February 9, 2026, 1:29 pm
Author – Steven W. Thrasher
This story was supported by the Pulitzer Center.
KAMPALA, UGANDA — Ever since President Donald Trump was elected a year ago, sex workers in Kampala have suffered. The sex has suddenly become too painful.
For years, sex workers and public health workers in Uganda say condoms and sexual lubricant were plentiful. Usually paid for by American foreign aid programs such as USAID and PEPFAR, they were distributed “in bars, in hospitals, in hotels, anywhere people gathered,” said Turinawe Samson, founder of Universal Love Alliance Clinic in Kampala. In a country where about 5 percent of the population has HIV — the tenth highest prevalence rate in the world — easy access was key to slowing the spread of the disease and saving lives.
But immediately after Trump’s election in November 2024 — months before the Trump administration cut funding to USAID and PEPFAR — things began to change in Uganda.
Lube became stigmatized as “an immoral product used by sex workers and homosexuals,” according to Samson. Uganda’s Ministry of Health doesn’t group it among “essential health commodities,” meaning its import isn’t subsidized. Few health facilities in Uganda are able to procure it. Where it can be commercially purchased, the product is either prohibitively expensive due to diminishing supply, being dangerously sold past its expiration date, or both.
This lack of lube and the broader shaming of sex in Uganda may well result in more vaginal and urinary tract infections, and more sexually transmitted infections — including HIV.
“We need to not be judged.”
People have started using “cooking oil, unhygienic products” or “nothing at all,” said Babu Ramahdan, an LGBTQ+ and human rights activist who is on his way to becoming an unlikely Ugandan lube manufacturer. “I’ve got all the ingredients,” he says with pride, and he’s already made some samples (including in different flavors). He even met with university researchers eager to help him produce it domestically. But for Ramahdan, getting his product through clinical trials may prove as difficult as finding funding: In Uganda, as in large swaths of the United States, gaining institutional approval to research anything seemingly related to LGBTQ+ health has become almost impossible.
Condoms, too, are harder to find. They are not being given away freely with the same frequency, so those who need them increasingly must buy them. But they are economically out of reach for those who need them most in a country where the average income is less than $100 a month. Interviews with 10 patients and practitioners at a clinic run for and by sex workers revealed the stark economics: Sex with a condom goes for as little as 2,000 shillings (less than 50 U.S. cents) and up to about 6,000 ($1.50). But a condom costs a sex worker 3,000 to 4,000 shillings (between 75 cents and $1) — meaning they might lose money having safe sex. Sex without a condom pays much more: up to 10,000 shillings (about $2.50).
The newfound scarcity of lube and condoms illustrates just one example of how Trump’s policies have disincentivized safe sex and encouraged the transmission of disease in Uganda — not just among sex workers and their clients, but also among men who have sex with men, transgender people, those who use injection drugs, and poor people. In Uganda, these people are euphemistically called “key populations,” or KPs, most at risk for HIV (terms that acknowledge or even hint at queerness have been long avoided, and since Trump was elected, that’s the case even for euphemisms like “minority”).
“We need to not be judged,” one sex worker said, describing her health care needs. “We need to be asked by a doctor, ‘What are your needs?’ We need to feel safe answering about the kinds of sex we have. We need to be listened to, honestly.”
But since the stop work order came on January 20, 2025, for projects funded by the United States, the kinds of clinics where KPs like her will not be judged have either closed with little or no notice or become overburdened by a lack of resources, an influx of clients, or both. This has pushed KPs toward Uganda’s public hospital system, where seeking care means putting themselves at risk of persecution from a homophobic government.
The sex worker who wished to not be judged is one of several who told The Intercept that women in Uganda who test positive for syphilis test three times at a public hospital are denied medication, accused of being a sex worker, or even turned over to the police. (The latter means she could be arrested, extorted, or raped.) People living with HIV report that if they seek antiretroviral medication at a public hospital, their privacy may not be respected and their HIV status may be exposed to their neighbors. Queer men, fearful of potentially being referred to the police for “aggravated homosexuality” and prosecuted under Uganda’s Anti-Homosexuality Act, often skip seeking health care at public hospitals altogether.
