A proposed US budget has placed Kenya at the centre of a major policy shift that could see Washington withdraw support for key HIV prevention tools, including condoms and male circumcision.
The plan, fronted by US President Donald Trump, signals a move away from funding certain health interventions abroad and introduces sweeping changes to global health spending.
Details contained in the 2027 US Government Budget request, released last Friday, show that Kenya is specifically listed among programmes targeted for cuts. The document argues that US resources should not be used to fund birth control and related services in other countries.
“The United States should not pay for the world’s birth control and therapy. Examples of eliminated activities include: Promoting health equity and providing condoms and contraception in Kenya,” the budget said.
The proposal also extends to male circumcision, stating that such programmes should not receive US funding anywhere in the world.
This shift follows earlier changes after the current administration dismantled USAID, which had been a key channel for health funding. Before the withdrawal, Kenya benefited from programmes supported through the Centers for Disease Control and Prevention and the President's Emergency Plan for AIDS Relief (PEPFAR), among others.
Overall, the proposal outlines a $4.3 billion reduction in global health funding compared to the previous year, reflecting a broader rethink of US support to developing nations.
“The budget includes $5.1 billion for Global Health to end the previous administration’s abuse of these programmes and to execute the state’s newly released America First Global Health Strategy (AFGHS),” the proposal says.
Even with the proposed cuts, Kenya remains part of a funding arrangement signed in December that could see it receive $1.6 billion between 2026 and 2030 under the AFGHS. However, the new plan suggests tighter direction from Washington on how such funds are applied.
Medical experts caution that removing support for condoms and circumcision could weaken efforts to control HIV, particularly in regions where infection rates remain high.
In its submission to Congress, the US government said the intention is to maximise impact while reducing spending and encouraging countries to take on more responsibility.
“The budget would focus on new compacts that unify funding, achieving economies of scale in both implementation and oversight,” the statement said.
The proposal also criticises past spending under PEPFAR, arguing that a large portion of funds did not reach frontline services.
"Under the prior administration, only about 40 per cent of Pepfar funds supported actual service delivery, including medications, testing, commodities and health workers, with the remaining 60 per cent wasted on duplicative administrative costs, unwieldy supply chains and layers of endless bureaucracy."
The plan is now headed to Congress, where lawmakers can amend, approve, or reject the proposed changes, meaning the final outcome remains uncertain.
Concerns have already been raised by the Kaiser Family Foundation, which noted that the proposal does not clearly allocate funding to the Global Fund.
“The bilateral funding does not include a specific funding amount for the Global Fund in financial year 2027 but commits to leveraging $2 from other donors for every $1 from the United States. It also states that funds may not exceed 33 per cent of the total amount contributed to the Global Fund,” KFF explained.
The same analysis points out that there is no direct funding set aside for Gavi, which plays a central role in supplying vaccines to Kenya.
“[It] does not provide funding for Gavi and states that any future FY 2027 funding for Gavi is “contingent on the organisation making necessary reforms and meeting certain benchmarks on vaccine safety.”
The proposal also seeks to scrap disease-specific funding lines, replacing them with a more flexible approach covering multiple illnesses.
“The budget would also eliminate disease-specific accounts and provide the department crucial agility to address the actual needs of each recipient country—across HIV-Aids and other infectious diseases such as malaria, tuberculosis and polio—to strengthen global health security and protect Americans from disease,” the budget statement said.
A separate analysis by Devex highlights that Congress has previously increased global health funding beyond presidential requests, noting that $9.4 billion was approved for the 2026 fiscal year despite a lower proposal.