The United States is restructuring how it delivers life-saving medical supplies for HIV and malaria to low-income countries, a shift that officials and health experts warn could disrupt treatment access across parts of Africa and Asia.

The changes centre on winding down the Global Health Supply Chain Program – Procurement and Supply Management, a U.S.-funded initiative run by Chemonics, which has coordinated the delivery of critical medicines and prevention tools since 2016. According to internal communications and multiple sources familiar with the matter, U.S. officials have been instructed to begin halting implementation of the programme by May 30.

From its inception through 2024, the programme distributed more than $5 billion worth of HIV and malaria-related commodities to 90 countries, with a primary focus on sub-Saharan Africa and parts of Asia. The supplies included antiretroviral drugs, malaria treatments and insecticide-treated bed nets, forming a key component of global disease control efforts.The restructuring follows broader changes to U.S.

foreign aid policy under the administration of Donald Trump, which has prioritised reducing reliance on contractors, cutting budgets and shifting toward direct agreements with recipient governments. The overhaul also comes after the dismantling of the United States Agency for International Development, which had previously overseen much of Washington’s development assistance.

Five sources familiar with the transition said the pace of the changes risks creating supply gaps for essential medicines, particularly in countries with fragile health systems. An internal email reviewed by Reuters warned that accelerating the transition without a clear implementation plan could jeopardise continuity of services.

The communication, sent by the U.S. State Department to staff in 17 African countries and Haiti, directed country teams to prepare for the end of programme operations while outlining potential risks. It did not provide a detailed roadmap for replacement mechanisms, instead asking local offices to identify vulnerabilities and report back to Washington.

A State Department spokesperson said the agency had not issued technical instructions for Chemonics to cease operations by May 30, though the contract is set to expire on September 30 in line with other USAID awards. The official end date is listed as November.

The uncertainty has revived concerns stemming from earlier disruptions. In January last year, a freeze on international aid left millions of dollars’ worth of medical supplies stranded in ports and warehouses worldwide, including HIV drugs and malaria prevention tools. Distribution resumed only after waivers were granted for life-saving interventions.

Six sources said the United States has been in discussions with the Global Fund to Fight AIDS, Tuberculosis and Malaria about potentially using its procurement and distribution systems to replace the existing programme. The Geneva-based institution already manages approximately $2 billion in annual purchases for HIV, tuberculosis and malaria programmes through partnerships with national governments and implementing agencies.

However, two sources said earlier plans had envisaged a transition timeline extending to November 2027, allowing sufficient time for procurement cycles and logistical adjustments. Compressing this timeline into a matter of months could create operational bottlenecks, they said, noting that delivering medical supplies to remote areas can take up to a year from order to distribution.

The Global Fund declined to comment on the discussions. The State Department did not directly confirm the talks but said it would rely on pooled procurement mechanisms to secure supplies at competitive prices from private manufacturers.The policy shift is part of a broader “America First” approach to global health funding, which aims to reduce what officials describe as inefficiencies in the existing system.

A strategy document released in September argued that contractor-led programmes had contributed to waste and inflated costs, and emphasised direct funding for frontline services and national governments.

Under the new approach, Washington has signed 28 bilateral health agreements with partner countries and is increasingly channeling funds directly to national authorities. It also plans to use private logistics firms to handle distribution rather than relying on large development contractors.

Recent agreements with countries such as Kenya, Rwanda and Uganda include commitments to increase domestic health spending alongside U.S. funding. However, implementation has encountered obstacles. In Kenya, a proposed deal faces legal challenges from activists concerned about data privacy, while negotiations with Zambia have been delayed as officials seek to safeguard national interests.

Health experts and aid practitioners say the transition risks compounding existing vulnerabilities in global disease control programmes. Previous disruptions linked to funding changes have already contributed to shortages of malaria treatments for children and gaps in HIV prevention services in several countries.

The State Department defended the overhaul, describing the current system as outdated and inefficient. A spokesperson said the new model would prioritise value for American taxpayers while maintaining support for critical health interventions.

Despite those assurances, several sources involved in programme delivery said the lack of a detailed transition plan remains a central concern. They warned that without clear coordination between donors, governments and implementing partners, the shift could interrupt supply chains that millions depend on for survival.

It’s no longer a death sentence.

The human immunodeficiency virus (HIV) attacks white blood cells, leaving you vulnerable to even minor infections. The term HIV is sometimes and incorrectly used interchangeably with acquired immune deficiency syndrome (AIDS).

AIDS is the result of long-term untreated HIV, and despite being called late-stage HIV or advanced HIV disease, Avert chronicles explained how AIDS was discovered first.

This was in 1981 when supposedly healthy individuals were diagnosed with a serious infection that typically happens to the severely immunosuppressed. In 1983, scientists were able to pinpoint HIV as the virus that caused AIDS.

