Rodela Romero was attending an event at her church in northern Manila when her phone rang. It was a local reporter asking her to comment on what was being described to her as a nightmare scenario.

Ms. Romero, who oversees the oil industry at the Philippine Department of Energy, had been following news of the U.S.-Israeli strikes on Iran that day in late February. Now, the reporter told Ms. Romero, the Strait of Hormuz — the vital maritime choke point through which the Philippines imports enormous amounts of crude oil — had been shut.

“We import almost 100 percent of our petroleum products,” said Ms. Romero, 64. “We’re so vulnerable,” she recalled thinking at the time.

In the ensuing weeks, government officials scrambled to secure supply from alternative producers, at great cost. Gasoline prices doubled and diesel prices tripled, triggering transit strikes in Manila and a sudden spike in inflation that experts warned could push more than a million Filipinos into poverty.

On March 24, President Ferdinand Marcos Jr. declared a national energy emergency. The Philippines was the first country to take such a step, highlighting the view that, outside the Middle East, the economic effects of the U.S.-Iran war are primarily a crisis for Asia.

Developing nations across Asia have been hit hard by the monthslong throttling of energy flows because of their deep reliance on Middle Eastern oil and gas. As clashes between the United States and Iran ramp up again, and shipping traffic in the Persian Gulf nears a halt, regional capitals in Asia are assessing how to prepare for a future of protracted instability.

The Philippines is leading what is expected to be a wave of developing nations seeking to build strategic petroleum reserves — stockpiles of crude oil that can be tapped during disruptions. Japan is offering financing and technical expertise, and officials in Tokyo say they are holding similar talks with Indonesia, Thailand and Vietnam.

Japan’s involvement is part of an effort to bolster its regional energy security, according to Taro Han, a former official at Japan’s trade ministry, who recently joined The Asia Group, a consulting firm. Even with its own substantial stockpiles, Japan remains deeply dependent on Southeast Asian supply chains for goods made with oil byproducts, including medical supplies.

Just as the 1970s oil shocks transformed the global energy architecture — spurring 16 of the world’s largest economies to establish the International Energy Agency, which requires member states to hold a 90-day cushion of net oil imports — a similar structural shift is underway today.

The question is whether, as electrification and renewable energy proliferate, it is the right time for a wave of fast-growing, energy-hungry countries to commit hundreds of millions of dollars to amass fossil-fuel reserves.

Over the past five decades, the maintenance and periodic deployment of these reserves have helped stabilize global supply and prices. In March, the I.E.A. set off the largest coordinated release in its history to help steady oil markets after the outbreak of fighting in the Middle East.

Yet the release had a muted impact on economies in Asia that are heavily dependent on Persian Gulf imports but don’t have national strategic reserves. In the Philippines, the first and most dramatic effects were felt by drivers who faced soaring fuel costs.

“The impact on drivers’ incomes has been huge,” said Mody Floranda, the national president of Piston, a labor coalition representing drivers of jeepneys — the flamboyant, chrome-plated utility vehicles that zigzag along the streets of Manila. Jeepney drivers charge a base fare of about 13 pesos, or 21 U.S. cents, to ferry passengers who hop onto the open backs of their vehicles.

Mr. Floranda, 60, was speaking from the group’s headquarters in Manila, a wood-paneled room littered with megaphones, cardboard sardine boxes and protest signs calling for economic relief and an end to “the U.S. war of aggression.”

He said that the daily wage needed to support a family of five in the Philippines was estimated to be around 1,200 pesos, or $20, but given the current fuel prices, a driver who works 12 to 18 hours a day takes home only about 400 to 600 pesos. “This is obviously not enough,” he said.

In April, Piston filed a petition to raise fares by 10 pesos per ride to reflect higher diesel prices. The group is awaiting official government approval. “Ten pesos does not affect income that much,” Mr. Floranda said. “It’s merely to survive the high price of oil.”

The Philippine Institute for Development Studies, a state-run think tank, warned in a report in April that crude prices of around $105 a barrel could push more than 1.3 million Filipinos into poverty. Global oil prices rose above that level in the early stages of the war, and though they have recently traded lower, at around $90 a barrel, an uptick in fighting has incited renewed volatility.

