"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."
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."
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.
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.”
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.
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.”
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.
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.
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.
(Citizen News Service)
5 August 2026
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