US Aid cuts are undermining Senegal’s fight against HIV

Clinics with limited capacity to absorb these shortfalls are now operating at risk of becoming sites of failure rather than care.

And without these local ‘nodes’ of care, patients are less likely to stay on their medication, less likely to receive psychological support, and more exposed to stigma.

That matters more than ever in regions where stigma remains high. According to Senegal’s 2024 Stigma Index 2.0, nearly one in five people with HIV report stigma tied to their status. In that context, community-based, trust-building interventions aren’t optional extras — they are part of what holds the whole system together.

What makes the situation so bitter is that Senegal has itself taken strides towards reforming its health policies – raising targets, extending domestic budgets, and promising change.

Speaking to The Guardian, Amy Mbaye, a midwife in charge of a Senegalese health post, said ‘the women here are warriors,’ with many of them having up to nine or 10 pregnancies. As abortions are illegal in Senegal, unsafe backstreet terminations are rife, and the importance of adequate contraceptive care can’t be understated.

‘Everything is linked to the sea’ says Mbaye, referring not only to the imports of medical aid from major donors like the US, but the reliance of local communities on fishing.

‘Too often you will call a woman to come for a checkup and she will say ‘there’s nothing come out from the sea so we don’t have enough, I can’t come.’

For HIV in particular, the cuts seem to bite hardest where success had once been won. Why? Because prevention and adherence programmes are often the more fragile parts of any public-health gain.

Treatment can be scaled in clinical settings, but maintaining the human infrastructure around it – counselors, community-led reminders, home-visits, education group meetings – is what stops progress becoming hollow gains.

As reproductive-health services falter, so do prevention-efforts for sexually-transmitted infections. When women lose access to contraception, or waiting-times increase, their engagement with health-care settings recedes. That can reduce screening, reduce contact with HIV education or testing campaigns, and ultimately increase vulnerability.

Meanwhile civil-society organisations warn that the risk is not just to prevention or treatment metrics, but to trust. When medical organisations are unable to provide adequate care, the relationship between citizens and the health-system is eroded.

Rebuilding that trust will cost far more than the money saved by cutting aid.

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