Transition Initiative

In the wake of unprecedented cuts to global HIV and sexual and reproductive health and rights (SRHR) funding, we have launched the Transition Initiative to ensure the long-term survival and sustainability of vital services across five countries in Africa.

WHY THIS WORK MATTERS

The global funding landscape for HIV and sexual and reproductive health and rights (SRHR) services has changed profoundly. The decision by the US government to drastically reduce foreign aid, including withdrawing support from PEPFAR, has accelerated a transition that many health systems were not prepared for. By early 2025, over 83% of USAID programmes had been shut down, with severe consequences for HIV and SRHR service delivery across sub-Saharan Africa and beyond.

For Frontline AIDS and our partners, the impact has been immediate and devastating. Many partner organisations have been forced to close programmes and clinics, leaving an estimated 1.6 million people without access to life-saving HIV and sexual and reproductive health services. The cuts have fallen hardest on programmes serving LGBTQ+ people, sex workers, people who use drugs, adolescent girls and young women, and survivors of gender-based violence: the very populations that are reliant on dedicated, community-led services.

This is not a temporary disruption. It represents a structural shift in how global health is financed, and it demands a long-term, strategic response.

WHAT THE TRANSITION INITIATIVE DOES

Launched in May 2025, the Transition Initiative supports coalitions of communities and civil society to work with governments to ensure that the transition away from donor-dependent funding translates into a sustainable nationally-owned HIV response. The Transition Initiative aims to strengthen national community and civil society leadership, hold governments to account and ensure that civil society and communities are positioned as meaningful partners in the national health system.

The programme is delivered as part of Frontline AIDS’s broader technical support, drawing on our experience and when applicable, highly qualified, Southern-based consultants to provide hands-on, responsive, and outcomes-focused support. This means partners receive not just strategic guidance, but practical, expert support tailored to their specific context and needs.

The Transition Initiative focuses on:

• Supporting civil society and community coalitions, including those developed through our United for Prevention programme, which have established access to national decision-making spaces and a proven track record of collaboration with governments on service integration, accountability and health financing.
• Supporting civil society advocacy coalitions, including those developed through our United for Prevention programme, which have established access to national decision-making spaces and a proven track record of collaboration with governments on service integration and financing.
• Building long-term financing solutions, including advocacy for increased domestic health financing, budget advocacy, integration of HIV and SRHR into universal health coverage (UHC) frameworks, development of social contracting mechanisms that enable governments to fund community-led services, and exploration of innovative financing approaches.
• Ensuring HIV integration, within the national health system, as well as HIV integration with co-morbidities.
• Restoring and strengthening services for the most marginalised populations, including key populations, adolescent girls and young women, and survivors of gender-based violence, where service gaps have been most acute.
• Aligning with global sustainability frameworks, including the UNAIDS Sustainability Roadmaps, the Accra , to connect country-level advocacy to international processes for long-term financing and policy change.

WHERE we WORK

The Transition Initiative has to date focused particularly on five countries: Kenya, Malawi, Nigeria, Tanzania and Uganda, all of which have experienced sharp reductions in HIV funding, with HIV prevention for key and vulnerable populations being the hardest hit. Frontline AIDS also are involved in advocacy on government accountability with established coalitions in Angola, Mozambique and Zimbabwe.

Our work in these countries is informed by our At a Crossroads country reports, published on World AIDS Day 2025, which draw on the community and civil society organisation experiences on the impact of the US Government funding withdrawal, to provide a detailed picture of how countries are navigating this critical moment, and the lessons that could shape the global fight against HIV.

The programme is funded by the Swedish International Development Cooperation Agency (Sida).

ACCESS TRANSITION INITIATIVE SUPPORT

Support through the Transition Initiative is available as part of our Technical Assistance offer. Whether you are a civil society organisation navigating funding changes, a coalition seeking to strengthen your engagement with government, or a partner organisation building the case for domestic financing, we can connect you with the expert guidance you need.

To find out more or request support, contact us at technicalassistance@frontlineaids.org.