The Interaction of Global Aid and National Policy: Aligning PEPFAR’s Global Reach with Malawi’s Fight Against HIV/AIDS

This thesis evaluates the extent to which PEPFAR-funded HIV programs align with Malawi’s National Strategic Plan (NSP) for HIV and AIDS (2020–2025). Using a mixed-methods approach of combining PALMS and amfAR database analysis with informal interviews from implementing partners and Ministry of Health officials, the study assesses whether the priorities of a major donor are effectively advancing Malawi’s national goals in HIV prevention, treatment, and health system strengthening. Findings demonstrate that while PEPFAR’s technical programming broadly supports NSP targets, particularly in areas like ART scale-up, viral load suppression, and HIV testing, critical gaps remain. Key populations, including adolescent girls and young women (AGYW), men who have sex with men (MSM), and pediatric patients, continue to face barriers to access and retention. Prevention programming remains underfunded relative to treatment, and legal and structural challenges further limit equitable care. These gaps are compounded by Malawi’s heavy reliance on external aid, as more than 90% of the HIV response is donor-funded, leaving the system vulnerable to geopolitical changes and funding instability. The analysis concludes that alignment on paper does not guarantee sustainability in practice. Without a transition toward greater domestic investment and institutional capacity, the long-term resilience of Malawi’s HIV response remains at risk.