Two health and gender rights leaders delivered a stark
assessment of what happens when major external funding
disappears overnight and organised opposition fills the
vacuum. The sudden withdrawal of US government’s funding
support has not merely reduced services – it has fractured
health systems, emptied pharmacy shelves, driven up
unplanned pregnancies and unsafe abortions, and enabled
anti-rights groups.
“Shelves go dry”: The immediate
collapse of care
Nelly Munyasia, Executive Director
of the Reproductive Health Network Kenya (RHNK), did not
soften her language. “We saw shelves go dry,” she said.
When the US Agency for International Development (USAID)
stop-work order took effect in January 2025, a system that
had long operated in silos simply stopped functioning. HIV
treatment, lifesaving antiretroviral refills, routine
check-ups, counselling and testing outreaches, and
community-based services for women, girls and key
populations came to a standstill.
Munyasia described a
healthcare architecture that had become dependent on a
single external agency. “USAID had a siloed approach to
providing HIV care. If you walked into a health facility,
you found a siloed way of providing HIV treatment. When they
left, that collapsed – the services that were provided, the
medicines, the ARVs, the checkups, the referrals, the
routine checkups – all that collapsed.”
The impact
was not limited to HIV. Family planning commodities also
disappeared. Outreach programmes that had taken testing and
counselling into communities ground to a halt. The result,
she said, is a health system “coming down on its
knees.”
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Nelly was speaking in the SHE & Rights
session hosted at the 26th International AIDS Conference
(AIDS 2026) by Global Center for Health Diplomacy and
Inclusion (CeHDI), CNS and partners.
Rising
pregnancies, reinfections and girls arriving with ruptured
uteruses
The human cost is already measurable. In the
second last week of July 2026, RHNK, working with the
Ministry of Health Kenya, the National Council for
Population and Development, IPPF and other partners,
launched a baseline survey in five counties. The early
findings are alarming: increased numbers of pregnancies,
rising HIV infections and reinfections, and a sharp rise in
reported cases of unsafe abortion.
“Girls are walking
to facilities with ruptured uterus. They are walking to
facilities bleeding almost to death,” Munyasia stated. She
rejected any attempt to treat HIV in isolation. “We cannot
talk about HIV in isolation. We need to make sure that we
are addressing what is the root cause of the issues we
continue to see now.”
The same adolescent who needs
HIV prevention also needs contraception, safe abortion care
when necessary, protection from gender-based violence, and
non-judgmental services. When those services vanish or
become inaccessible, the consequences appear across every
indicator.
Anti-rights groups move into the
vacuum
Munyasia was equally clear that the funding
collapse has been accompanied by a calculated political and
social offensive. Organised anti-rights and anti-gender
groups are “leveraging on everything that is happening
globally and now narrowing it and bringing it down.” They
promote narratives that claim to ‘Africanise’ values while,
in her words, perpetrating hate. “African is not hate.
African appreciates and recognises everyone in their
diversity.”
The practical effects are already visible.
Some organisations that once worked on sexual and
reproductive health and rights have dropped the word
“rights.” Governments that previously positioned themselves
as champions of diversity, equity and inclusion have gone
quiet. The word “gender” is being scrubbed from
websites. Healthcare providers face heightened surveillance,
harassment and even arrest for offering safe abortion care
or services to LGBTQI people and
adolescents.
Community-level harassment of the LGBTQI
community has intensified. Healthcare workers who continue
to provide care operate in a climate of fear. “This really
creates an environment that is very hostile for this
population that so much needs care,” Munyasia
said.
She insisted that the response cannot be limited
to monitoring the opposition. “We are just not monitoring
opposition… but we are answering the critical question
‘so what?’, because services must be provided, policies
must be developed, and we must continue to create an
enabling environment for the populations that we serve to
thrive.”
Four pillars to rebuild: A practical
roadmap from the ground
Dr Edison Omollo, Programme
Director at RHNK, outlined the concrete strategy the
organisation and its partners are pursuing to fill the gap
left by USAID. He listed four interconnected
pillars.
