Ahead of AIDS 2026 and as part of the Rethink. Rebuild. Rise. campaign, VirusOFF continues its series on what HIV prevention looks like today in Central and Eastern Europe and Central Asia — not as a polished phrase in strategies, but as daily work: counselling, pathways, trust, supplies, outreach, community support and a person’s real ability to reach a service.
This time, we look at what happens when funding is cut.
HIV prevention does not disappear in one day. It is often dismantled piece by piece. First, there is less outreach. Then counselling hours are reduced. Then supplies disappear. Then there are not enough people to respond to messages, accompany someone to a doctor, explain a pathway or simply say: “You are not alone, let’s figure this out.” And for some time, reports may still make the system look functional — because a clinic formally exists, testing is available somewhere, PrEP is included in a protocol and treatment is being procured.
But for the person, access has already broken.
In June 2026, UNAIDS warned that external funding cuts, a rollback on human rights and chronic underfunding of prevention and community-led services could reverse years of progress in the HIV response. According to UNAIDS, global development assistance fell by 23% in 2025 — the largest decline ever recorded. In high-burden countries, HIV testing programmes declined by 22% between 2024 and 2025; condom funding in some cases fell by more than 90%; and PrEP coverage in 62 countries reporting to UNAIDS fell by 38% between 2024 and 2025.
These figures matter not only as a global alarm. They show very clearly what most often “falls” first: not slogans, strategies or big words about ending AIDS, but the everyday prevention infrastructure — testing, condoms, PrEP, outreach, community-led work, accompaniment and trust.
For Central and Eastern Europe and Central Asia, this is especially acute. According to the UNAIDS 2025 regional profile, around 2.1 million people were living with HIV in Eastern Europe and Central Asia in 2024; there were approximately 130,000 new HIV cases; and only 51% of people living with HIV were receiving treatment. The same profile notes that most countries in the region fund antiretroviral medicines from domestic resources, while prevention services, community outreach and human rights-based approaches remain highly dependent on external donors, including the Global Fund and the Government of the United States.
And this is the key point: when funding is cut, the first elements to suffer are often those that may formally seem “additional”, but in practice are the entry point into the system.
Tool ≠ access
In HIV prevention, it is important to distinguish between two things: a tool and access.
A tool can be a test, PrEP, PEP, condoms, lubricants, sterile injecting equipment, naloxone, opioid agonist therapy, antiretroviral treatment, viral load monitoring, U=U, counselling or referral.
Access means that a person can actually use that tool.
They can reach the service.
They can ask a question without judgement.
They can speak a language they understand.
They do not have to fear the police, a doctor, an employer, a partner, migration authorities or their own community.
They can get support outside the capital.
They can come not only between 09:00 and 17:00 on a weekday.
They can seek help without a “perfect” set of documents.
They can receive not just an address, but accompaniment if the system is complex or frightening.
When funding is cut, the tool sometimes remains on paper. Access disappears first.
A medicine may exist in the country — but a person may not know where to get it.
Testing may be free — but the site may work at an inconvenient time or be far away.
Condoms may be procured — but they are no longer distributed through outreach.
A service may exist — but there is no longer a counsellor who can explain the pathway.
An organization may formally keep operating — but without money for people, transport, supplies, translation, communication and a safe space, it loses its reach.
This is not a technical detail. It is the difference between “a service exists” and “a person received support”.
Funding cuts rarely look like one large sign saying “prevention is closed”. More often, they are dozens of small losses that become visible only when people stop reaching services.
1. Outreach
The first thing often cut is what is “invisible” to office-based logic: reaching people where they are, being present in communities, working in chats, on platforms, in meeting places, in small towns and in environments where people will not come to a clinic on their own.
Outreach is not leaflet distribution. It is trust in motion. It is when a service goes to where people are, instead of waiting for people to move through fear, shame, stigma, transport, queues and a confusing system by themselves.
When outreach disappears, the first people to disappear from view are those who were already the least visible: people without documents, people in migration, people who use drugs, people engaged in sex work, LGBTIQ+ people, young people, women who have experienced violence, people in small towns and people who do not trust state institutions.
2. Navigation and accompaniment
Navigation is often the next thing to be “optimized”. A website remains, a phone number remains, a list of addresses remains. But the person who can explain where exactly to go, what to say, which documents are needed, what to do if someone is refused, where it may be safer, where there is a doctor who will not judge, and where confidential counselling is available — disappears.
For the system, this may look like a small detail. For a person, it is the difference between “I will try” and “I will not go”.
