Kenya is being forced to rethink how it delivers HIV services as a decline in international funding puts pressure on the country to sustain the progress it has made in fighting the disease.
The country is now moving HIV care closer to the wider health system, with services being incorporated into primary healthcare, maternal and child health programmes and universal health coverage.
Dr Andrew Mulwa, head of the National Aids and STI Control Programme (Nascop), said the change would be important as Kenya works to maintain HIV services while relying more on government funding.
Mulwa spoke in New York during a high-level forum on paediatric HIV held on the sidelines of the United Nations General Assembly.
He said the previous arrangement, where HIV services largely operated as a separate programme, was no longer sustainable as countries face reduced external financing.
“Kenya’s health system is undergoing a rapid transformation. I keep saying the HIV subsector has been the leader of transformation,” Mulwa said.
He said Kenya was working towards a national universal health coverage plan centred on strong primary healthcare, which is being financed by the government through the primary healthcare fund.
The government is also putting in place a community health network involving 107,000 local health promoters who are being paid and equipped to provide services.
Community structures have been central to Kenya's HIV response for years, with peer educators and other workers helping people obtain prevention, testing and treatment services.
Mulwa said the HIV programme had, however, remained largely separate from the wider health system despite its contribution to health sector changes.
“So the HIV subsector is now playing catch-up, because we were left vertical, siloed, and the magic word is now integrating the HIV response into the national health system.”
The changes come as countries face a growing shortage of international resources for HIV programmes.
Unaids says international HIV resources fell by 18 per cent last year, from $8.8 billion to $7.3 billion.
At the same time, global development assistance from multiple donor countries declined by 23 per cent, the largest fall recorded.
Kenya has also been affected by the reduction in funding. The HIV component of its latest Global Fund allocation has been reduced by 18 per cent as the fund seeks to encourage countries to rely more on domestic resources to finance their health programmes.
The funding pressure has raised concerns over how countries can continue providing HIV prevention and treatment services while maintaining the progress already achieved.
For Kenya, the issue is especially important in paediatric HIV, where children continue to have less access to treatment than adults globally.
Unaids reports that nearly half of children living with HIV had no access to antiretroviral treatment in 2025.
During the same year, an estimated 1.2 million people acquired HIV globally, while 570,000 died from illnesses linked to Aids.
At the New York forum, Mulwa pointed to Kenya's progress in preventing mother-to-child transmission, detecting HIV early among babies and increasing access to treatment for children and adolescents.
He said Kenya now had to find ways to preserve those gains even as international health financing declines.
“That’s the critical question we need to ask ourselves as we look to the future. How do we maintain our past momentum in terms of countries adopting new global guidelines and policies that come out?” he asked.
“For the space of pediatric HIV, the failure of our pediatric reform is the failure of adults.”
Kenya's latest national HIV figures show that 91 per cent of people living with HIV were receiving treatment in 2025.
The same figures show that 87 per cent had achieved viral suppression, while prevention of mother-to-child transmission coverage stood at 91 per cent.
These gains now face the challenge of being sustained as Kenya works to reduce its dependence on external financing.
Unaids says domestic sources accounted for about 60 per cent of HIV funding in low- and middle-income countries in 2025.
Domestic HIV financing increased by four per cent during the year, while more than 55 countries reported plans to raise their own HIV budgets.
The reduction in funding has already affected prevention and community-based HIV services in different countries.
Unaids says HIV testing programmes in high-burden settings dropped by 22 per cent between 2024 and 2025. Some countries also reported reductions of more than 90 per cent in funding for condoms.
Kenya's move to integrate HIV services into the wider health system is therefore expected to form part of the country's effort to keep essential services available while taking on a larger share of the financial responsibility for its HIV response.