Immediate risks and disruptions

1. Loss of PEPFAR support:
   • The community outreach programme is on hold while clinical services continue in the 22 clinics supported by PEPFAR (out of 880 clinics nationally providing ART) across the 4 provinces out of 21 in Angola.
   • Across the country, facilities/service points delivering antiretroviral treatment are working with the same capacity. While stocks of antiretroviral supplies, HIV, viral load and other lab test kits are available, recent reports indicate challenges with distribution.
   • Logistics disruptions have led to facility-level stockouts of HIV commodities, despite stock being available in regional warehouses.
   • The purchase of condoms by INLS and partners, including PEPFAR and the Global Fund, has historically covered only half of the estimated need due to resource limitations. A national condom strategy is currently under development.
   • PEPFAR distributed condoms in the 22 clinics they support and via outreach programmes, which are now on hold.
   • There has been a disruption in the PEPFAR data collection system. Data for Q4 (September-December 2024) is still being collected and analyzed due to a lack of human resources to support DHIS2 (health logistics data) reporting. Eighteen PEPFAR-supported sites are included in the Estimation and Projection Package Spectrum model for calculating HIV incidence; however, PEPFAR antenatal care testing data was not available to serve as a benchmark against the reports submitted in DHIS2.
   • Angola received PEPFAR funding for work on community-led monitoring. This has been terminated.
   • PEPFAR support for stigma, discrimination and enabling legal environments has stopped.
2. Government mitigation measures:
   • The Government has planned mitigation measures for each of the PEPFAR programme components. The plan indicates that the national budget is suggested to cover testing, treatment and laboratory consumables, while it is suggested that community programmes should be supported by public and private institutions.

Documented impact on services

A rapid assessment of the impact of the US funding cuts on service delivery is available. As outlined by the Institute for the Fight Against HIV/AIDS (INLS), the greatest impact of the loss of US support in Angola will be felt in the quality of services, as indicated below: 

1. Peer education for adolescents and youth:
   • In 2024, PEPFAR supported training and mentoring for 467 health professionals creating mutual support groups and peer-to-peer programmes for adolescents and youth.
2. Prevention of vertical transmission of HIV:
   • As of September 2024, 1,163 pregnant women living with HIV were enrolled in a programme to prevent vertical transmission of HIV in 22 health units supported by PEPFAR.
   • Community support programmes for treatment, adherence and psychosocial support are on hold.
3. Early infant diagnosis:
   • In addition to support for early infant diagnosis in the 22 health units covered by PEPFAR, the community component of PEPFAR supported a pilot to collect blood samples in the community, which led to an increase in early infant diagnosis from 36% to 88% in health units supported by PEPFAR. The loss of community outreach undermines these lifesaving efforts.
4. Clinical management for people living with HIV:
   • PEPFAR supports about 6% of HIV tests in the country.
   • As of September 2024, 3,609 people were newly identified as HIV-positive, with 84% enrolled on antiretroviral treatment (ART). Without US funding, lower case identification will occur, increasing the risk of transmission and health complications.
   • By 2024, a total of 26,999 people living with HIV were on treatment at PEPFAR supported sites, representing about 16% of people on ART across the country
   • In addition, active community outreach ensured that out of 1,007 people who interrupted treatment in the third trimester of 2024, 707 (70%) were successfully re-enrolled in treatment;
   • Only in places where there is support from PEPFAR or the Global Fund (Benguela, Bié, Cuanza Sul, Huambo and Lunda Sul), is systematic community engagement effectively implemented (focused on pregnant women, children and high-risk young people); the backing of  mutual support groups of people living with HIV; the provision of psychosocial support for enhanced adherence to HIV treatment, information, education and active communication on HIV prevention, including the distribution of condoms and community based testing and linkage to services.
5. Strengthening the health system:
   • PEPFAR has facilitated training and capacity building for HIV health workers, improving local health systems.
   • Support for data collection and monitoring has reinforced health systems and enabled data-driven decision-making.
   • PEPFAR is the only program that supports the evaluation of the quality of diagnosis, increasing the accuracy, effectiveness and quality of HIV testing services in the country.

Politically relevant updates

1. Government convening and mitigation measures:
   • The National Institute for the Fight Against AIDS (INLS) has developed a mitigation plan, proposing the national budget cover clinical staff and medical inputs for users of 13 health units supported by PEPFAR.
   • Resource mobilization from public and private institutions is identified to cover community engagement and programmes.
   • INLS is coordinating the mitigation measures with the Ministry of Health and the CCM.
2. Civil society impact:
   • Community Led Monitoring programmes have been terminated.
   • Community outreach programmes, including those for youth, pregnant women, and people living with HIV, are on hold.
   • Civil society organizations are struggling, and while some have alternative funding sources, most organizations are unable to continue their planned work.
3. UN response:
   • UNAIDS has met with networks of people living with HIV and key populations to assess emerging challenges and discuss mitigation measures.
   • In collaboration with Government and civil society, plans to develop national approaches to PEPFAR-supported community-led models are underway.