While the acute-phase supply panic appears to have subsided, the economic damage is lingering as higher fuel costs bleed through the economy, inflating the price of everything, including food. “The impacts on poverty, welfare and growth are still unfolding,” said Adoracion Navarro, a senior research fellow at P.I.D.S.

The Asian Development Bank expects rising commodity costs to drag down growth. In a report released this month, the bank lowered its growth forecast for developing economies in Asia and the Pacific to 4.9 percent in 2026, a slowdown from 5.5 percent growth in 2025.

Recent A.D.B. board meetings have been dominated by discussion about how best to support the Philippines and other developing Asian countries particularly vulnerable to oil-supply disruptions. Officials have debated whether to help countries build emergency stockpiles or accelerate the transition away from oil.

Strategic petroleum stockpiles are expensive and time-consuming undertakings. Building a 90-day reserve is expected to cost nearly half a billion dollars for the Philippines. Crude oil also has a shelf life in storage, meaning that costs are ongoing.

Albert Park, the A.D.B.’s Manila-based chief economist, said he was cautious about recommending support for stockpiling oil.

“If you have an option to just scale up renewable energy and reduce dependence, that’s another way to build resilience,” he said. “Not to say you shouldn’t do it, but you’d better have a clearheaded understanding of the costs and benefits of that strategy because it’s expensive.”

Mr. Han, the former Japanese trade ministry official, said that Tokyo was advocating reserves that meet the I.E.A. benchmark of 90 days’ worth of demand. “We need a more long-term, comprehensive approach in order to strengthen our energy security in the region,” he said. Helping Asia build up reserves “is at the very core of our diplomacy at this particular moment,” he said.

At the Philippine Institute for Development Studies, Ms. Navarro thinks the answer is to build a modest level of strategic reserves, while also pushing for investments in energy efficiency, electric vehicle charging infrastructure and Manila’s skeletal rail networks.

“A 90-day reserve is a lot of money,” she said. “It’s I.E.A. levels, and we’re not yet an economically advanced country.”

The legislature in Manila is still conducting hearings on how to codify a strategic petroleum reserve policy into law. The Department of Energy is also looking into how to encourage the construction of more refineries, so that the Philippines will have the capacity to turn crude reserves into refined products like gasoline and diesel, according to Ms. Romero, the department official.

That was another vulnerability exposed recently, when China halted exports of refined petroleum products in March. It was a big blow to the Philippines, which relies on China’s diesel supplies.

In her office, tucked away in the back of a sun-bleached compound in Manila, Ms. Romero recounted when she received the news of China cutting off exports via another call from a local reporter.

That time she wasn’t at church. “Otherwise, I would have just prayed,” she said. “Prayed for a miracle.”

The Trump administration’s cuts to the largest global H.I.V. program last year resulted in sharp drops in both prevention efforts and treatment for the people most at risk from the disease, according to the first large survey of organizations that had received the funds.

The findings show a grimmer picture of the impact of the cuts than the State Department’s data, released in April, which seemed to suggest that the program had helped to treat about as many people last year as it had in 2024.

To comply with the administration’s policies, the new survey, conducted by the H.I.V. charity amfAR, found, three-quarters of the organizations stopped providing services to those at highest risk from H.I.V. — sex workers, men who have sex with men, transgender people and people who inject drugs. The results are scheduled to be presented next week at a large international AIDS conference in Rio de Janeiro.

A second study, conducted by a multinational group of scientists, which will also be presented at the conference, found that the cuts had disproportionately affected children with H.I.V. The program, called the President’s Emergency Plan for AIDS Relief, or PEPFAR, supported treatment for about 77,000 fewer children in 2025 than it had the previous year, representing a 14 percent decline, the study found.

“We have not verified this specific report, but we can categorically say that its methodology is flawed,” the State Department, which oversees PEPFAR, said in an emailed statement, “The Trump Administration has strengthened PEPFAR through clear strategic direction, promoting greater recipient-country ownership, and sharpening the program’s focus on measurable health outcomes.”

