As international funding for HIV declines, countries that rely on global support to fight HIV are being forced to adapt quickly. In Tajikistan, the effects of these changes are already being felt. If U.S. funding is not restored or replaced, Tajikistan will lose about 60 percent of its HIV program funding.
In an interview, UNAIDS Country Director for Tajikistan Aziza Khamidova discusses the country’s achievements in recent years, the immediate impact of the U.S. funding cuts, and what is at stake for the most vulnerable populations.
How would you describe the progress Tajikistan has made in fighting HIV before the recent U.S. funding cuts?
Tajikistan has made significant progress in fighting HIV in recent years. Since 2020, HIV-related deaths have halved. Programmatic data on vertical transmission rates among women receiving care show that rates have declined from 2.6% in 2018 to just 0.8% in 2024, with only one case reported this year. Blood transfusion safety has remained impeccable for almost 22 years, thanks to the efforts of the Global Fund, UNAIDS and other partners. The cost of antiretroviral therapy has also been significantly reduced – from US$254 to less than US$65 per year – through partnerships with PEPFAR, the Global Fund and UNAIDS. Antiretroviral therapy is now available to all people living with HIV in the country. Outreach programmes, particularly for key populations such as people who inject drugs, men who have sex with men, sex workers, youth and women living with HIV, have ensured good treatment and testing coverage. Pre-exposure prophylaxis (PrEP, a medication to prevent HIV) was also available and promoted through civil society organizations. Importantly, community-based monitoring became an important, institutionalized part of the national HIV program.
What was the immediate impact of the US funding cuts on the HIV response in Tajikistan?
While the provision of basic HIV services, including testing and treatment in public health facilities, was not significantly impacted—mainly due to support from the Global Fund—there was a notable reduction in outreach and access to services for key populations. PEPFAR investments were critical to improving the quality and reach of these services. As a result of the funding cuts, coverage, access to PrEP, testing, and counseling decreased. Two highly popular community health centers, known for providing stigma-free services, were closed, and community services for key populations that these centers served were completely discontinued. Community monitoring, an important mechanism for ensuring the impact and accountability of the program, has also been discontinued.
What are you hearing from communities directly affected by these closures and service cuts?
Our partners and beneficiaries report the cessation of outreach, interruption of comprehensive support programs, and deterioration in mental health. We are seeing a decline in adherence to antiretroviral therapy, especially among clients who previously relied on community organizations or health centers. Many people taking PrEP no longer feel safe or supported and have left the program.
In addition, qualified professionals who provided these services have faced burnout and job instability, and some have left the sector altogether. Community organizations that have lost funding for community monitoring are now unable to meaningfully participate in advocacy and policy development or the implementation of the national HIV program.
Although PEPFAR funding for community health centers and outreach activities was temporarily restored in late April, we are still seeing a decline in testing and client engagement, as well as the loss of a number of clients to follow-up.
How have the government and partners responded to the funding cuts, and what is UNAIDS doing to support them?
Tajikistan never planned to remain dependent on external support forever.
In 2024, with the support of UNAIDS, the country conducted a national AIDS spending assessment that found that over 60% of the national HIV program was funded externally, mainly by the Global Fund and the US government. In response, the government, with the support of UNAIDS, PEPFAR, and the Global Fund, developed its first HIV Sustainability Roadmap, aimed at ensuring the sustainability of the national program by 2030. The sudden cessation of funding came as a shock to all stakeholders, prompting the government to take extraordinary measures. A strategic prioritization exercise is currently underway with the support of UNAIDS, and while additional funding has been allocated from the state budget for 2026, it is still insufficient. Additional external resources are still needed, especially for key populations.
What will happen if U.S. funding is not restored or replaced?
If U.S. funding is not restored or replaced, Tajikistan will lose about 60% of its HIV program funding. This will jeopardize the progress we have all worked so hard to achieve and could return the country to a time when access to testing and treatment was limited. There will be disruptions to prevention, testing, treatment, and care, and the gains made over years of hard work could quickly be reversed. The most vulnerable populations will be at greatest risk, and the overall effectiveness of the national HIV response will be seriously compromised.
What message do you want to send to the international community?
Tajikistan’s HIV response, like so many other countries, is a testament to the power of global solidarity and smart investments. The collective actions of donors, governments, organizations, communities, and civil society have saved millions of lives. Now that we are so close to achieving the 2030 goal of ending AIDS, this solidarity must not weaken. Continued support is essential to sustain the progress made and prevent the loss of gains.