Earlier this year, the Trump administration announced that it would end the US Agency for International Development’s (USAID) funds to the Joint United Nations Programme on HIV/AIDS (UNAIDS). Funding cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR) triggered a wider crisis in global HIV financing—with the Global Fund, a global partnership to end HIV, Tuberculosis and Malaria, struggling to fill the gap. These funding cuts threaten to reverse decades of progress in HIV prevention and treatment, especially for the most marginalised groups, who already lack access to inclusive and stigma-free services.
South Asia: Years of Progress at Risk
Across South Asia and the globe, vulnerable communities who are at an increased risk of HIV, including men who have sex with men (MSM), women and gender-diverse people who use drugs, and sex workers, now face a collapse of critical HIV services. “Women who use drugs were already a historically ignored group and will continue to remain one. The cuts have only made access to sexual and reproductive health services, and HIV prevention and treatment services, further difficult due to the heavy stigma associated with drug use. Access to harm reduction supplies such as clean needles and syringes, and opioid agonist treatments, such as buprenorphine and methadone is getting more and more scarce. Life-saving supplies like antiretroviral medication and condoms are routinely out of stock”, says Nandini Thapa, Coordinator of The Regional Collective of Women who use Drugs (TRCWUD), hosted at the IPPF South Asia Region (IPPF SAR).
In South Asia, the impacts of the aid cuts have already started emerging.The Population Services and Training Centre (PSTC), IPPF SAR’s Associate Member in Bangladesh, provides HIV prevention and treatment services to people who use drugs with the support of a large international donor. However, the project is now operating under severe constraints - unable to procure equipment or scale-up services. According to PSTC’s latest estimates, if funding is halted, 21,148 beneficiaries will lose access to HIV prevention services, posing a serious risk of increased HIV infections in the country.
Our community-led partner in Bangladesh is facing a similar challenge. Shale Ahmed, the Executive Director, says, “Our HIV interventions have long provided comprehensive support for gender-diverse populations. However, the recent aid cuts have deeply affected our ability to maintain these essential services, leading to over 26,000 individuals at risk of losing essential support services. We are also unable to address the recent rise in opportunistic infections (OIs) and life-threatening diseases, such as HPV, Hepatitis B and C.”
The impact of shrinking international funding is especially stark in Nepal. Dristi Nepal, a pioneer organization in delivering services and advocating for the health and human rights of women who use drugs, is at risk of their services being scaled down or halted altogether. This can put an end to years of critical advocacy and programs, including essential sexual and reproductive health services, HIV prevention services, and mental health support to women and gender diverse people who use drugs in Nepal. Parina Subba Limbu, Founder of Dristi Nepal, notes, “Since the onset of COVID-19 and due to the recent wave of funding cuts, women who use drugs have become increasingly marginalised - both in service delivery and in advocacy spaces”.
when
region
South Asia
Subject
HIV and STIs
The recent rise in HIV cases across Asia and the Pacific, considering ongoing funding cuts and donor setbacks, is alarming. This will have a significant impact on the key populations, who are already at the margins of SRH service delivery. - Tomoko Fukuda, Regional Director (Interim), IPPF SAR
Aid Cuts Deepen New Crises
Not just services but newer, innovative and cutting-edge HIV research are also at a possibility of being defunded. Anindita Dasgupta, Assistant Professor of Sociomedical Sciences at Columbia University, whose research focuses on understanding how gendered inequities of health intersect with sexual and reproductive health, is worried about the trickling effects of the aid cuts on vulnerable communities disproportionately impacted by HIV, lack of access to maternal health, and sexual and gender-based violence. “Research studies over the years have directly led to reductions in HIV rates, intimate partner violence, mental illness, and additional SRH concerns for women who use drugs. This is a targeted attack on reproductive justice, especially on women who use drugs. It could lead to a significant setback to years of work on harm reduction by community-led and SRHR organizations”. Dasgupta hopes that academia and the private sector will help step up to fill the widening funding gaps.
A deepening crisis unfolds in South Asia and Southeast Asia, with a recent spike in HIV cases, specifically in countries such as Afghanistan, Bangladesh, Fiji, Lao PDR, Papua New Guinea and the Philippines. “We are deeply alarmed by the recent rise in HIV cases across Asia and the Pacific, considering ongoing funding cuts and donor setbacks. We recognise the impact this has on the key populations, who are already at the margins of SRH service delivery. However, we remain hopeful. Within the federation and among our partners, we have the expertise and experience needed to respond effectively, drawing from past learnings and adapting to today’s realities. Our Member Associations are resilient and they continue to serve communities despite growing challenges”, says Tomoko Fukuda, Regional Director (Interim), IPPF SAR.
Looking for Sustainable Solutions
The HIV movement stands at a critical crossroad. The choices made by global health actors today will shape the future of entire communities. While immediate reinvestment is vital, the crisis has also underscored the urgent need to reduce dependency on international donors. Data shows that while international funding for HIV responses in Asia and the Pacific has steadily declined - from USD 1.6 billion in 2009 to just USD 0.6 billion in 2022 - domestic contributions have increased significantly, rising from USD 1.3 billion in 2009 to USD 3.1 billion in 2022. This shift signals both a challenge and an opportunity. Strengthening domestic financing, expanding sustainable models such as social enterprises, and investing in feminist, community-led responses can build long-term resilience.
Prioritising the needs of women and gender diverse people who use drugs is not only a programmatic necessity, but also a moral imperative. “Without immediate reinvestment and political will, we risk entrenching a “crisis”, which will disproportionately harm those most silenced and excluded”, says Thapa. Further, women and gender diverse people who use drugs are disproportionately affected by stigma, gender-based violence, and systemic exclusion, but continue to be framed almost exclusively through the lens of being a “high-risk group” for HIV, often at the cost of their broader rights and realities. Acknowledgement of equal rights to health and dignified care by governments and societies is the first step to inclusive healthcare and effective policy measures including financing. “Until we are seen as whole individuals with diverse needs, not just as part of HIV statistics, our community will continue to be left behind” adds Parina.
This article is contributed by Reshma Narayan, Regional Director's Secratariat Officer, IPPF South Asia Region
