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Article

The Cost of Cutbacks: How Reduction in Development Assistance for Health May Affect Progress Made in HIV/AIDS Control in Africa

by
Richmond Nketia
1,2,*,
Daniel Atta-Nyarko
2,3,
Ebenezer Gyamfi
2,4,
Rostand Dimitri Messanga Bessala
1,5,
Naomi Adotei
2,6,
Benjamin Asare-Kyei
2,7,
Faustina Ameyaa Marfo
1,8,
Prosper Tonwisi Luri
2,9,
Charles Limula
1,10,
Abubakr Ahmed Farhan
1,11,
Michele Castelli
12 and
Austin Gideon Adobasom-Anane
2,13
1
Department of Research and Data Analytics, Sub-Saharan Africa Research for Sustainable Development (SSARSD) Project, Berekum BB-0663-3578, Ghana
2
Department of Global Health Policy and Development, Sub-Saharan Africa Research for Sustainable Development (SSARSD) Project, Berekum BB-0663-3578, Ghana
3
Allied Health Professions Council (AHPC), Ministry of Health, Accra GA-221-9798, Ghana
4
Department of Medicine, Methodist Hospital, Wenchi BW-0017-7604, Ghana
5
Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde P.O. Box 3077, Cameroon
6
Department of Paediatrics, St. Luke Hospital, Kasei AJ-1798-9833, Ghana
7
Administrative Unit, College of Health Yamfo, Yamfo B2-2129-4216, Ghana
8
Department of Health Sciences, Faculty of Sport, Technology and Health Sciences, St. Mary’s University, Twickenham TW1 4SX, UK
9
Department of Surgery, Salaga Municipal Hospital, Salaga N4-00012-2664, Ghana
10
Skerne Medical Group (NHS), Harbinson House, Front St, Sedgefield TS21 3BN, UK
11
Department of Clinical Care, Savannah Regional Health Directorate, Damango SW-00000-1451, Ghana
12
Department of Statistics and Quantitative Methods, University of Milano Bicocca, 20133 Milan, Italy
13
Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi AK-312-1059, Ghana
 
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Venereology 2025, 4(2), 8; https://doi.org/10.3390/venereology4020008
Submission received: 10 April 2025 / Revised: 15 May 2025 / Accepted: 22 May 2025 / Published: 29 May 2025
(This article belongs to the Special Issue Toward Eliminating Sexually Transmitted Infections: Monitoring, Evaluating Global Progress, Equity and Sustainability)
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Abstract

Background/Objectives: The recent Executive Order suspending the United States Agency for International Development (USAID) programmes, including Development Assistance for Health (DAH), has sparked serious debates about the sustainability of ongoing HIV/AIDS control programmes, particularly in Africa. In this study, we examined HIV/AIDS-specific DAH allocation to Africa from 1990 to 2022, and the potential effects of funding cutbacks on disease outcomes. Methods: We nested 54 countries within five sub-regions of Africa and applied linear mixed-effects models to estimate the effects of DAH on HIV/AIDS incidence and mortality rates, accounting for clustering by sub-region and potential variability due to baseline incidence and mortality and other sources of heterogeneity. Results: Total DAH allocated to Africa increased from US$534,343 in 1990 to US$5,273,264 in 2022. The United States (U.S.) public sector contributed nearly two-thirds (US$58,399,088; 63.01%) of the total funding. Most of these funds were disbursed to Southern and Eastern Sub-Saharan Africa (SSA), particularly countries with the highest HIV/AIDS burdens, including South Africa and Kenya. The fixed effects results and predicted margins indicate that, in addition to having a direct effect, U.S. public sector-specific DAH moderates the effectiveness of other international donor funding and domestic general government health spending (GHES) on HIV/AIDS incidence and mortality. Conclusions: Based on the historical trends and funding interactions, the cutback in U.S. DAH could be associated with weakening of the overall effectiveness of other donor funding and GHES. However, any future effects are contingent on African countries’ resilience to evolving challenges and resource allocation.
Keywords: development assistance for health; HIV/AIDS; Africa development assistance for health; HIV/AIDS; Africa
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MDPI and ACS Style

Nketia, R.; Atta-Nyarko, D.; Gyamfi, E.; Bessala, R.D.M.; Adotei, N.; Asare-Kyei, B.; Marfo, F.A.; Luri, P.T.; Limula, C.; Ahmed Farhan, A.; et al. The Cost of Cutbacks: How Reduction in Development Assistance for Health May Affect Progress Made in HIV/AIDS Control in Africa. Venereology 2025, 4, 8. https://doi.org/10.3390/venereology4020008

AMA Style

Nketia R, Atta-Nyarko D, Gyamfi E, Bessala RDM, Adotei N, Asare-Kyei B, Marfo FA, Luri PT, Limula C, Ahmed Farhan A, et al. The Cost of Cutbacks: How Reduction in Development Assistance for Health May Affect Progress Made in HIV/AIDS Control in Africa. Venereology. 2025; 4(2):8. https://doi.org/10.3390/venereology4020008

Chicago/Turabian Style

Nketia, Richmond, Daniel Atta-Nyarko, Ebenezer Gyamfi, Rostand Dimitri Messanga Bessala, Naomi Adotei, Benjamin Asare-Kyei, Faustina Ameyaa Marfo, Prosper Tonwisi Luri, Charles Limula, Abubakr Ahmed Farhan, and et al. 2025. "The Cost of Cutbacks: How Reduction in Development Assistance for Health May Affect Progress Made in HIV/AIDS Control in Africa" Venereology 4, no. 2: 8. https://doi.org/10.3390/venereology4020008

APA Style

Nketia, R., Atta-Nyarko, D., Gyamfi, E., Bessala, R. D. M., Adotei, N., Asare-Kyei, B., Marfo, F. A., Luri, P. T., Limula, C., Ahmed Farhan, A., Castelli, M., & Adobasom-Anane, A. G. (2025). The Cost of Cutbacks: How Reduction in Development Assistance for Health May Affect Progress Made in HIV/AIDS Control in Africa. Venereology, 4(2), 8. https://doi.org/10.3390/venereology4020008

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