These fears are not confined to so-called KPs: They are making patients who may be suffering from anal fissures, vaginal infections, or rectal cancer refrain from seeking care because they are too afraid. In a country where abortion is illegal and more than 1 million people are living with HIV, this campaign of anti-queerness will result in more people forced to have children they do not want, more people becoming infected with HIV, and without medication, more people eventually dying of AIDS.
In November 2025, almost a year after Trump’s global stop work order, it was nearly impossible to drive anywhere in Kampala and avoid the profile of a mustached man in a white shirt and Panama hat against a stark yellow background.
It was the height of Uganda’s election season, and President Yoweri Museveni was running for a seventh term as Uganda’s president. His face — sometimes rendered several stories in height — was inescapable. At age 81 and already president for four decades, Museveni would soon secure another term after an election in which he shut down the internet and his opposition candidate claimed to have been abducted. Museveni will serve at least 45 years as president of Uganda, if he doesn’t die in office.
Accompanying his 50-foot-high face was the phrase “Protecting the Gains — as we make a qualitative leap into high middle income status.”
Seeing this propaganda spelled out over Uganda’s unpaved roads (and even a UNICEF school made out a fraying tent) led Ugandans who spoke with The Intercept to ask: What gains?
Uganda is not without any resources. It is known as the “pearl of Africa,” a term perhaps first coined by Winston Churchill while on a safari to describe Uganda’s beautiful plants and animals. Today it applies to American, European, and Chinese interest in Uganda’s bounty of rare earth minerals. Uganda is also the birthplace of the River Nile, which not only feeds Northern Africa with fresh water but also the foundations of Western religion — like the story of Moses in the reeds in Judaism, Christianity, and Islam.
But Uganda has been subjected to what Guyanese historian Walter Rodney has called the deliberate European underdevelopment of Africa. Largely falling historically into five Bantu kingdoms, modern Uganda was colonized in the 19th century, with the Imperial British East Africa Company claiming control of the region in the 1880s. (Anti-queerness was part of the colonial playbook: Despite local ways of living that today might be described as queer or trans, when the British Empire named Uganda a colony in 1894, it criminalized queer sexuality by way of Penal Code Section 377, which punished “whoever voluntarily has carnal intercourse against the order of nature with any man, woman or animal.”)
Amid a wave of anti-colonial resistance in Africa, Uganda shook Britain off in 1962. But over the course of six decades of independence, Uganda’s presidency has been defined mostly by two men.
Idi Amin, Uganda’s third president, often cast as a brutal dictator in the West, is remembered, among other things, for expelling all British and 80,000 members of Uganda’s Indian community. Locally, he is remembered as “Big Daddy.” (Among those calling for recasting Amin as a more sympathetic anti-colonial figure is one of those Ugandans whom Amin expelled: Mahmood Mamdani, author of “Slow Poison: Idi Amin, Yoweri Museveni, and the Making of the Ugandan State” and father of the newly elected Uganda American New York City Mayor Zohran Mamdani).
“Why have we been relying on the United States for 20 years? Why hasn’t my government made this a priority for us?”
Museveni, Uganda’s ninth president, has ruled since 1985, coinciding with the AIDS era. He quickly became a major face of Uganda’s “ABC” approach to HIV: Abstain before marriage, be faithful in marriage and — if you fail at those two — use a condom. Ugandan HIV prevention workers who did not wish to be named for fear of persecution describe Museveni as indifferent to the crisis and having outsourced all responsibility to foreign funding.
For instance, as one medical doctor put it, when PEPFAR began funding HIV medication in the early 2000s, “it was supposed to be an emergency plan. It’s right there in the name,” the President’s Emergency Plan for AIDS Relief. “Why have we been relying on the United States for 20 years? Why hasn’t my government made this a priority for us?”
As he managed to retain power for decades, Museveni increasingly turned a tactic of social control favored by political leaders from Vladimir Putin in Russia to Keir Starmer in England to Trump in the United States alike: Whipping up a moral panic about LGBTQ+ people.
