Zambia's HIV treatment system has faced significant disruption following US aid cuts, with PEPFAR funding reductions leading to closure of 32 drop-in centers serving 20,000+ people on antiretroviral therapy. Modeling studies warn that prolonged disruption could drive millions more HIV infections and deaths, especially critical since the US provided 84% of Zambia's HIV financing in early 2025. The number of people stopping HIV treatment collection doubled after the stop-work order, from 82 in late 2024 to 115 in early 2025, showing the immediate human cost as a healthcare system loses critical funding support. What's less discussed: Zambia itself rejected a $1 billion US health funding agreement, with President Hichilema requesting revisions over clauses tying aid to mining partnerships, adding a sovereignty dimension to the aid disruption crisis.