In Malawi, the fight to get HIV services back on track post-USAID cuts

For years, Malawi has been at the forefront of HIV prevention efforts in sub-Saharan Africa, including spearheading the introduction of a new long-acting injectable method last year. That coincided with a drop in new HIV infections from an estimated 19,000 in 2020 to an estimated 11,800 in 2024.

But this progress is under threat after the Trump administration eliminated U.S. support for most HIV-prevention services globally. That hit hard in Malawi, where donors fund around 85% of the country’s HIV response. The money comes primarily from the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to which the U.S. has been the largest donor.

Officials are now struggling to preserve both traditional methods, such as condom distribution, without squandering the new — and still expensive — innovations in long-acting injectable preexposure prophylaxis, or PrEP.