All of this history made it so that when public health workers in Uganda encountered what they called the “three disasters” of their recent history, it was hard to recover.
The first occurred on March 21, 2020, when the first Covid-19 case was reported in Uganda, which led to strict lockdowns that made HIV care very difficult to provide.
The second struck in the spring of 2023, with the passage of Uganda’s Anti-Homosexuality Act. It made “aggravated homosexuality” punishable by death and “promoting homosexuality” — which could include gatherings of LGBTQ+ people, discussions to plan HIV prevention, and every meeting attended by The Intercept in reporting this story — punishable by up to 20 years in prison. The standard penalty for consensual same-gender sexual acts is life imprisonment.
The Anti-Homosexuality Act passed after evangelical missionaries from the United States spent years, and tens of millions of dollars, spreading homophobia in Africa in general and in Uganda specifically. Of the $54 million spent by more than 20 U.S. evangelical groups in Africa’s 54 nations from 2007 to 2020 “to influence laws, policies, and public opinion against sexual and reproductive rights,” about a third went to Uganda, according to OpenDemocracy.
And the third disaster came on November 5, 2024, when Trump was reelected. Not only did PEPFAR and USAID funds quickly disappear, but strict restrictions were also placed on the little aid that survived. For example, PrEP — pre-exposure prophylaxis, which prevents HIV infection — could no longer officially be given to those most at risk, such as sex workers or gay men, but only to pregnant and nursing mothers.
And yet, despite the “three disasters,” dedicated queer and trans Ugandans — many who could flee to exile to secure their own personal safety — refuse to give up trying to protect the health of their community, even as they’re being crushed.
Things are so bad under Trump, some Ugandan health care providers are pining for George W. Bush.
“George Bush Jr., is my best friend,” Dr. Edith Namulema, chief of the HIV/AIDS Counseling and Home Care Department at Mengo Hospital in Uganda, told The Intercept.
Over the sound of chirping tropical birds, Dr. Namulema spoke in a large, breezy part of her ward that is mostly used to treat patients with tuberculosis, who slept on the other side of thin blue curtains. Just outside was an adjacent clinic room with a roof but no walls for treating people with HIV, where patients were having their blood drawn by smiling young phlebotomists in dark blue scrubs.
Namulema never met Bush. But despite his global trail of destruction spurred by his war on terror — and his generally homophobic domestic agenda — such effusive praise for “Bush Jr.” is common among African AIDS researchers and doctors.
Namulema has worked with HIV since the 1990s, before there were medications that prevented an HIV diagnosis from becoming a guaranteed AIDS death sentence. For years, she buried one patient after another.
But when Bush made antiretroviral medication available circa 2001 via PEPFAR, she saw the deaths begin to slow within a week.
A nurse at Universal Love Alliance described a startling shift in the first year of Trump’s second term. “I have seen people die with HIV before,” she said. “But I rarely saw someone die because they could not adhere to their medications.” Over the last decade, the nurse witnessed maybe one death per year due to a patient failing to take their medication. In 2025, she saw this happen 10 times.
Every nurse and HIV peer educator in a community clinic who spoke to The Intercept said they have seen an uptick in HIV-diagnoses and related deaths. Official statistics do not show this trend — sources say it’s because they are not able to record “KP data.” The Trump cuts have, predictably, caused a chaotic data scenario. The Uganda Ministry of Health predicts four Ugandans are becoming infected with HIV every hour. Meanwhile, the Uganda AIDS Commission reported a “sharp fall” in AIDS-related deaths of 64 percent to the Parliament in October.
One doctor interviewed by The Intercept at a large hospital said they have not seen an increase in HIV positivity, but attributed it to the fact that “KPs are in hiding” and the hospital lost all funding to hire people to go where KPs dare to live.
En route to a “KP clinic” in Kampala, The Intercept rode in a four-wheel-drive Toyota. The passengers included Samson, who fled his rural village town for Kampala when he realized the other boys were trying to burn him with acid because he was gay, and Kukunda Sharon, a former school instructor who goes by “Teacher” and “had to escape” her village when her lesbianism was met with an attempt to coerce her into a forced marriage; she is now associate director of Universal Love Alliance.
