitted infection screening, cervical cancer screening and family planning.