This is especially true in Central and Eastern Europe and Central Asia, where stigma, criminalization, aggressive law enforcement and discrimination continue to prevent people from seeking HIV-related and other health services. UNAIDS notes that all 16 countries in the region criminalize sex work; 13 countries criminalize HIV non-disclosure, exposure or transmission; and seven countries criminalize possession of small amounts of drugs for personal use.
In this context, navigation is not “additional support”. It is protection of access.
3. Low-threshold services
When there is less money, systems often try to preserve “the essentials”. But what may seem secondary to a policymaker can be the only entry point for a person.
A low-threshold service is a place where a person can come without fear and without having to present a perfect life story. A place where the conversation does not start with moral judgement. Where people are not asked, “Why didn’t you come earlier?” Where a person can receive a test, counselling, referral, condoms, lubricants, sterile supplies, information about PrEP or PEP, peer support, a doctor’s contact, support after violence or simply the first safe conversation.
When such services weaken, people do not automatically move into the state system. Often, they simply disappear from the radar.
4. Materials and supplies
In prevention, there are things that are easy to underestimate while they are available: rapid tests, condoms, lubricants, sterile injecting equipment, safe disposal containers, naloxone, information materials, mobile communication, fuel or transport tickets for outreach teams.
When these are cut, prevention loses its concreteness. A counsellor may say all the right words, but without a test, without materials, without a referral and without the possibility to help now, trust is quickly exhausted.
5. Access outside large cities
In a crisis, services often shrink back to capitals and large cities. This may look like “concentration of resources”, but in practice it means that people in small towns, villages, border areas or frontline regions face a longer pathway, higher costs, greater risks and fewer chances of receiving help in time.
In Central and Eastern Europe and Central Asia, this is especially important because of war, migration, labour mobility, inequalities between capitals and regions, and because community-led organizations are often the only structures that truly know where people are and how to speak with them.
Why this affects trust
In HIV prevention, trust is not a “soft indicator”. It is infrastructure.
A person does not seek testing, PrEP, PEP, harm reduction or treatment simply because a service exists. They seek support when they believe they will not be humiliated, that their status will not be disclosed, their data will not be shared, and they will not be judged for their sexuality, work, drug use, migration status or life situation.
Funding cuts undermine trust in very practical ways.
When a counsellor disappears, a person loses a familiar contact.
When a service reduces its opening hours, a person may not come back a second time.
When there are no supplies, a person feels that “there is nothing here anymore”.
When an organization cannot respond quickly, crisis situations are left without accompaniment.
When staff burn out or leave, community memory, informal pathways and years of built trust leave with them.
UNAIDS states directly that when community-led organizations lose funding, the entire HIV response loses reach, trust and effectiveness. In a community-led survey of 79 organizations in 47 countries, there was a 50% decline in support services for people living with HIV, an 82% decline in services for people engaged in sex work and an 85% decline in services for gay men and other men who have sex with men.
This is the real cost of “optimization”.
Community-led organizations are not decoration for the system
When funding is stable, community-led organizations are often called “partners”. When a crisis begins, their work may be the first to be described as “flexible”, “temporary” or “less critical”.
That is a mistake.
Community-led organizations do what formal systems often cannot do alone:
they speak the language of communities;
they know real pathways, not only official ones;
they see people who are invisible in statistics;
they work with distrust, fear and self-stigma;
they explain complex things in plain language;
they accompany people between services;
they notice where the system humiliates or loses people;
they raise issues of rights, safety and discrimination.
UNAIDS has emphasized that community-led organizations are the backbone of the HIV response in many countries because they provide access to HIV services for communities most affected by HIV, advocate for human rights and monitor the HIV response. At the same time, data from community-led organizations showed mass closures of peer-led services, major or complete budget cuts, loss of staff, and increasing stigma and discrimination.
If the community-led link is removed or exhausted, prevention may remain in protocols — but lose the pathway to the person.
When there is less money, it is very easy to start thinking in spreadsheets: what to keep, what to merge, what to optimize, what to move online, what to “temporarily pause”. But HIV prevention is not sustained by spreadsheets alone. It is sustained by the pathway to a person.
If that pathway is cut — if outreach, navigation, low-threshold access, supplies, trust, community-led work and access outside large cities are removed — the tools may remain, but people will not reach them.
This must be the main lesson of the funding crisis.
Prevention under pressure does not mean giving up ambition. On the contrary: now is the time to say more clearly what cannot be treated as secondary.
Peer counsellors are not secondary.
Outreach is not secondary.
Supplies are not secondary.
Confidentiality is not secondary.
Post-test support is not secondary.
Community-led organizations are not secondary.
People whom the system already sees last are not secondary.
HIV prevention is not only about the existence of tools.
It is about whether those tools reach people.
And when funding is cut, the first thing to protect is this pathway.