Even in Kampala’s center near the U.S. Embassy — an intimidating imperial outpost that takes 10 minutes to drive around — the roads are not great, but at least they are paved. But as the SUV sloped downhill, it traveled onto rough red clay roads lined by open gutters of untreated sewage. The buildings grew lower, then came single-story metal roofed shacks, where people live largely without electricity or plumbing.
Nearly 7 million people live in Kampala, and yet the city has no functional train or bus system. Kampalans move about in “taxis” (minivans that seat 14, which LGBTQ+ people consider too dangerous), or on the back of “boda boda” motorbikes. Such movement is difficult for people who are sick and, given the high price of petrol, it is economically prohibitive; gas is roughly the same price as in the United States, even though the average income in Uganda is just about 1 percent of America’s average income. People walk long distances on roads without sidewalks to get where they need to go — nearly impossible for sick people.
Thus when it comes to treating HIV effectively, it is necessary to have many clinics spread throughout the city’s poorest areas so that people living with HIV can come for their medical care, or have their medicine delivered. A year ago, the Ugandan Health Ministry announced it would be shutting all HIV/AIDS and tuberculosis clinics in the country. According to Sky News, one official said the closure of HIV clinics was a necessary response because of the loss of funding from USAID. Also shuttered were standalone pharmacies supplying antiretroviral drugs. Millions in Uganda, especially the more than 1 million people living with the virus, depend on these facilities to provide HIV treatments and preventative therapies. According to an International Planned Parenthood Federation survey published in December 2025, some 1,175 affiliated IPPF health sites closed across Africa, affecting 396 staff positions and 5.9 million clients due to the funding changes. Thousands of health workers in Uganda — including doctors, nurses, and community experts — have lost their jobs.
The Intercept visited one of the few “KP clinics” still operating, despite a government raid and threats of arrest for its staff. It sits in a compound behind a wall, just off of a busy street. It is extremely hot, without air conditioners or fans in any of the simple examination and testing rooms.
Staff members from three of the remaining KP clinics gathered here to speak with The Intercept in a room that usually hosts group therapy, whenever a trustworthy volunteer therapist can be found.
At first, the conversation was taciturn. The meeting is technically illegal, the gathered medical workers weren’t all familiar with each other there, and there are always worries in such get-togethers that someone might be a spy. But after sitting on the floor and eating samosas, “the boys” — as these young men refer to themselves and each other — begin to open up.
They talk about the cuts. At one clinic, salaries were reduced by 50 percent. At another, the staff was trimmed from 15 to just four — a medic there says he’s wracked with survivor’s guilt. He tells a common story: He was a preacher’s son who knew he was different. It wasn’t until he went to the clinic looking for sexual health information that he could even talk to anyone like himself. He fell into a global pattern in queer health — largely destroyed by Trump — in which someone goes to a clinic for services, then becomes a volunteer, then starts working there and helping others.
“It was the only place I could just be … me,” he said, with a heavy sigh, indicating he did not have to hide appearing gay. He loved working with “the boys” and was gutted that 11 co-workers lost their jobs. Most of them, he said, still show up at the clinic and work unpaid for three reasons: “They have nothing else to do,” “There is nowhere else to go for them to be themselves with other people,” and “for food” available at the facility.
When people with little or no money have to choose between food and HIV medications, they will always choose food.
Two suddenly gregarious medical assistants (also both preachers’ kids) talk with candor about their shared situation: Being gay meant both had to leave their families and their churches. One said he’s still happy to go to work despite seeing his wages cut in half, but is dismayed that the cuts mean he simply cannot offer the care that clients need. The number of people they treat has plummeted. This is in part because USAID cuts took away money for the clinic’s staff to make outreach tours to sex work and gay “hot spots.” It’s also because the clinic used to feed clients who came in for the treatment. The free food helped mitigate the cost to patients for traveling to the clinic and is necessary because HIV medications don’t work for people who aren’t consistently eating enough. (When people with little or no money have to choose between food and HIV medications, they will always choose food.)
