How Mpox revealed an epidemic of untreated HIV in Sierra Leone – as Trump’s aid cuts begin to bite
September 16, 2025
Sierra Leone’s Mpox outbreak has exposed a deeper health crisis: untreated HIV. For patients living with HIV without access to medication, Mpox becomes deadly, as Dr Elin Hoffman Dahl’s heartbreaking account illustrates. Despite strong progress in case management, vaccination, and surveillance, gaps remain. Trump-era aid cuts stripped away flexible funding that once enabled rapid responses, slowing Sierra Leone’s efforts and straining resources for HIV and TB. While local leadership has stepped up, inequities in vaccine access and persistent HIV stigma undermine progress. Sierra Leone’s experience highlights the urgent need for sustained global support alongside stronger, African-led health systems.
Sierra Leone’s current Mpox outbreak has highlighted how fragile health systems intersect with deeper challenges like untreated HIV. For many, Mpox is an uncomfortable yet manageable illness. But in Sierra Leone, where stigma and underfunded HIV programs have left many without treatment, Mpox has turned into a deadly disease. Doctors on the ground, including Dr Elin Hoffman Dahl with Médecins Sans Frontières, were shocked at the high proportion of Mpox patients also living with untreated HIV. These patients face severe immune suppression, making even modest infections life-threatening.
The crisis was compounded by the loss of flexible U.S. foreign aid funding following cuts to USAID under the Trump administration. In the past, this type of funding allowed immediate responses, from paying health workers to mobilizing testing resources. Without it, Sierra Leone’s Mpox response started slowly, and fewer international organizations joined compared with past Ebola or COVID-19 crises. Local health leaders have been forced to stretch already limited budgets, with longer-term risks of rising HIV and TB rates creating even more vulnerable populations.
Despite these constraints, Sierra Leone has made notable progress. More than 200,000 vaccine doses have been secured, 400 new hospital beds established, and surveillance and risk communication strengthened. Yet inequities persist. Private-sector doctors treating Mpox patients were left unvaccinated, while individuals with political connections received doses. These gaps threaten trust in the response and leave the most vulnerable at risk.
There is a silver lining: stronger African-led leadership. National agencies are increasingly directing outbreak management, reducing dependence on foreign experts. Case numbers have fallen by half in recent weeks, showing that progress is possible. But to sustain these gains, Sierra Leone and its neighbors need consistent international support and investment in resilient health systems that address both outbreaks and underlying epidemics like HIV.