Health care workers navigating the unravelling of HIV exceptionalism: ‘Now it is your health, your responsibility’

This article examines how frontline health care workers in Kenya navigate the end of HIV exceptionalism as donor-funded comprehensive HIV care unravels. Drawing on ethnographic fieldwork conducted in Kisumu between August and December 2024 and in November 2025, the paper traces how the sudden withdrawal of USAID/PEPFAR support accelerated an already planned integration of HIV services into the public health system. Through the experiences of three health care workers, Mary, Dan and Samuel, the analysis shows how the erosion of psychosocial support, specialised labour and long-term care relationships transformed both HIV care and the work of providing it. Health care workers attempted to sustain continuity through improvisation, moral labour and unpaid support even as their own employment became precarious. The paper argues that the end of HIV exceptionalism is experienced not as the normalisation of HIV, but as the unravelling of comprehensive care, accompanied by a gradual shift from therapeutic clientship toward patienthood and a redistribution of responsibility onto both clients and frontline workers.