“We used to give away bags of food two times a week,” he said. “Now, we have only given it out two times this whole year, which is basically nothing.”
The Trump-era cuts have pushed KPs out of other medical settings, he said, which makes them wary of trusting any medical care. When USAID money was flowing, he said, patients told him that they were tolerated when they sought care at a public hospital because the workers there knew they would be compensated. But since the cuts, “some of our patients tell us they’ve been told, ‘There’s no money in you now. Go away.’”
Referring people to get viral load tests — an important step in managing HIV care — has also become nearly impossible in Kampala. It’s not just that the U.S.-financed health care workers who did the tests were laid off; some of them took the equipment with them when they left.
Then, there’s the issue of medication. The U.S. still pays for some antiretrovirals. But while The Intercept saw ample supplies of emtricitabine and tenofovir, the most common antiretrovirals, at most clinics visited, not everyone can take that treatment. When people fall out of treatment, they may grow resistant to specific medications and need a different combination should they survive long enough to restart medication in the future. But since the cuts, little aside from the common combo is available to treat HIV; doctors say it is almost impossible to get anything else.
“When someone comes looking for something they need” and a clinic doesn’t have it — whether it’s food, medicine, or just a kind ear to listen to them — “they usually won’t come back,” one of the medical assistants said.
Then, they’ll become infectious and HIV will move throughout their networks.
The boys were already seeing bad trends. They used to see a positive HIV diagnosis every two or three months. Now they said they are seeing one a week.
Asked by The Intercept if they, or their patients, are able to use geolocation hookup apps like Grindr, the boys laugh.
“Yes,” they answer.
“How?”
“VPNs. People have needs.”
“But how do you know someone isn’t a cop?”
“You don’t!”
“What can you rely on to lessen the chances he’s a cop?”
“Luck!”
“Sometimes,” another health worker chimes in, “a guy will meet another guy on Grindr, have sex with him, and then arrest him.” In theory, this kind of undercover sting could lead to prosecution for “aggravated homosexuality,” but mostly, cops do this for extortion, which is rampant. By the end of 2025, Uganda’s Human Rights Awareness and Promotion Forum had “handled a total of 956 cases involving actions specifically targeting LGBTQ+ persons,” which have affected 1,276 individuals, since the implementation of the Anti-Homosexuality Act in 2023.
And that fear of prosecution and harassment keeps people who may have HIV or even signs of cancer from seeking medical treatment.
“Here, we do not tolerate trans people,” said Gabbie, who is trans. “It is as simple as that.”
Ramahdan, the LGBTQ+ activist, along with Samson and Sharon of Universal Love Alliance, have set up a meeting with a dozen trans and gender-nonconforming people in a conference room at a hotel near the Gaddafi Mosque. It is not a “gay hotel” — no such thing exists in Kampala. It was chosen because it is trusted by the community to be friendly enough and discreet. Security is a huge concern for everyone. The trans Ugandans span late teens to mid-50s, and their body language reveals nervousness: Any time a waiter comes into the room through a swinging door, everyone falls silent until they leave.
Their fear is understandable. A show of hands reveals everyone has been arrested at least once. At the municipal jail, they said they have been tortured (forced to strip and humiliated in front of all the other detainees), sexually assaulted (sometimes under the pretense of checking their gender, sometimes not), and even raped. A Muslim trans woman (who wears both a hijab and also a mask to protect against Covid) was arrested on her first-ever date with a man. (People in the room chuckles knowingly when she shares that the date did not intervene when the police took her away, and she never saw him again.)
When arrested, trans women are often put into men’s holding area, at least initially; they are terrified of becoming infected with HIV from rape. Most everyone has been kicked out of their families of origin or lost jobs (usually when a relative has outed them).
Fear of being subjected to the “queer tax” — when a landlord charges more or an employer pays less under threat of outing — was universal in the group. One young trans man, not yet 20, cried when describing his fear to even leave his house. His landlord figured out he is trans and was trying to evict him, but he cannot move until he pays off the extortion money. (The group took a collection to pay off his debt.)
