UCSF

Introduction: In January 2025, the United States government froze most foreign assistance and issued a 90-day stop-work order affecting many global health, education, and nutrition programs. Methods: Using a qualitative case study approach, we examined perceptions about experiences around how this abrupt funding disruption affected HIV care in one county in Kenya through in-depth interviews with women and men living with HIV and with healthcare providers. Results: Participants described immediate and severe antiretroviral therapy (ART) rationing and broader, cascading effects across the HIV care continuum, including missed visits, interrupted monitoring, and heightened anxiety about treatment continuity. Respondents also reported that rapid integration of HIV and primary care services-implemented amid the funding shock-undermined confidentiality in clinical settings, intensifying stigma concerns and discouraging care seeking among people living with HIV. Discussion: These findings highlight how sudden financing shocks can destabilize HIV programs in ways that extend beyond medication supply. We translate qualitative evidence into actionable recommendations to support person-centered HIV services during periods of uncertainty, including safeguarding continuous access to affordable/free ART, reducing access barriers such as transportation costs, and strengthening confidentiality protections as HIV and primary care services integrate. Systematic review registration: https://www.who.int/publications/i/item/9789241549684.