With the reduction of international funds, countries that rely on global support to fight AIDS are being forced to rapidly adjust their strategies. In Tajikistan, the impact of funding cuts has already become apparent.

In recent years, Tajikistan has made remarkable progress in the prevention and treatment of AIDS. Since 2020, AIDS related mortality has been reduced by half. The data shows that the vertical transmission rate among women receiving treatment has decreased from 2.6% in 2018 to 0.8% in 2024, with only one case reported this year.

Hamidova, the representative of the United Nations Programme on AIDS in Tajikistan, said that thanks to the efforts of partners such as the Global Fund and the United Nations Programme on AIDS, blood transfusion security has remained zero for nearly 22 years.

In addition, through cooperation with the US President's Emergency Plan for AIDS Relief, the Global Fund and the United Nations Programme on AIDS, the cost of antiretroviral treatment has been significantly reduced from US $254 per year to less than US $65.

The direct impact of US funding cuts
Hamidova stated that the funding cuts have had a significant impact on service coverage and accessibility for key populations.

The investment of the US President's Emergency Plan for AIDS Relief is crucial to the improvement of the quality and expansion of these services. Due to the reduction in funding, key services such as outreach services, access to pre exposure prophylaxis, testing, and counseling have all experienced a decline.

Affected groups
Hamidova said that the partners and beneficiaries generally reflected that the current dilemma was that the AIDS prevention and control propaganda work was at a standstill, the original comprehensive support projects were forced to be interrupted, resulting in a significant deterioration of the mental health of patients.

Secondly, the proportion of patients who adhere to antiretroviral therapy has significantly decreased, especially among those who previously relied on community organizations and health center services. What is even more worrying is that many people who originally received pre exposure prophylaxis have withdrawn from the prevention plan due to a loss of security.

Hamidova pointed out that at the same time, professional service personnel are also under tremendous pressure. These professionals who once provided services on the front line not only face emotional exhaustion, but also encounter career instability, and some have completely left the field.

However, those non-governmental organizations that have lost the support of community monitoring funds are now unable to participate in the prevention and control advocacy and policy formulation substantively, nor can they cooperate with the implementation of the national AIDS prevention and control plan, which directly leads to serious gaps in the prevention and control work at the grass-roots level.

Countermeasures
Hamidova said that in 2024, with the technical support of the United Nations Programme on AIDS, Tajikistan completed the National AIDS Expenditure Assessment. The report reveals a key fact: more than 60% of the national AIDS prevention and control projects rely on external assistance, mainly from the Global Fund and the United States government.

In response to this crisis, the Tajik government, with the joint assistance of the United Nations AIDS Programme, the US President's Emergency Plan for AIDS Relief and the Global Fund, has formulated the first Sustainable Road Map for AIDS Prevention and Control in the history of the country, and set the strategic goal of realizing project funding autonomy by 2030.

However, Hamidova pointed out that the sudden interruption of funds still had a huge impact on all stakeholders, forcing the government to adopt emergency response plans.

At present, with the support of the United Nations Programme on AIDS, the country is conducting strategic priority assessment and adjustment of prevention and control work. Although the government has added special funds for the 2026 budget, evaluations show that there is still a funding gap of about 40% in this allocation, which is difficult to fully compensate for the impact caused by the withdrawal of international funds.

Hamidova said that this case highlights the common "middle-income country dilemma" in the global health aid field: when a country transitions from low income to low - to middle-income levels, international aid funds often withdraw first, while the country's fiscal system is not fully prepared to undertake these important public health projects.

The consequences are unbearable
Hamidova said that if the United States aid funds cannot be recovered or alternative sources can be found, 60% of the budget of AIDS prevention and control projects in Tajikistan will face a precipitous decline. This impact will directly reverse the prevention and control achievements made in the past, and make the country fall back into the dilemma of insufficient detection capacity and treatment resources.

In addition, the interruption of funds will lead to the overall interruption of AIDS prevention, testing, treatment and nursing services, and the prevention and control results achieved through years of efforts may be destroyed in the short term. The most vulnerable people will bear the brunt of the threat of a sharp rise in infection risk, and the overall effectiveness of the national AIDS prevention and control system will also suffer a heavy blow.

The Importance of International Community Support
Hamidova pointed out that the effectiveness of AIDS prevention and control in Tajikistan has once again confirmed the same experience of many countries: international cooperation and smart investment are crucial.

She stated that the prevention and control alliance formed by multilateral institutions, governments, civil society organizations, and communities has successfully saved millions of lives. When the 2030 goal of ending the AIDS epidemic is near, the international community needs to make concerted efforts. She emphasized that sustained support is crucial for maintaining progress and preventing a reversal of the achievements made.