The extortion threat has only grown with the collapse of USAID. At a follow-up meeting at a Kentucky Fried Chicken a few days later, Gabbie arrived after an expensive two-hour journey on a trans-friendly boda boda. “You cannot afford for random drivers to know where you live,” she said. (Another trans person The Intercept interviewed in a homeless shelter said they would take three boda bodas from home to work, switching rides like a spy to keep anyone from being able to trace her.)
Gabbie has been pushed from her family to a queer church shelter, which was raided and evicted, to another group situation, that was also raided and evicted. She now shares a studio apartment with four trans women at the outskirts of Kampala. Their water and electricity are periodically turned off for non-payment, and they open the windows when they cook on a coal stove to avoid breathing carbon monoxide.
Gabbie dropped out of college when her family saw a video of her preaching in a queer-affirming church, cut her off, and told her never to come back. Six months later they invited her back, then locked the gate behind her; she was trapped in an exorcism and had to escape over the wall.
It was never easy to be trans in Uganda. Surgeries — even those performed abroad — are almost unheard of, and long before Trump it was difficult to source hormones. Since Trump’s reelection, Gabbie has found that it’s theoretically possible, if prohibitively expensive, to source hormones on the black market. There is the physical danger: Injecting hormones with unsterilized syringes from unverified sources without a doctor’s supervision exposes trans people to HIV, hepatitis, and the possibility of dangerous, even lethal, side effects. But part of why Gabbie has stopped taking hormones and is now passing as a man in public is because sourcing hormones on the black market “opens you up to extortion” by anyone along the supply chain. She can’t afford that. (While in the West, most trans people use the terms “passing” to refer to being accepted as their true gender, in much of Africa, many trans people use it to refer to “passing” for the gender assigned to them at birth.)
The cuts hit Gabbie’s job at a trans-affirming nonprofit, where the staff was reduced from five people to just one: Gabbie. The office was abandoned, and she only works part-time, out of the studio she shares with four people.
“It was very painful, returning to this body, this body I do not want.”
Gabbie is also a model, and hopes to feel free presenting as her true feminine self at least while at home with her roommates. But they’ve been raided doing that, too. On her phone, she showed The Intercept a series of photos. In the first few, she and her girlfriends are happy, decked out in high glam in their apartment. But in the last photo, in an image reminiscent of the 1969 Stonewall Riot arrest photos, she is crying in the back seat of a police car. Their house had been raided, presumably on a complaint from a neighbor. After six weeks in jail, she was released without charges. But the damage was done: She made the difficult decision to stop her transition — to “go stealth,” as she put it, in public as a man.
“It was very painful,” she said, “returning to this body, this body I do not want.”
She hopes one day to transition again. “You can’t not be yourself 24 hours a day,” she said, sniffling slightly, her eyes darting around the KFC, hoping no one would notice her tears or hear us.
Two weeks later after the meeting at the Kampala KFC, Gabbie texts pictures of herself in a graduation robe. Without her family’s help, it took her a few more years than she wanted. But she had graduated from university, with a degree in accounting — which she wants to use to secure more resources for LGBTQ+ work in Uganda.
Near a sex “hot spot,” there is a clinic for sex workers. Inside the open garage door of a modest house, a half dozen sex workers were waiting for treatment. A medic draws a patient’s blood. One patient bounced an infant gently to soothe its cries. Another laid her newborn gingerly on the floor on a blanket; he smiled up at all the faces smiling down at him.
Up until the Trump stop work order, this clinic was run by a team of 17, including medics, peer educators, and community health navigators. They went out and recruited patients, educated them on STIs, and followed up with people to keep them adherent on antiretrovirals. Ten people lost their jobs, and the number of medics dropped from 12 to five. Those who remain have seen steep pay cuts: Average earnings fell from 800,000 Uganda shillings a month (about $222 USD) to just 250,000 (about $70).
