The sudden withdrawal of US foreign aid is unforgivable

The US government’s freeze on foreign aid funding is devastating for people living with HIV—in Uganda and globally. I ask myself what it is going to be like having to return to the challenges of HIV care we experienced in the 1990s. Many of us in our 50s to 70s living with HIV today remember how our survival was enabled by the AIDS Support Organisation which was founded in communities in Uganda in 1987 and has been partially supported by the United States Agency for International Development (USAID) and other donors. Many had to survive on second hand HIV drugs from deceased patients in Europe and the US. Pill collection centres were established by advocates in the global south and coordinated with advocates in the global north. Advocates would attend international conferences to collect left over pills to send to Uganda. We subsisted this way until the 2000s. More recently, with steady uninterrupted antiretroviral therapy supplies we got a second lease of life, thanks to the US Presidential Emergency Fund for AIDS Relief.

After more than 20 years USAID has suddenly been halted, as directed by US president Donald Trump.1 Contract terminations are rife across the world, including for projects, medical supplies, and services for people with HIV. “Making America great again” has come with a toll, especially for countries that are resource limited. The Ugandan government affirmed swift integration of health services to fix the gaps, while HIV and tuberculosis standalone clinics have been “collapsed” into outpatient clinics. With no warning, funding decisions in the US are causing widespread damage across the world.

There are about 1.5 million Ugandan people living with HIV,2 including those who are virally non-suppressed, who need personal peer and psychological support and counselling but have now lost touch with their support buddies because of aid cuts and stop work orders. People with HIV, especially those who are newly diagnosed, grapple with stigma, discrimination, HIV related intimate partner violence, and lost social and educational support. Community health workers who live far from their patients cannot travel to see them regularly, since laptops with data, bicycles, and motorcycles linked to USAID funded projects have been withdrawn. The pain of knowing that a mother, baby, or colleague will progress to advanced HIV or AIDS and finally die is a heavy burden.

This sudden withdrawal of funds is unforgivable and will result in deprivation of care and preventable deaths. Health workers have also lost their livelihoods. The impact of lost jobs is immense, the mental anguish caused is indescribable, and the financial cost will be substantial. Across nations, people of all ages, gender, race, creed, and geographical locations have felt the funding freeze. Millions will be harmed by this targeting of the most powerless, most vulnerable, most criminalised, most marginalised, most unprotected people in the world. For many countries, including mine, this is a time bomb. HIV services in 50 countries have been affected by the aid freeze.3 The extent of this emergency will become apparent when the next annual reports and indicators reflect a worsening trend of HIV and other diseases, beyond what we saw in the covid-19 pandemic.

We must not accept this aid freeze silently and meekly. Countries and individuals must reorganise and respond immediately. National budgets need to reflect a greater investment in healthcare services and support. Local industries and manufacturing must increase production and be subsidised by our governments to produce affordable medical products. Communities must remind ourselves what we did in the 1990s to sustain our lives before antiretroviral treatment, we must remember our value—our “Ubuntu,” which translates to “our humanity towards others.” Individuals, donors, the private sector, and philanthropists need to work quickly to help networks of people living with HIV across the world to fund and sustain community based, life saving support. We must reach out to patients, communities, and families and refer them to the available social support services to avert an impending crisis in mental health and other diseases.

As communities and patients we must continue to engage and challenge those in power and provide each other moral support and solidarity. We must remain positive as we co-create local solutions to this global challenge.