THAD0405 | PROMISE, POLICY, AND PRACTICE: HOW SUB-SAHARAN AFRICAN COUNTRIES RESPOND TO UNITED STATES FUNDING CUTS ON HIV, TUBERCOLOSIS, AND MALARIA

Abdulhammed Babatunde¹, Oluwakorede Adedeji², Mutmainat Alabi³, Yusuf Babatunde², Abdulmumin Ibrahim² | ¹Mybelle Digital Maternal & Child Health Organisation, Ibadan, Nigeria; ²University of Ilorin, Ilorin, Nigeria; ³University of Ibadan, Ibadan, Nigeria; ⁴London School of Hygiene and Tropical Medicine, London, UK

On January 20, 2025, the United States (US) paused all its foreign aid, notably the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund. This significantly impacted HIV pro- grams, including TB and malaria in Africa. This cut is projected to cause the deaths of about 500,000 children in Sub-Saharan Africa (SSA) annually. Additionally, the funding cut has resulted in socio-economic, political, and medical crises in SSA. This review describes the responses of countries in SSA to the US funding cut to mitigate its impact on HIV programs. We conducted a narrative review of the UNAIDS database (https://www.unaids.org/en/resources) published in April 2025 on the impacts of the US funding cut. We also included data from USAID, the US government website, and the country's agencies. We conducted a thematic analysis of findings into three categories: (1) plans by government and its agencies (promises), (2) legislation and policies (policy), and (3) allocated funding and initiatives already launched (practice). A total of 21 African countries have responded to the funding cut by the US. The governments of most countries have made promises to sustain HIV programs. Some of the immediate responses by countries include the constitution of technical working groups or taskforce teams, an impact assessment of funding cuts, and the development of a mitigation plan. Policy changes include: Zimbabwe is exploring airtime taxation for health financing; Togo is including HIV as a chronic disease in its health insurance policy; Nigeria’s legislature is inaugurating an AIDS, TB, and Malaria TWG; and South Africa’s parliament is approving an additional budget for health. Practices implemented by countries include the DR Congo's mobilization of resources for a national HIV forum and the establishment of the Ghana Medical Trust Fund. Countries have also allocated funds through the Ministry of Health, such as South Africa ($1.5 billion), Nigeria ($3 million), Uganda ($1.6 million), Liberia ($300,000), and Mali ($200,000). While some countries have made practical efforts, the governments of many countries are still promising. There is a need for countries to facilitate innovative funding sources and enhance domestic resource mobilization to sustain existing HIV, TB, and malaria programs in sub-Saharan Africa despite the funding cuts.