Abstract

The HIV/AIDS epidemic has posed significant public health, social, and economic challenges in East Africa over the 
past three decades. International organizations—including UNAIDS, PEPFAR, the Global Fund, and the World 
Bank—have played a central role in shaping national HIV/AIDS policies by providing financial resources, technical 
guidance, normative frameworks, and programmatic support. Their interventions have facilitated rapid scale-up of 
antiretroviral therapy, prevention of mother-to-child transmission programs, and health system strengthening, 
contributing to substantial reductions in HIV-related morbidity and mortality. However, reliance on external 
funding has also introduced challenges, including program fragmentation, limited national ownership, inequities in 
service delivery, and vulnerability to funding fluctuations. This review examines the mechanisms through which 
international actors influence policy, the impacts on health systems and population outcomes, and the tensions 
between donor priorities and national strategies. It further explores policy recommendations to enhance 
sustainability, equity, and resilience, emphasizing domestic financing, integration into primary healthcare, regional 
cooperation, and community engagement. The study underscores the need to balance international support with 
national autonomy for a robust and equitable HIV/AIDS response in East Africa.