Funding Cuts Threaten Malawi's HIV Response

Funding cuts have severely impacted HIV prevention services in Malawi, leading to a significant decline in HIV testing and disruptions in the delivery of essential services. According to UNAIDS country director David Chipanta, HIV testing has declined by 15-16%, while some prevention interventions have stopped due to inadequate funding for community-level service delivery. This has exposed the vulnerability of Malawi's HIV response, which relies heavily on external financing.

The disruptions have affected various aspects of HIV prevention and treatment services. Stocks of pre-exposure prophylaxis (PrEP) tablets remain undelivered due to a shortage of community workers. Additionally, voluntary medical male circumcision services have been suspended, further exacerbating the situation. Chipanta warned that continued disruptions could reverse gains made in the national HIV response, emphasizing that health facilities alone cannot effectively reach people who default on treatment or mobilize communities to access available services.

A national dialogue involving government, civil society organizations (CSOs), development partners, and other stakeholders has been convened to explore ways of financing community healthcare services through domestic resources. The dialogue aims to address the funding crisis and find sustainable solutions to support community-led interventions. Stakeholders are pushing for a social contracting framework that will allow the government to use domestic public funds to formally engage and finance NGOs and community-based organizations to deliver essential health interventions.

The proposed social contracting framework could build on Malawi's experience with healthcare service agreements involving the Christian Health Association of Malawi (Cham). This framework would enable the government to channel public resources through grants and sub-grants to NGOs and community-based organizations delivering essential healthcare services. Civil Society Advocacy Forum vice-chairperson Simon Sikwese emphasized that community-led organizations reach populations that conventional public health systems often struggle to serve, including key populations, young people, girls, and marginalized communities.

However, the National Aids Commission (NAC) acting chief executive officer Tione Chilambe noted that the biggest obstacle to implementing the proposed framework is the limited availability of public resources amid competing national priorities. Chilambe challenged CSOs to diversify their funding sources by engaging the private sector, arguing that businesses have an interest in supporting healthy communities and a productive workforce.

Malawi's HIV response has long relied heavily on external financing, which accounted for 78% of the national response in 2022. The United States Government contributed about 60% of the HIV budget. However, the withdrawal and suspension of US support since January 2025, alongside an 8% reduction in the Global Fund grant, have intensified pressure on community-led interventions.

The funding crisis has significant implications for Malawi's ability to combat HIV. Key stakeholders, including UNAIDS and CSOs, are working together to find sustainable solutions to support community-led interventions. The outcome of the national dialogue and the implementation of the proposed social contracting framework will be crucial in determining the future of Malawi's HIV response.

Key points

• A 16% decline in HIV testing has been reported in Malawi due to funding cuts.
• The proposed social contracting framework aims to enable the government to use domestic public funds to finance NGOs and community-based organizations delivering essential health interventions.
• Malawi's HIV response relies heavily on external financing, which accounted for 78% of the national response in 2022.