The health clinic where Alice Okwirry collects her HIV medication in Kenya’s capital Nairobi has been rationing supplies of antiretrovirals to one-month refills since the US government froze foreign aid.
Source: Reuters.
On the outskirts of the city, meanwhile, millions of life-saving doses sit on the shelves of a warehouse, unused and unreachable.
The clinic is a half hour’s drive from the warehouse, but for Okwirry, they may as well be an ocean apart.
Without US funding, distribution from the warehouse, which stocks all US government-donated HIV medicine to Kenya, has ceased, leaving supplies of some drugs worryingly low, according to a former USAID official and a health official in Kenya.
The 90-day foreign aid freeze, ordered by US President Donald Trump after taking office on Thursday, 20 January 2025, has upended the global supply chain for medical products to fight HIV and other diseases. It is also blocking the distribution of drugs that long ago reached their destination countries.
“I was just seeing death now coming,” said 50-year-old Okwirry who was diagnosed with HIV in 2008 and has a 15-year-old daughter, Chichi, who is also HIV-positive.
Okwirry used to receive six-month supplies of ARVs from the clinic but now can only get one month’s supply.
“I told Chichi: what about if you hear the drugs are doomed?” Okwirry said, growing emotional. “She told me: Mom, I’ll be leaning on you.”
The State Department issued a waiver last month exempting funding for HIV treatment from the freeze.
But the USAID payments system in Kenya is down after the cuts, meaning contractors who implement the programmes cannot be paid, said Mackenzie Knowles-Coursin, who was the deputy head of communications for USAID, East Africa, until resigning on Monday, 3 February 2025 in protest at the dismantling of the agency.
“Projects are left wondering: ‘Well, how am I going to resume activities if you’re not paying me money?” he said. “The waivers that have been given are really waivers on paper.”
In Kenya, officials in Washington have not authorised the release of money required to distribute the $34m worth of medicine and equipment at the warehouse, he added.
According to a Kenyan government document seen by Reuters, about $10m is needed for that distribution. The Mission for Essential Drugs and Supplies, the Christian charity that runs the warehouse, supplies drugs to some 2,000 clinics nationwide, its website says.
Knowles-Coursin noted the commodities at the warehouse include 2.5 million bottles of ARVs, 750,000 HIV test kits and 500,000 malaria treatments.
USAID referred a request for comment to the State Department, which did not respond. The Mission for Essential Drugs and Supplies did not respond to requests for comment.
Kenya’s Health Minister, Deborah Barasa, said she expected her government to mobilise funds to allow the supplies at Mission for Essential Drugs and Supplies (Meds) to be released within two to four weeks.
“We have identified the resources that are required,” she said in an interview.
Fear and anxiety
Kenya has the seventh-largest number of people living with HIV in the world, at around 1.4 million, according to World Health Organization data. The President’s Emergency Plan for Aids Relief, the main US vehicle for funding HIV treatment, supplies some 40% of Kenya’s HIV drugs and supplies.
A health official in Kenya, who asked not to be named because of the sensitivity of the matter, said stocks of two critical HIV treatments, Dolutegravir and Nevirapine, were low but he did not know exactly how much remained nationwide.
Dolutegravir is often used to treat coinfections of HIV and tuberculosis. Nevirapine is often used to prevent mother-to-child transmission.
Barasa, the health minister, said there would be enough Dolutegravir to last five months and Nevirapine to last eight months once the Meds stocks were released.
For the time being, some patients can only get refills of their ARVS for one week at a time, said Nelson Otwoma, director of the National Empowerment Network of People Living with HIV/Aids in Kenya.
Lawsuits aiming to compel the Trump administration to restore funding for humanitarian programmes and reinstate thousands of fired or furloughed USAID workers are working their way through US courts.
On Monday, 10 March 2023 Secretary of State Marco Rubio said the Trump administration has cancelled more than 80% of all USAID programmes.
The Kenyan government’s council on syndemic diseases estimated in an internal brief last month, that the US cuts had created funding gaps of around $80m.
Finance Minister, John Mbadi told senators last week that the government was reviewing whether to allocate emergency funding to compensate for US aid cuts before it delivers the 2025/26 budget in the coming months.
