The real cost of the US funding freeze on healthcare workers and people living with HIV in Zimbabwe

By Rumbie Gumbie

We gathered in the small boardroom of a District Hospital in Zimbabwe, waiting for healthcare professionals and community representatives to arrive. We intended to discuss the design of an integrated Sexual and Reproductive Health (SRH) and HIV intervention in Zimbabwe. We aimed to recognise the importance of a holistic approach to improving health outcomes, reducing the duplication of services, and ensuring more efficient use of resources. However, another topic loomed over the discussion—the recent order from the United States to halt funding for global health programs, that had sent shockwaves through the district. Healthcare workers and community members were scrambling to understand what this meant.

Rumours were spreading. "I heard that they have been asked to surrender their cars", one healthcare worker remarked, referring to workers for NGOs working on HIV care and prevention, supported by US funding who had been in possession of organisational vehicles. Another added: "Even HIV drugs can’t be given anymore." Whole organisations were told to leave their offices and not to come to work. On January 20, 2025, President Donald Trump had issued an executive order titled " Reevaluating and Realigning United States Foreign Aid," pausing most U.S. foreign assistance for 90 days. While framed as a reassessment of foreign aid priorities, for Zimbabwe’s most vulnerable, it felt like a death sentence.

USAID and PEPFAR have long been the backbone of global health initiatives, particularly in countries where national health funding is insufficient. PEPFAR provides ARVs to over 20 million people worldwide, and in Zimbabwe, it is the primary provider of these life-saving medications. With the funding freeze, the fear in the room was palpable—would healthcare facilities still be able to function?

A former ART counsellor, now working in the hospital kitchen, shared his long-term anxiety about job insecurity. "I left the profession and joined the hospital kitchen. I felt insecure in the NGO world. Joining the government is better—I’ll at least have a pension and benefits." His decision may not have been directly influenced by the funding halt, but his words reflected the fear among health workers who depend on donor-funded salaries.

It became clear that the uncertainty had already taken root. Patients were avoiding healthcare facilities, afraid of bad news. "I know a facility where they have been told to lock the cabinet where drugs from the U.S. are supplied," one participant shared. Meanwhile, others spoke of patients hoarding medication or skipping doses, trying to stretch out their supply—a dangerous practice that increases the risk of drug resistance, which can lead to other opportunistic health problems.

For PLWHIV, the funding freeze was not an abstract policy—it was a matter of survival. The threat to ART supplies was immediate and real. A mental health nurse admitted to struggling with reassuring patients when they themselves had no answers. The weight of uncertainty seemed to be burning out an already overstretched workforce.

The psychological toll was undeniable. Some patients, already battling self-stigma, began to turn to traditional or spiritual remedies, seeking stability where the health system was failing them. Even longtime HIV advocates were hesitant to speak out, unsure of what the future held.

Beyond the impact on patients, the funding freeze threatened livelihoods. Many facilities rely on donor-funded salaries, training, and operational costs. One NGO, entirely dependent on USAID, funds a nurse per facility overseeing HIV statistics. Without this role, critical data would be lost, severely compromising the district’s HIV response. A health official warned that without donor funding, clinics might be forced to cut services or close entirely—an unthinkable scenario in a district already grappling with low HIV viral suppression rates and staff shortages.

As the discussions wrapped up; the consensus was clear: waiting for foreign donors to resolve the crisis was not an option. There is an urgent need for locally driven and international support, through international cooperation, and contingency plans to keep essential health services operational. Some proposed strengthening community-led initiatives, while others urged advocacy to push the government and other international partners, for greater intervention.

The next 90 days will decide whether the district’s health facilities weather the storm or crumble under its weight. Regardless of what happens, one thing is certain: the scars left by this funding freeze will endure long after this initial shock.

This blog post was written by Rumbie Gumbie, a Research Fellow at the London School of Hygiene & Tropical Medicine. Her research focuses on investigating integrated HIV and sexual and reproductive health (SRH) services for adolescents and young people living with HIV, working with health providers in both rural and urban settings in Zimbabwe. This article presents the author’s research and observations and does not represent the official position of THRU ZIM or the London School of Hygiene & Tropical Medicine