How Economic Resilience Projects are Helping HIV Patients Survive Aid Cuts

By David Njagi // 23 July 2025

It was during a visit to Jinja, Uganda, last month that Chris Macoloo, the regional director for Africa at the global nonprofit World Neighbors, grasped the worsening effects of funding cuts to the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR.

People living with HIV and AIDS, or PLWHA, were receiving only a week’s worth of antiretroviral, or ARV, medication, instead of the two-month supply they had come to rely on. Sometimes, there was no medication at all.

That meant patients had to make repeated trips to health facilities to check for availability — a costly disruption in terms of transport and incidental spending.

Luckily, PLWHAs supported by World Neighbors could afford to keep searching. The nonprofit has worked with hundreds of PLWHAs in the Lake Victoria basin of Kenya, Uganda, and Tanzania for 15 years, Macoloo said.

What began as a program to address stigma and get bedridden patients back on their feet has grown into one focused on building economic resilience — helping people access treatment, improve nutrition, and regain independence.

By 2020, the program expanded again, providing PLWHAs with economic support to access care during emergencies such as the COVID-19 pandemic. Now, that same resilience is helping groups navigate shocks such as the PEPFAR cuts, said Macoloo.

Through the programs, participants receive training in entrepreneurship, business development, and record-keeping to prepare them for microfinance schemes such as village savings groups and table banking — a group-based financial model where members contribute savings and loan the pooled funds to each other — which provide them with ready cash flow and access to loans at 5%–10% interest to cover health care needs.

“People who thought they were too poor and vulnerable now realize that they can mobilize local resources to continue getting ARVs and good nutrition. We help them establish themselves through training and support groups with the funding we mobilize from private donors, church organizations, and individuals,” Macoloo said.

World Neighbors raises funds in the U.S. to seed economic resilience programs for PLWHAs in East Africa, then hands over the programs to community groups to manage them once they are viable. With flexible cash flows, beneficiaries can cover transportation to clinics, testing, psychosocial support, and prescription renewals.

“Most of these patients had suffered high levels of stigma and this took away their confidence to work or do something for themselves,” he said.

The Trump administration’s freezing and cancellation of foreign aid programs disrupted PEPFAR operations. The program is currently functioning under a waiver, which restricts the scope of services it can provide. This scale-down has disrupted HIV and AIDS services across the region. Clinics have shut down, and operating ones face ARV and condom stockouts.

That’s a dangerous trend, said Dr. Ahmed Ogwell, chief executive at U.S.-based nonprofit VillageReach, which also supports economic resilience programs. He warned of the risk that the virus could develop resistance if patients receive inconsistent medication.

“When you don’t provide health products in time, it is the communities that are going to suffer. Apart from the fact that the virus will not be controlled in their bodies, other opportunistic infections will also grow and you end up with a triple burden where HIV is growing,” said Ogwell.

In food-insecure areas of Kenya, Uganda, Tanzania, and Ethiopia, nutritional programs once funded by PEPFAR — including school meals, therapeutic foods, and nutrition counseling — have folded.

But studies have shown how economic resilience programs can help. The Towards an AIDS Free Generation project in Uganda reported that village savings and loan associations helped communities pay health costs, hence facilitating HIV care for children. In western Kenya, a study showed that PLWHAs who joined a microfinance group were more likely to retain HIV care, compared to patients who were not enrolled in the groups.

“At World Neighbors, our program recipients haven’t gone down due to resilience built over time,” Macoloo said.  “But they are negatively affected due to shortage of ARVs and other drugs.”

This article originally appeared on devex.com on July 23, 2025.