For years, community health workers in Western Kenya have helped families affected by HIV navigate challenges beyond hospitals, following up on children who miss appointments, supporting caregivers and helping patients adhere to treatment.
For female sex workers and other key populations, dedicated drop-in centers provided confidential access to HIV prevention, testing, treatment and other health services.
But funding cuts by donors have disrupted these community-based services, forcing some programs to scale back or close and shifting clients to public health facilities, where stigma, confidentiality concerns and additional costs may discourage them from seeking care.
The disruptions followed a major shift in foreign assistance policy. In January last year, the United States froze foreign aid and issued stop-work orders affecting programs funded through the President’s Emergency Plan for AIDS Relief, or PEPFAR, including those implemented by the US Agency for International Development, or USAID, and the Centers for Disease Control and Prevention.
Kenya and the US subsequently signed a five-year Health Cooperation Framework on Dec 4, 2025, under which Washington pledged up to $1.6 billion in health support. In July 2026, the two governments signed a Strategic Objective Grant Agreement to guide implementation.
But for people who relied on community-based services, the transition has brought significant challenges.
At Oruba Dip Dispensary in Migori County, Peter Omollo, a member of a key population, remembers the time when he could access services at a dedicated drop-in center.
“Initially, we were confined in one place where we could meet all services under one roof with a lot of confidentiality, with a lot of positive approaches, with a lot of care,” he said.
Omollo, who had received services through a drop-in center since 2010, said some clients were reluctant to seek care after the services were integrated into a public facility, fearing relatives and other community members might discover their HIV status or sexual orientation.
“The integration has increased stigma among peers,” he said.
He said some clients who previously received free services now face charges for consultations, tests and treatment for other conditions.
These costs can be particularly difficult for people without stable incomes, identification documents or working phone numbers needed to register with the Social Health Authority system.
Diana Ross Ouma, director of Faraja Women Initiative, a Migori-based nonprofit organization supporting female sex workers and other key populations, said the uptake of prevention services had declined following the integration of services into public facilities.
The organization previously worked with a dedicated drop-in center offering HIV prevention, pre-exposure prophylaxis, or PrEP, treatment, sexually transmitted infection screening, cervical cancer screening and family planning.
‘Service uptake down’
“Service uptake has definitely gone down after the services were integrated into public health facilities,” Ouma said.
Wendy Kigami Juja, a nurse attending to key populations at Oruba Dip Dispensary, said the former drop-in center provided HIV testing, antiretroviral therapy, PrEP, post-exposure prophylaxis, sexually transmitted infection treatment and referrals for survivors of gender-based violence.
Peer educators helped health workers reach people who might otherwise avoid health facilities. The center typically served 15 to 20 clients daily, with numbers sometimes reaching 20 to 30, depending on bookings and walk-ins.
“Once they realize there is a facility or there is a safe space where they can access these services, they come out clearly,” she said.
After PEPFAR funding stopped, the center struggled to meet the operating costs, including rent. Its services were integrated into Oruba Dip Dispensary in June 2025, and outreach activities were discontinued.
Juja said condoms, lubricants, antiretroviral drugs and HIV prevention medicines continued to be supplied through other channels, including the Global Fund and the national government. However, reaching clients outside health facilities remained difficult.
She estimated that a consultation, urinalysis and treatment for a sexually transmitted infection could cost between $3.90 and $5.40, potentially discouraging people struggling to meet basic needs.
Without peer educators and outreach workers, health workers have also lost contact with some clients, particularly those in hard-to-reach areas.
The cuts have also affected programs supporting orphans and vulnerable children, including those living with HIV.
Vincent Okonya, head of programs at the Rural AIDS Prevention and Development Organization in Migori, said its USAID-funded program, implemented through PATH Kenya, supported 6,604 orphans and vulnerable children, including 2,733 children and adolescents living with HIV and about 348 HIV-exposed infants.
The program supported treatment adherence, followed up on children with unsuppressed viral loads and helped families meet school, nutrition and livelihood needs.
When funding ended following the January 2025 stop-work order, the organization laid off program staff members and transferred care services to government health facilities and the State Department of Children Services.
Okonya said the loss of community follow-up has left families struggling to meet basic needs and maintain children’s treatment routines.
Desmond Otieno, program manager at the Integrated Development Facility in Homa Bay, said his organization had transferred care responsibilities to the subcounty hospital.
Before funding was withdrawn, the program served about 28,000 people across Homa Bay, Vihiga and Nyamira counties. Its focus has since narrowed to about 4,000 children living with HIV, while its workforce fell from 68 to 14, he said.
“A child coming from a poor household who can’t afford food can’t take drugs. USAID funding was giving economic support to some of the caregivers to buy food,” he said.
Otieno warned that prolonged funding constraints could reverse progress in reducing HIV infections.
About 1.5 million people are living with HIV in Kenya, according to the 2026 estimates by the National Syndemic Diseases Control Council. Nairobi County has the highest number, at 189,907, followed by Homa Bay with 129,087, Kisumu with 115,147, Siaya with 96,439 and Migori with 80,217.
County health officials are integrating HIV services into routine healthcare but acknowledge that government systems cannot immediately replace all the functions previously performed by donor-supported organizations.
In Homa Bay, Stephen Omondi, the county’s AIDS and STIs (sexually transmitted infections) control coordinator, said the stop-work order affected programs for adolescent girls and young women, voluntary medical male circumcision, orphans and vulnerable children, mentor mothers and peer educators.
The DREAMS project, which supported adolescent girls and young women through life skills and HIV prevention, was among the programs halted. More than 1,000 peer educators working with key and vulnerable populations were affected, Omondi said.
Although HIV treatment and other services have been integrated into the county’s health system, the loss of technical support, mentorship and community outreach remains a challenge.
In neighboring Migori, Andrew Magige, deputy HIV/AIDS coordinator, said funding reductions had affected staffing, patient tracing, training, and prevention programs.
“There have been challenges in terms of doing community service delivery, being able to trace back the clients who have been lost and bring them back to the system,” he said.
Magige said the county’s mother-to-child HIV transmission rate had risen from about 5.2 percent to slightly above 10 percent. The county is incorporating HIV services into annual work plans and seeking private-sector partnerships to sustain care.
Tom Odhong, Migori County’s deputy director of public health and sanitation, said the county has taken on additional responsibilities, including transporting laboratory samples. He said 84 dispensaries are operating with at least one nurse or clinical officer, while the county has allocated about $23,128 in additional funding for HIV services.
However, Odhong said the resources remained insufficient to replace all the lost support.
For clients such as Omollo, maintaining access to HIV medicines is not enough. They also need confidential services, affordable treatment for related conditions, and health workers who understand their needs.
Juja said HIV prevention efforts would be more effective if key populations were treated as part of the wider community rather than being marginalized.
“If we continue segregating them and stigmatizing them, we shall not achieve that,” she said.
Sustaining Kenya’s progress against HIV will require not only keeping medicines available but also restoring outreach, peer education, confidential support and follow-up services for people who might otherwise remain outside the health system.
edithmutethya@chinadaily.com.cn
