In a humble abode in Nakuru, a city located in Kenya’s Rift Valley, Minne Gachau’s life has been profoundly shaped by her experience with HIV/AIDS. After her husband succumbed to AIDS-related complications in 2006, it took the diagnosis of their son and his subsequent antiretroviral treatment to prompt her own pursuit of life-saving medication, four years after her initial diagnosis. At a candle-lighting ceremony in Nakuru to honor those lost to AIDS-related illnesses, Gachau reflected on the vital role antiretroviral treatment has played in her life, stating, “Without it, I would be long dead and forgotten.”

Gachau has since remarried, given birth to an HIV-negative child, and now dedicates herself to assisting pregnant women in preventing HIV transmission to their babies. Her journey intertwines with the President’s Emergency Plan for AIDS Relief (PEPFAR), a program initiated in 2003 by former U.S. President George W. Bush. PEPFAR, which has provided HIV/AIDS treatment to nearly 1.3 million Kenyans, faced a moment of unease when the U.S. government opted for a one-year funding renewal in 2023, shifting from its prior five-year commitments due to resistance from certain Republican lawmakers.

The contentious issue revolved around demands to prohibit non-governmental organizations receiving PEPFAR funding from supporting or offering abortion services, although U.S. laws already forbid the use of such funding for such purposes. The shorter funding renewal raised apprehensions about its long-term continuity, prompting genuine concerns about the fate of HIV/AIDS initiatives in Kenya and beyond.

Kenya, home to 1.4 million people living with HIV/AIDS but with a significantly reduced prevalence rate, has made substantial progress in combating the virus, thanks in large part to PEPFAR’s support. The program, a significant contributor in the fight against HIV/AIDS, brought the country closer to achieving the UN’s 2025 goals, which aim to ensure that 95% of people living with HIV know their status, that 95% of those diagnosed receive antiretroviral treatment, and that 95% of those undergoing treatment display viral suppression.

UNAIDS revealed that Kenya has recorded a 78% reduction in new HIV/AIDS infections and a 68% decrease in HIV/AIDS-related deaths since 2013. Nonetheless, concerns linger about Kenya’s overreliance on external funding, underscoring the necessity of developing sustainable plans to safeguard the HIV/AIDS program’s continuity.

The apprehension surrounding reduced funding has resonated with individuals like Dickson Mwaniki, a 52-year-old street vendor living with HIV for 19 years, who relies on PEPFAR-funded treatment to maintain a suppressed viral load, thereby safeguarding his wife from the virus. However, the financial burden of treatment, which exceeds Mwaniki’s daily earnings, looms as an insurmountable obstacle for many employed in Kenya’s expansive informal economy.

Younger individuals, particularly women, face heightened vulnerabilities, exemplified by a 23-year-old recipient of free antiretroviral treatment. Unable to support herself financially, she expressed the possibility of turning to sex work if compelled to pay for her treatment – a stark illustration of the perilous predicament confronting high-risk groups in Kenya.

At a Nakuru clinic benefiting from PEPFAR support, counselor Philemon Ogola expressed concern about the potential repercussions of disrupted funding, underscoring the facility’s remarkable reduction in new cases and the impact on impoverished patients reliant on the program’s aid. Ogola’s apprehension mirrors the broader sentiment shared among many who fear the destabilizing effects of funding uncertainty on the fragile fabric of HIV/AIDS treatment in Kenya.

As the world grapples with the ravages of the HIV/AIDS pandemic, the resilience and determination of individuals like Gachau and Mwaniki epitomize the profound impact of sustained international support. The broader narrative underscores the urgent need for sustainable strategies to fortify Kenya’s HIV/AIDS program, ensuring that the lifeline extended by initiatives such as PEPFAR remains unwavering in the face of evolving challenges.

This article is part of a series supported by HIVOS’s Free To Be Me program, advocating for inclusivity and empowerment across diverse communities.