Kenya integrates HIV care into primary health system amid donor funding cuts

The money is running out, and Kenya is betting that its health system can absorb what international donors are no longer willing to pay for. Last year, global HIV funding dropped by $1.5 billion—an 18 percent decline that landed particularly hard on countries already stretched thin. Kenya's allocation from the Global Fund, one of the world's largest sources of HIV financing, was cut by the same proportion as the fund deliberately shifted its strategy: countries would have to fund more of their own response, or they would have less.

Dr. Andrew Mulwa, who leads Kenya's National Aids and STI Control Programme, stood before a United Nations forum on pediatric HIV in New York and laid out the country's answer. Kenya would no longer treat HIV as a separate program running parallel to the rest of the health system. Instead, HIV services would be woven into primary care, maternal and child health, and the broader universal health coverage framework the government is building. It was not a choice born of ambition. It was a choice born of necessity.

The numbers that forced this reckoning are stark. International resources for HIV dropped from $8.8 billion to $7.3 billion in a single year. Development assistance from donor countries fell even more sharply—23 percent, the steepest decline on record. HIV testing programs in high-burden countries contracted by 22 percent between 2024 and 2025. Some nations reported cuts exceeding 90 percent in condom funding. The architecture of the global HIV response, built over decades with external money as its foundation, was cracking.

Kenya had built something worth protecting. By 2025, the country had achieved treatment coverage of 91 percent among people living with HIV, with 87 percent achieving viral suppression—the point at which the virus becomes undetectable and untransmittable. Prevention of mother-to-child transmission had reached 91 percent. These were not abstract statistics. They represented millions of Kenyans alive and healthy because of a response that had, until recently, been heavily subsidized by the outside world. Globally, 1.2 million people acquired HIV in 2025, and 570,000 died from AIDS-related illnesses. Kenya's progress stood against that backdrop as evidence that the right investments, sustained over time, could bend the curve.

But the old model—HIV as a vertical program, separate and specialized—had become a liability in a world of shrinking external funding. Mulwa acknowledged the paradox plainly: the HIV sector had been the leader of health system transformation in Kenya, yet it had remained siloed, dependent on dedicated funding streams and parallel infrastructure. "The HIV subsector is now playing catch-up," he said, "because we were left vertical, siloed, and the magic word is now integrating the HIV response into the national health system."

The government is building the scaffolding for this integration. A national universal health coverage plan anchored in primary care, financed through a dedicated primary healthcare fund, is taking shape. A community health network of 107,000 workers, paid and equipped by the government, is being established to reach people at the local level. These structures could absorb HIV services—testing, treatment initiation, adherence support, prevention counseling—without requiring the separate funding streams that are no longer reliable.

The stakes are highest for children. Globally, nearly half of all children living with HIV lack access to antiretroviral treatment, a gap that persists even as adult treatment coverage has expanded. Kenya has made progress here too, but the gains are fragile. Mulwa framed the challenge with unusual directness: "For the space of pediatric HIV, the failure of our pediatric reform is the failure of adults." The question he posed to the UN forum applied equally to Kenya: how do you maintain momentum in adopting new treatment guidelines and policies when the money to implement them is shrinking?

Unaids data offers one measure of hope. Across low- and middle-income countries, domestic sources now provide about 60 percent of HIV funding, up from lower levels in previous years. Domestic funding rose by four percent in 2025. More than 55 countries have announced plans to increase their domestic HIV budgets. Kenya is not alone in this transition, though being part of a global trend does not make the local challenge any smaller. The country must now prove that integration can work—that people living with HIV can receive treatment through ordinary health services, that children and adolescents will not be left behind, that the specialized skills and community networks that built Kenya's response will survive the shift to a broader system. The test is not theoretical. It is already underway.