In those days, being diagnosed with HIV was a death sentence — it was novel and incurable. However, following scientific advancements, people with HIV can now have long and normal lives with proper treatment. The first HIV drug, zidovudine, became available only in 1987. While it was a failed cancer drug from the 1960s, it proved able to block the proteins that HIV needed to spread inside the body. However, having only one drug meant the virus could mutate so the medication would eventually be rendered ineffective.

The 1990s saw a wave of new kinds of drugs — such as saquinavir, which stops the virus from copying itself, and combination pills, which contained two anti-HIV drugs. As of present writing, there are at least 30 HIV medications that people can take to effectively manage the virus. Below is a quick rundown of the classifications:

Combination Pills

First on this list is the combination pills, which are actually the most commonly prescribed drugs for people with HIV. These were invented because people often quit their HIV treatment because they had to take multiple pills a day — combination pills made it easier for people to stick to the treatment. Most combination pills out there contain three or more anti-HIV drugs, such as Triumeq and Genvoya.

A study on Wiley Online Library says that these remain the standard as they reduce mortality by lowering the number of resistant mutations. However, those who can’t tolerate or afford three-drug pills can still opt for two-drug pills like Combivir.

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

NRTIs keeps HIV from multiplying by preventing it from correctly copying its RNA into DNA. The previously-mentioned zidovudine falls under this kind of anti-HIV drug. It’s worth noting that some NRTIs, on their own or in combination with other medications, are referred to as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medicines.

SymptomFind features these two in their health guide on HIV, explaining that PrEP pills like Truvada can protect you from getting HIV as long as you take it before you potentially get exposed to the virus. Taking this drug daily will lower your chances of getting it. Meanwhile, PEP medicines like Retrovir are taken as soon as possible after potential exposure to HIV. These can usually prevent you from being infected, though they must be used within 72 hours of the exposure and continued for 28 days.

Protease Inhibitors (PIs)

HIV uses the enzyme protease to replicate itself. As the name of these drugs suggests, PIs block the actions of protease so HIV can’t multiply. Saquinavir, the first anti-HIV drug after zidovudine is one such drug. While these might seem effective, using single-agent PIs may result in drug-resistant HIV. To prevent this, and to make the drugs fully effective, they’re used in combination drugs, such as Evotaz. There are combination pills that contain only PIs, such as Kaletra (having lopinavir and ritonavir), but they’ll still need to be taken with other anti-HIV pills.

Interestingly, a previous article we wrote on WHO drug trials talks about how Kaletra was also initially used in COVID-19 trials due to the similarities of the viruses. But it was discontinued when the drugs failed to reduce mortality.

HIV treatment has improved greatly since the first anti-HIV drug. Proper treatment will enable those with HIV to live a full and typical life. It’s no longer a death sentence.

For more news and health related information do read our other articles here at Milli Chronicle.

There has been a steady increase in HIV transmission rates through unprotected sexual intercourse, rather than intravenous drug use.

A Czech-based Persian cum English Radio broadcasting service Radio Farda published a detailed analysis about the increase of AIDS/HIV disease among Iranians due to unprotected sex and excessive drug addiction.

Following is the report taken without any manipulation:

Despite the government’s pledge to end the AIDS epidemic by 2030, the number of individuals suffering from AIDS/HIV in Iran has been steadily rising.

According to a 2016 survey by the United Nations, there were roughly 5000 new infections between the years 2010 and 2016, adding up to the total of 66 thousand people living with HIV. However, some estimates claim that there may be over 100 thousand Iranians suffering from HIV, highlighting significant discrepancies between official statistics and reality.

The AIDS epidemic in Iran has a significant drug-related dimension. Being part of the Golden Crescent, a region spanning Afghanistan, Iran and Pakistan with prominent illicit opium production, Iran has served as a pathway for drug traffickers in the shipping of narcotics from Afghanistan to Europe.

While the Iranian government does not treat drug trafficking lightly, the illegal drug trade has fueled the country’s growing problems with drug addiction.

According to a survey carried out by the Iranian Drug Control Organization, there are about 2.8 million Iranians who regularly use narcotics. Out of those, roughly 67 percent take heroin as their primary drug.

The widespread availability of heroin and other opiates, which are often taken intravenously, has served as an important vector spreading AIDS/HIV among drug addicts, with UN statistics claiming that 9.3 percent of Iranian drug addicts currently have HIV.

While there have been efforts undertaken by the government to promote the use of clean needles and other practices targeting the spread of AIDS/HIV among drug users, the country’s policy against addicts has sometimes been called a “vicious cycle”.

According to Mohammad Bakhshandeh, the chief of the Drug Police of Greater Tehran, the problem is largely caused by ineffective policies which treat drug addicts as criminals, rather than victims of addiction.

“If we have accepted the fact that addicts are not criminals and consider them as sick individuals, we should also accept that it is the duty of municipal and health departments to look after them, not the police’s,” Bakhshandeh said. In turn, HIV has entered Iranian prisons, with roughly 1 percent of Iran’s prisoners now suffering from HIV.

