While the global HIV response reeled from sudden U.S. aid cuts, one rural Tanzanian clinic refused to close its doors. The Chronic Diseases Clinic of Ifakara (CDCI) kept delivering lifesaving antiretroviral treatment, testing and outreach throughout 2025 — even after salaries for 35 staff members were halted overnight.

Patients from the remotest villages in the Kilombero Valley heard the news within days. Many arrived at the clinic in panic, remembering the pre-2004 era when antiretroviral drugs simply were not available. Yet the clinic never shut down. Staff continued showing up unpaid. A group of private individuals in Switzerland stepped in quietly to cover salaries for key laboratory and clinical personnel for more than six months. Services never stopped.

“It was a sobering experience that international collaboration might no longer be taken for granted,” the clinic’s 2025 annual report states. The USAID funding stop “was a threat to its uninterrupted service delivery since 2004.”

A community celebration amid uncertainty

The resilience was on full display at Siku ya Kongano — a vibrant community day organised at the clinic. District commissioner’s office representatives, the hospital director, clinical director and leaders from the KONGA community network joined patients and staff. Booths showcased crafts made by people living with HIV. Adults living with the virus celebrated together, dancing, empowering one another and demonstrating that life with HIV continues with dignity.

Photographs from the event show smiling faces, colourful fabrics and patients proudly displaying handmade goods — a powerful counterpoint to the funding fears that had swept the valley only months earlier.

National and global stakes

The drama at CDCI mirrors a wider crisis. In 2025, USAID halted or massively downsized most of its international HIV development programmes. A promising new preventive drug — administered by injection only twice a year — had just reached the market, offering a potential breakthrough for stopping new infections, especially among young people. Yet the funding squeeze threatened to derail its rollout.

In Tanzania the numbers are stark. Less than 2 % of HIV programme costs are covered by domestic sources. Nationally, 43,000 people acquired HIV in 2024 and 26,000 died of AIDS-related causes. While the care cascade has improved (87 % know their status, 82 % are on treatment, 79 % are virally suppressed), the country still falls short of the UNAIDS 95-95-95 targets. Vertical transmission remains at 8 % despite 98 % of pregnant women living with HIV accessing treatment.

The report warns that further international funding reductions “will hit Tanzania particularly hard.”

Despite everything, care continued

Even as the political crisis hit Tanzania at the end of 2025, CDCI staff maintained high-quality services. They ran targeted outreaches to fisher camps and schools, integrated cancer and non-communicable disease screening, and kept the laboratory functioning as a national referral hub. Viral suppression among patients on active follow-up stayed at 95 % (<1,000 copies/ml) and 93 % (<50 copies/ml) — among the highest rates in rural Africa.

A “health summit day” organised with the Ministry of Health reassured patients that commitment to their care remained unbroken.

A model of quiet defiance

The story of CDCI in 2025 is more than survival. It is a demonstration that committed local teams, supported by creative international solidarity, can keep essential services running when big-donor systems falter. As the clinic’s leaders noted, the shared enthusiasm of staff and partners “remained unbroken,” allowing them to reach vulnerable rural communities, children, adolescents and pregnant women even during the storm.

With domestic funding pressure mounting and new prevention tools at risk, the clinic’s experience offers both a warning and a quiet blueprint for resilience across sub-Saharan Africa.

>> Read the full report, here.