US foreign aid freeze: Counting the cost for Uganda

KAMPALA - Uganda will lose about $350 million (sh1.29 trillion) if the sweeping executive orders to freeze foreign aid by US President Donald Trump are fully effected.

This is the total amount that has been contributed every year by the US government through the President Emergency Plan for AIDS Relief (PEPFAR).

It also represents 55 percent of the total funding available in the fiscal year 2025.
Part of the sh1.29 trillion is money that has been used to pay salaries for health workers who run the associated clinics, the Americans managing PEPFAR programmes, development partners, buying and fuelling of vehicles, plus managing of NGO work.

Already, $101 million (sh370.8 billion) has been used to procure and distribute drugs and supplies for TB and HIV, which represents 19.5 percent of the entire health commodity budget.

Without the money, the availability of life saving ARVs will reduce by 30 percent, laboratory supplies by 70 percent, condoms by 50 percent, PrEP commodities by percent, and male circumcision kits by 100 percent, according to Dr Vincent Bagambe, the director of planning and strategic information at the Uganda AIDS Commission (UAC).

Worth noting, over 29, 000 US government-supported health workers will not be available to provide services, hence disrupting HIV prevention, treatment and care at the health facilities and in the communities. 

'Second wave' 

Bagambe said that additionally, Uganda will also lose the support that was provided through the community programmes, which again were largely funded by the development partners.

In light of this threat, he said there is need to intervene quickly to ensure services for HIV prevention, testing and putting people on treatment are not disrupted.

“If we can continue offering HIV services, then new HIV infections will continue to reduce. However, if we are unable, the risk is high, and we shall see a second wave; a reversal of the gains we have registered."

Bagambe was speaking at a meeting Uganda AIDS Commission (UAC) held with the Parliamentary Committee for Presidential Affairs at Serena Hotel on Wednesday (March 5).

In attendance was the Minister for the Presidency Milly Babirye Babalanda and the chairperson of Uganda AIDS Commission, Canon Dr Ruth Senyonyi.

Babalanda called for increased government budget to fund the entire HIV care, treatment and services in the country to avoid the uncertainties due to withdraw of funds by the donor communities.

On her part, Senyonyi urged the parliamentary committee members to establish a basket fund, which if well conceptualized, will be a self-sustaining fund for Uganda and which other disease programmes can benefit from.

She also called on the legislators to increase and ring-fence the HIV mainstreaming funds in the sectors and local governments to support the HIV response. 

Babalanda (C) called for increased government budget to fund the entire HIV care, treatment and services in the country to avoid the uncertainties due to withdraw of funds by the donor communities. (Credit: Nancy Nanyonga)

She also urged the MPs to operationalize the national HIV Insurance Scheme as well as support the UAC funding priorities for the next five years.

The lawmakers appreciated the challenges the US fund freeze will cause and agreed that putting additional resources from the national budget is crucial.

They said all stakeholders need to devise ways beyond funding that will make it possible for Uganda to implement services within its domestic means.

Adjumani Woman MP Jesca Ababiku said there is need to think outside the box and see what the government can do to sustain the epidemic response, instead of becoming perpetual beggars.

She said the health ministry and UAC should discuss and work out ways of manufacturing ARVs.

Agago County MP David Lagen said Uganda has been sluggish in building a sustainable strategy to meet the targets of 2030. 

"For example, from the time the HIV epidemic hit the country, we are still depending on foreign donors (80 percent) instead of building a reserve account or investing to have a sustainable livelihood for people who are living with HIV."

Lagen further noted that having a sustainable livelihood for people living with HIV will require fighting corruption.

“We are losing billions of money in this country at the expense of the HIV programme. We have all the resources required and if we invest faithfully, we shall not be having these gaps," he said.

The lawmaker said it is a wakeup call for Uganda to look into domestic financing in order to reduce the rate of donor dependence to meet the targets of 2030.

HIV burden

Uganda's HIV prevalence among the adult population (15-49 years) has continued to decline, and currently stands at 5.1 percent, down from 5.5 percent in 2020.  This means that in a crowd of 100 people, there are only five who are infected with HIV.

The prevalence is still higher among women (15 to 49 years) at 6.6 percent compared to the men in the same age bracket at 3.6 percent, the according to the annual Joint AIDS Review report 2023/2024.

New HIV infections reduced from 46,000 in 2020 to 38,000 in 2023, which translates to 100 people getting infected with HIV every day.

The same report indicates that in the space of one year, only 4,700 children between 0 to 14 years acquired HIV infection from their positive mothers, hence translating into a 5.04 percent infection rate. This is a reduction from 5,900 new HIV infections that were recorded among children in 2023.

In 2020, Uganda was registering 21,000 AIDS-related deaths, and they have just slightly reduced to 20,000 by June 2024, against the 2025 target of 10,800.

An estimated 1,492,410 people were living with HIV in Uganda as of December 2023. Of these, females are more.