In early 2025, the global HIV response was thrown into crisis as abrupt funding cuts from major international donors led to clinic closures, layoffs of health workers, and the collapse of community programmes that had supported millions for decades. For people living with HIV, these cuts translated into missed appointments, treatment interruptions, medication stockouts, and growing fear of being abandoned by already overstretched health systems. What appeared as a policy shift at the global level became an immediate and deeply personal emergency at the community level.
As countries turned to integrating HIV services into primary healthcare as a sustainability strategy, serious questions emerged about what integration truly means in the absence of funding, trained personnel, and community-led infrastructure. Case studies from Nigeria, Kenya, Indonesia, Ghana, Zimbabwe, and Eswatini show that while integration can improve access, reduce stigma, and support holistic care, it is often being implemented without the community workers, peer supporters, and outreach systems that historically made HIV services effective and trusted. The removal of mentor mothers, adherence counselors, and community-led monitoring has weakened prevention of mother-to-child transmission, reduced follow-up, and eroded accountability.
Across countries, people living with HIV report mixed experiences. Integrated services can reduce the visibility of HIV-specific clinics and allow clients to access multiple services in one visit, but they also risk increasing stigma when health workers lack adequate training or when continuity of care is lost due to staff rotation. Fear of disclosure, breaches of confidentiality, and discriminatory treatment continue to drive people away from nearby facilities, forcing them to travel long distances or disengage from care altogether. These risks are especially acute for newly diagnosed individuals, people with advanced HIV disease, and key populations who previously relied on specialized, community-based safe spaces.
Resource constraints remain a defining barrier to successful integration. Health facilities are often understaffed, under-equipped, and unable to absorb additional responsibilities such as counseling, mental health screening, and long-term HIV management. Ongoing stockouts of antiretroviral medicines, diagnostics, and laboratory supplies reflect broader failures in domestic financing and unmet co-financing commitments. While some countries are exploring health insurance schemes, earmarked taxes, and domestic resource mobilization to reduce donor dependence, progress remains uneven and fragile.
The experiences documented across these six countries highlight a consistent message from PLHIV networks: integration must strengthen, not replace, what has worked in the HIV response. Policies and frameworks exist, but implementation lags due to gaps in financing, capacity, training, and genuine community engagement. Integration will only succeed if governments protect privacy and dignity, invest in community cadres, ensure accountability through data and monitoring, and meaningfully involve people living with HIV in decision-making. The future of integrated HIV services depends not on policy ambition alone, but on political will, sustained resources, and community leadership at every level.