First, building an intersectoral movement for
sustainable sexual and reproductive health and rights. No
single group can replace donor funding. RHNK is convening
national and regional coalitions that bring together not
only health actors but also education, gender and finance
ministries and civil society. The goal is alignment with
government systems rather than parallel structures.
Positioning sexual and reproductive health and rights (SRHR)
as a development, education, economic and gender equality
issue – and not merely a health issue – is central to this
effort. Domestic resource mobilisation, Omollo emphasised,
requires finance actors at the table.
Second,
strengthening government systems instead of creating
parallel programmes. RHNK itself has shifted from multiple
parallel projects to a single strategy that supports
government priorities. The organisation is assembling a
“winning coalition” of actors, each contributing
complementary strengths so that public systems are
reinforced rather than competed with. “It is only the
government system that is able to deliver at scale,”
Omollo noted.
Third, genuine integration of services.
Communities do not experience health problems in isolation,
and neither should the health system. RHNK is pushing for a
continuum of care that combines SRHR, HIV services,
contraception, maternal health, gender-based violence
response, cervical cancer screening and self-care. Omollo
argued that treating a girl in silos is both inefficient and
ineffective.
Fourth, investing in digital health
innovations and self-care. The funding collapse demonstrated
that many needs can be met outside congested facilities.
Digital tools offer confidential, non-judgmental pathways
for information, self-care and referral networks that
connect people to appropriate public or private providers.
For gender-diverse individuals especially, the ability to
access care from home expands reach and protects bodily
autonomy. Digital innovation is presented not as a
replacement for health workers but as an extension of their
reach.
A system that must serve the whole
person
Both Nelly and Omollo returned repeatedly to
the same core insight: the people most affected –
adolescents, women, sex workers, LGBTQI communities – cannot
be segmented into disease categories or funding streams. An
adolescent seeking HIV services might also need
contraception, might be at risk of gender-based violence,
and might face stigma that keeps her away from facilities.
When the system collapses in silos, she falls through every
gap.
Munyasia put it bluntly: healthcare providers
cannot open a facility and declare they will only provide
HIV care. The work of rebuilding must therefore be holistic,
rights-based and firmly anchored in national systems rather
than external parallel structures.
The Kenyan
experience is not isolated. Across many countries that once
relied heavily on external HIV and reproductive health
funding, similar patterns of service disruption, commodity
shortages and opportunistic anti-rights mobilisation are
emerging.
I, as the SHE & Rights host, said in the
session that progress toward the 2030 targets on ending AIDS
is already under threat from a broader backlash against
health and gender rights. With only 54 months remaining, the
testimonies from Kenya serve both – as a warning and as a
call to action. The response must be integrated,
domestically owned, and unapologetically rooted in the
rights and leadership of those most affected.
The
shelves are dry. The numbers are rising. The opposition is
organised. The question now is whether the global AIDS
response — and the governments and movements that sustain
it — will match the urgency of the crisis unfolding on the
ground.
Shobha Shukla – CNS (Citizen News
Service)
(Shobha Shukla is a feminist, health and
development justice advocate, and an award-winning founding
Managing Editor and Executive Director of CNS (Citizen News
Service). She serves as Chairperson of Global AMR Media
Alliance (GAMA), Host and Coordinator of SHE & Rights
(Sexual Health with Equity & Rights), President of Asia
Pacific Media Alliance for Health, Gender and Development
Justice (APCAT Media), and founder leader of DJOP
(Development Justice for Older Persons) initiative. She was
also the Lead Discussant for SDG-3 at United Nations
inter-governmental High Level Political Forum 2025. GAMA ,
led by her, received the AMR One Health Emerging Leaders and
Outstanding Talents Award at UN High Level Ministerial
Conference on AMR 2024. Follow her on X @shobha1shukla or
read her writings here www.bit.ly/ShobhaShukla)
–
Shared under Creative Commons
(CC)