However, more than ever before, there has been a steady increase in HIV transmission rates through unprotected sexual intercourse, rather than intravenous drug use. This is not limited only to Iranian sex workers, where up to 2 percent of all sex workers suffer from HIV, but to the younger generation in general.

Indeed, whereas about 70 percent of sex workers suffering from HIV know their status, only 41 of the general population suffering from HIV are aware of their condition. Similarly, the country’s treatment services have also delivered lackluster results, with only 13 percent of HIV-positive individual having suppressed viral loads as part of treatment.

This has been particularly problematic for the younger generation. According to Parvin Afsar Kazerouni, the head of the Health Ministry’s AIDS department, more than 50 percent of HIV patients in Iran are between 21 and 35.

Although the government continues to blame illegal drug use as the chief source of HIV transmission, unprotected sexual intercourse is becoming a significant factor.

This can be partly explained through the lack of sexual education program offered to Iran’s youth, with only 18 percent of Iranian youth aged between 15-24 knowing about HIV prevention.

The government’s inability to provide well-rounded sexual education to its young population highlights an equally difficult challenge to the regime’s fundamentalist character.

While drug addiction and prostitution continue to be deemed as “social problems”, the ostracized nature of HIV-positive individuals in the general public presents an immensely problematic issue, which effectively prevents the possibility to educate individuals on HIV and living with an HIV-positive status.

In turn, this ineffective policy may lead to the further spread of this disease, particularly to at risk group such as gay men who already retain a highly stigmatized position in Iranian society, as well as to other segments of the Iranian population.

According to a 2016 survey by the United Nations, there were roughly 5000 new infections between the years 2010 and 2016, adding up to the total of 66 thousand people living with HIV. However, some estimates claim that there may be over 100 thousand Iranians suffering from HIV, highlighting significant discrepancies between official statistics and reality.

The AIDS epidemic in Iran has a significant drug-related dimension. Being part of the Golden Crescent, a region spanning Afghanistan, Iran and Pakistan with prominent illicit opium production, Iran has served as a pathway for drug traffickers in the shipping of narcotics from Afghanistan to Europe.

While the Iranian government does not treat drug trafficking lightly, the illegal drug trade has fueled the country’s growing problems with drug addiction.

According to a survey carried out by the Iranian Drug Control Organization, there are about 2.8 million Iranians who regularly use narcotics. Out of those, roughly 67 percent take heroin as their primary drug.

The widespread availability of heroin and other opiates, which are often taken intravenously, has served as an important vector spreading AIDS/HIV among drug addicts, with UN statistics claiming that 9.3 percent of Iranian drug addicts currently have HIV.

While there have been efforts undertaken by the government to promote the use of clean needles and other practices targeting the spread of AIDS/HIV among drug users, the country’s policy against addicts has sometimes been called a “vicious cycle”.

According to Mohammad Bakhshandeh, the chief of the Drug Police of Greater Tehran, the problem is largely caused by ineffective policies which treat drug addicts as criminals, rather than victims of addiction.

“If we have accepted the fact that addicts are not criminals and consider them as sick individuals, we should also accept that it is the duty of municipal and health departments to look after them, not the police’s,” Bakhshandeh said. In turn, HIV has entered Iranian prisons, with roughly 1 percent of Iran’s prisoners now suffering from HIV.

However, more than ever before, there has been a steady increase in HIV transmission rates through unprotected sexual intercourse, rather than intravenous drug use. This is not limited only to Iranian sex workers, where up to 2 percent of all sex workers suffer from HIV, but to the younger generation in general.

Indeed, whereas about 70 percent of sex workers suffering from HIV know their status, only 41 of the general population suffering from HIV are aware of their condition. Similarly, the country’s treatment services have also delivered lackluster results, with only 13 percent of HIV-positive individual having suppressed viral loads as part of treatment.

This has been particularly problematic for the younger generation. According to Parvin Afsar Kazerouni, the head of the Health Ministry’s AIDS department, more than 50 percent of HIV patients in Iran are between 21 and 35.

Although the government continues to blame illegal drug use as the chief source of HIV transmission, unprotected sexual intercourse is becoming a significant factor.

This can be partly explained through the lack of sexual education program offered to Iran’s youth, with only 18 percent of Iranian youth aged between 15-24 knowing about HIV prevention.

The government’s inability to provide well-rounded sexual education to its young population highlights an equally difficult challenge to the regime’s fundamentalist character.

While drug addiction and prostitution continue to be deemed as “social problems”, the ostracized nature of HIV-positive individuals in the general public presents an immensely problematic issue, which effectively prevents the possibility to educate individuals on HIV and living with an HIV-positive status.

In turn, this ineffective policy may lead to the further spread of this disease, particularly to at risk group such as gay men who already retain a highly stigmatized position in Iranian society, as well as to other segments of the Iranian population.

Article first published on RadioFarda