As a “stud lesbian,” one sex worker tells The Intercept, this kind of clinic is the only place “where I can ask a doctor about my needs.” Most doctors assume she has sex with men, and until she sought out this clinic, she had no idea what was safe, or not, in her ways of having sex.
The situation for lesbian women in Uganda is dire. “You are forced into a marriage you do not want. You are forced into getting pregnant with a baby you do not want. In a body you don’t want. And you cannot get an abortion, and so you are forced into having a baby and raising a child you do not want,” said one queer sex worker.
It has become harder to insist their customers use condoms — if they can even afford them.
Sex work has grown more difficult since the cuts. Beyond health expenditures, USAID paid for construction projects and conferences. “When people are in town for a conference, they have money to spend on entertainment: on restaurants, on hotels, on us,” one sex worker put it. But USAID stopped most of that.
With laid-off people turning to sex work, more Ugandans are trying to sell sex to fewer customers. This is economically deleterious, making it harder for the workers to dictate the terms of their encounters. The result is that they have less power in the kinds of sex they are willing to have. It has become harder to insist their customers use condoms — if they can even afford them.
The clinic is struggling to keep up with their clients’ urgent needs. There’s a sudden lack of STI medication. HIV self-testing kits have become almost impossible to source, condoms are scarce, and lubricants “disappeared entirely,” said the clinic’s project manager.
“When you use too many men, you get dry,” the project manner noted, “and you can’t avoid the condom breaking.”
PrEP and birth control pills could theoretically help prevent HIV and pregnancy. Uganda adopted oral pre-exposure prophylaxis in 2016 and by the end of December 2023, over 550,000 clients had initiated the treatment. But since the cuts, PrEP is not officially available to most sex workers — only to pregnant women and nursing mothers. Birth control pills were paid for by USAID; now they are prohibitively expensive.
Trump isn’t alone in his policy of foreign austerity. The United Kingdom and the Netherlands, along with some private funders, have followed Trump’s lead in cutting off any money to Uganda that might help trans people. (We document this funding crisis in our short film “A Visit to the Homeless Shelter for Trans Ugandans.”)
There is some hope on the horizon for more foreign aid, but questions remain about how much of it will reach the country’s so-called KPs.
On December 10, the U.S. and Uganda signed “a five-year, nearly $2.3 billion bilateral health cooperation agreement that signifies the importance of the relationship between the two countries,” in which “the United States plans to invest up to $1.7 billion to combat HIV/AIDS, tuberculosis (TB), malaria and other infectious diseases across Uganda while helping strengthen Uganda’s health system.”
No one who spoke with The Intercept spoke expected this money could undo the lost trust, unemployment, and damage of the last year — nor did they expect such efforts to make their way to KPs. One public health activist, who did not want to be named for fear of persecution, claimed that “that money is not for health, it was given a month before the elections. That money was for elections.”
Dr. Peter Kyambadde, the senior program officer at the Ministry of Health, said, “Key populations still remain among the prioritized populations for epidemic control” but admitted that “how much of those resources will be committed to key populations” remains an open question.
“They consider us criminals.”
Samson, of the Universal Love Alliance, did not believe any government resources will flow their way. “What you see Trump doing in the United States aligns with Uganda’s goals. They consider us criminals.”
The potential return of U.S. health funding comes as an injectable form of PrEP that lasts for six months called was just approved for use in Uganda. The medication is considered a breakthrough in HIV prevention that, if distributed widely enough, has the potential to eradicate the virus.
But only 1,000 doses of the shot have been delivered to Africa, and none to Uganda.
It costs $28,000 a year. A $40 generic version won’t be ready until at least 2027. And the distribution channels in Uganda — namely the clinics where patients trust they could access such a drug without risk — have largely been undermined or destroyed.
This essay is part of the series Global Stop Work Order, featuring reporting about how the Trump administration’s cuts are affecting LGBTQ+ health and HIV/AIDS around the world. The series is supported by a Pulitzer Center Global Reporting Grant and the Fund for Investigative Journalism.
The post By Slashing Foreign Aid, Trump Is Fueling the Spread of HIV in Uganda appeared first on The Intercept.
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Author: Steven W. Thrasher