Worldwide, nearly half of all children living with H.I.V. do not have access to treatment, according to UNAIDS, the United Nations program.

President George W. Bush started PEPFAR in January 2003, when H.I.V. medications were still unavailable in many parts of the world. The program is credited with saving 26 million lives, across more than 50 countries, making it the most successful endeavor of its kind.

But last year the Trump administration reshaped the program, saying the low-income nations that benefited must take on more of the costs of treating and preventing H.I.V. among their own citizens.

“We unfortunately are going through a very complex and difficult moment, where all these good achievements are challenged by the new policies,” Dr. Beatriz Grinsztejn, president of the International AIDS Society, said at a press briefing last week.

It is too early to gauge the impact of the cuts on H.I.V. rates, and it may continue to be challenging because many data collection programs have been scaled back or shut down as a result of the U.S. aid cuts.

In the first study, researchers collected information from 166 organizations, about one-quarter of the total funded by PEPFAR, in 46 countries. Delayed or terminated awards in 2025 caused these groups to shut down at least 1,700 sites that had delivered H.I.V. services, and to lay off more than 16,000 workers, the survey found.

Just six organizations accounted for 85 percent of the site closures, an indication of how the loss of funding to a single recipient can shutter hundreds of service points at once, the researchers said.

Sites that stayed open also felt the effects of the cuts.

“Even if a site doesn’t close, what you’re seeing is longer wait times, and fewer staff, and nonfunctioning data systems,” said Jennifer Sherwood, amfAR’s director of research and public policy.

The disruptions hit local organizations the hardest, contrary to the administration’s stated goal of empowering such groups and helping them move away from multinational aid organizations, she said.

After an initial freeze on all PEPFAR funds early in 2025, the administration allowed treatment to continue, but limited funds for prevention mostly to programs to stop transmission of H.I.V. from pregnant and breastfeeding women to their children.

In January, the administration also expanded the so-called Mexico City Policy, forbidding organizations that receive U.S. funds from providing most services related to gender, diversity, and reproductive health. More than 60 percent of organizations stopped providing at least one service and 44 percent stopped serving specific populations, the amfAR survey found.

Some organizations were required to revise their materials and strip out words that pertained to specific topics, and some of those changes altered the larger meaning. For example, in one case, “sex work” was revised to read “sex trafficking,” a term “which describes something entirely different,” noted Elise Lankiewicz, a policy associate at amfAR.

In some cases, the changes had nothing at all to do with prohibited concepts, and flagged phrases like “transfer of knowledge,” perhaps because it contained the fragment “trans.”

About half of the organizations surveyed also reported disruptions in their supply chains, including difficulty procuring condoms, lab supplies and antiretroviral drugs for treatment.

“For better or worse, PEPFAR ended up being a really interconnected system,” Ms. Lankiewicz said. “Trying to carve out and cancel certain awards had ripple impacts throughout the whole program.”

The system that is left “is really a treatment-heavy model, which isn’t really conducive to controlling the H.I.V. epidemic long-term,” she added.

But some evidence suggests the cuts have also affected treatment. In a separate analysis published last month in the journal Nature Health, Ramona Godbole, a senior manager at the Clinton Health Access Initiative, and other researchers reported a 10 percent decrease in the number of people treated with support from PEPFAR.

In the new study to be presented next week, the same researchers focused on PEPFAR support for children living with H.I.V., because they “can get very sick very quickly without access to drugs, and so the stakes are really high,” Ms. Godbole said.

The State Department said its policies have reduced the number of children becoming infected in the first place. “The number of children testing positive and on treatment for H.I.V. has continued to decline,” the department said in its statement.

The number of children receiving treatment for H.I.V. has slowly been decreasing in recent years because of the success of efforts to prevent babies from being born with the virus. But the 14.2 percent decline last year was a bigger drop than has been seen before, she said. India and South Africa each reported a decline of more than 45 percent.

“It’s a signal, not a verdict,” Ms. Godbole said. “But it’s certainly the signal to do more investigation.”