Angella Langat, MBS, director at the National Syndemic Diseases Council.
Kenya has made significant progress in its HIV response with improved antiretroviral therapy (ART) coverage, declining new infections, and pioneering community-led approaches. But warnings from delegates to the International AIDS Society Conference 2025 (IAS 2025) in Kigali show these gains are at risk, particularly as global funding cuts hit home in many sub-Saharan countries.
IAS 2025 heard of commendable bold political commitment from countries such as Rwanda and South Africa, but a worrying trend of reduced focus elsewhere. The conference brought renewed calls for African ownership of HIV/AIDS responses.
Leadership, integration and people for progress
Organisations in Africa are reporting funding delays affecting outreach services such as testing, and linkage to care among key populations. As new antiretrovirals like lenacapavir, the long-acting injectable PrEP (Pre-Exposure Prophylaxis) now endorsed by WHO, are being introduced, countries must confront the reality that access will be out of reach without sustained investment and political will.
At IAS 2025, it became increasingly clear that fragmented, siloed programs are no longer viable for governments seeking sustainable, efficient health systems. Integration – or service convergence – is the likely pathway many governments, including Kenya, will adopt as part of broader health system reforms. However, integration must not come at the cost of patient trust, safety, or dignity. For people with HIV, service delivery models must remain people-focused and patient-centred. This means preserving tailored, affirming care while enhancing coordination across services such as tuberculosis, mental health, and sexual and reproductive health.
Kenya’s early progress towards Universal Health Coverage (UHC) and county health initiatives are promising, but the next phase must be intentional. As emphasised in Kigali, integration is not simply about merging systems, it is about reimagining care that meets people where they are. As Rosemary Mburu of WACI Health says, “design for the people. respond to their realities. When you plan around patients, not systems, you get results.”
Staying the course with local investments
While recent bipartisan efforts in the United States to safeguard the President’s Emergency Plan for AIDS Relief (PEPFAR) against severe funding cuts is a positive development, the ripple effects of earlier disruptions are already evident. Declines in HIV testing, reduced ART initiations, and loss of access to life-saving services for thousands across the global south underscore the fragility of current gains.
For Kenya, a longstanding beneficiary of robust support from PEPFAR and the Global Fund, this is a pivotal moment. The country must continue to advocate for sustained donor engagement while concurrently stepping up domestic investment in the response. In doing so, it must also demonstrate commitment through enhanced transparency, improved efficiency, and measurable results. Fiscal constraints must not become a rationale for policy stagnation or delayed action.
The scaling down of PEPFAR-supported parallel delivery systems in Kenya has left a significant void, not only in services, but in the people who delivered them. Community health workers, peer educators, and grassroots service providers, many living with HIV, have lost their jobs, even as their roles remain critical.
The crisis extends beyond services to severe staffing shortages and stockouts of essential medications, including co-trimoxazole – an antibacterial – and HIV test kits. Approximately 41,500 health workers, estimated to have been supported through US funding, now face being laid off. Youth-friendly clinics have shut down, leading to a 55% dropout rate among adolescents, while stigma and lack of privacy in integrated care settings have driven vulnerable groups away from care.
The resultant challenge is now not just about restoring servicesbut redefining roles, responsibilities, and relationships. As Kenya recalibrates its HIV response within the Universal Health Coverage (UHC) framework, the central question remains how the state meaningfully partner with communities. not just as beneficiaries, but as co-implementers and co-designers of care.
Systems, not applause
At IAS 2025, lenacapavir, approved by the United States Food and Drugs Administration (FDA) is the first and only HIV prevention option offering 6-months of protection has been was hailed by the WHO as a major advancement in HIV prevention. Yet, the promise of scientific breakthroughs can only be fulfilled through systems that ensure equitable access. For Kenya, it means accelerating regulatory approvals, investing in workforce training, and adopting forward-looking procurement strategies to make long-acting prevention options widely available.
Emerging innovations such as MK-8527, a monthly oral PrEP, and AI-powered diagnostic tools, demonstrate how science is rapidly reshaping the response landscape. But the true impact of these technologies will depend on their integration into real-world settings. Applauding innovation is not enough; building the systems to support their delivery is where transformation happens. Kenneth Ngure, IAS President-elect, “Kenya has the tools, talent, and tenacity to lead Africa’s next chapter in the HIV response. But it must act now—with courage, clarity, and commitment.”
