‘People will die’: Chaos and mounting fear in Uganda as USAID cuts lead to ‘total panic’ and HIV clinic closures
In what will be seen as a signature act of the new Trump administration, the president and his team have denounced and dismembered the US government’s international assistance arm, USAID, in a matter of three weeks.
It is a decision that will have serious, real-world consequences – and the impact is already being felt in countries such as Uganda.
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The health ministry in Uganda has announced its intention to shut all dedicated HIV/AIDS and tuberculosis (TB) clinics in the country. Stand-alone pharmacies supplying antiretroviral drugs will also be closed.
These facilities provide HIV treatments and preventative therapies to millions of people in Uganda, including an estimated 1.5 million currently living with the virus.
An official said the closure of HIV clinics was a necessary response as the country grapples with the loss of funding from USAID.
The cuts have sparked protests outside USAID’s now-closed building in Washington DC. Pic: Reuters
Directors and staff at the country’s public hospitals have been instructed to offer the same services at their outpatients and chronic care departments.
A USAID initiative called the President’s Emergency Plan For AIDS Relief – or PEPFAR – has bankrolled much of Uganda’s HIV/AIDS relief plan and it’s an initiative that has wielded impressive results.
Specially trained staff and dedicated clinics are credited with bringing infection rates down from 19% in the late 1990s to 5% in 2024.
‘We are still reeling’
Flavia Kyomukama, from the National Forum of People Living with HIV/AIDS Networks Uganda (NAFOPHANU), said she was stunned by Donald Trump’s decision.
“We are still reeling from the shock of what they have done, it is very difficult to understand,” she said. “There was a memorandum of support [between both countries], there was roadmap [towards zero infections] and they make this decision in a day.”
Flavia Kyomukama
Shifting HIV/AIDS-related care to public hospitals is deeply problematic, Ms Kyomukama added.
These facilities are often overwhelmed, and they offer little, or no, privacy. It is a serious issue in a country where those carrying the virus are badly stigmatised.
“Surveys show 30% of health workers have a negative attitude towards people with HIV,” Ms Kyomukama said. “So, we’re going to see [patients] dropping out [of their treatment plans], drug resistance will increase and we will see more violence in hospital as people with HIV get attacked.”
World is worryingly dependent on US – it now faces a major shock and impossible choices
The Trump administration’s destruction of USAID will bring about the virtual collapse of the international aid and development system, experts have warned.
The US government puts far more money into humanitarian assistance than any other country.
In 2023, the most recent year for which data is largely complete, the Americans disbursed $71.9bn (£57bn) in foreign aid, representing 1.2% of total US government spending.
It is a spending commitment that has remained remarkably consistent over the years.
The Americans underwrite programmes in 177 individual countries with Ukraine registering as the biggest recipient in 2023. It received $16.6bn (£12.9bn) to maintain government services after the Russian invasion.
PEPFAR, USAID’s best-known initiative, provides antiretroviral treatments to 20 million people infected with HIV/AIDS.
The initiative supports NGO-run groups with an extended workforce of 350,000 people – with many employed at local clinics.
The US also bankrolls key UN organisations, such as the refugee agency (UNHCR). Its total budget of $4.8bn (£3.8bn) is propped up by the Americans, who put in US$2bn (£1.6bn).
Without this funding, it is difficult to see how UNHCR can continue to support tens of millions of refugees in countries including Sudan, Syria, Turkey and the Democratic Republic of Congo.
If the residents of refugee camps are not supported with basic services, they are likely to move.
The question then is how US funding compares to other donors – and the answer is startling.
According to the UN’s real-time financial tracking service, Germany contributed funds in 2024 representing 8% of total humanitarian aid contributions, as did the European Union, with the United Kingdom at 6%.
The world, then, is worryingly dependent on the United States.
Former international aid worker turned consultant Thomas Byrnes said: “The modern humanitarian system has been shaped by a long-term commitment from the US.
“For decades, organisations like the UN agencies have relied on this predictable funding stream to address global crises.
“The world faces a major shock and I don’t think anyone is prepared for it.”
To alleviate the situation, Mr Byrnes said other donors – such as the UK and Germany – will need to make up the funding shortfall from USAID.
But that is highly unlikely to happen.
The United Kingdom, currently contributing $2.1bn (£1.7bn), would need to contribute an additional $1.5bn (£1.2bn) – representing a 74% increase.
For Germany, the required extra contribution would be $1.8bn (£1.5bn), representing a substantial increase of 70%.
Furthermore, Trump’s move comes at a time when Germany, France, Sweden and others are planning deep cuts to international aid.
The world is looking at a colossal funding gap – and a colossal crisis – as the number of people in need of humanitarian assistance rises to 305 million people, Mr Byrnes added.
“We’re facing a perfect storm,” he said. “The brutal math means we’re heading toward humanitarian aid of just 17 cents per person per day.
“This isn’t a funding dip – it’s a systemic shock that will force impossible choices about who receives help and who doesn’t. People will die as a result of this.”
‘It’s total panic right now’
Brian Aliganyira is the director of Ark Wellness Hub, a busy health clinic for the LGBT+ community in Uganda’s capital, Kampala.
The clinic has sourced supplies – such as antiretroviral drugs, preventative ‘PrEP’ therapies and testing kits – from partners who are underpinned by USAID.
Now, the 37-year-old has got a major problem on his hands.
“It’s total panic right now,” he said. “Our response teams are panicking and there is a lot of panic in the community.
“We are telling people to go home and it’s not just [our clinic]. There is no more medication left – or maybe there’s one refill at the most. But people keep asking us, ‘have you got any extra, any extra’?
“Without the support we need, HIV will surge and people will die.”
Brian Aliganyira
‘Lives will be lost’
There are some still clinging to hope.
On 1 February, US secretary of state Marco Rubio issued a waiver exempting the PEPFAR programme from the new administration’s cuts to foreign aid.
However, President Trump issued a contradictory order banning programmes designed to “advance equality and human rights for lesbian, gay, bisexual, transgender, queer, and intersex people”.
Read more:
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Funding gap leaves South Africans in turmoil
Donald Trump and Marco Rubio have given contradictory messages about parts of the USAID cuts. Pic: AP
The result in Uganda is chaos – and mounting fear.
“Really, we are grieving about this, we are grieving,” Ms Kyomukama said. “Livelihoods will be lost – and lives will be lost.”
US
Most advanced US aircraft carrier arrives close to Venezuela as Donald Trump administration builds-up forces
The most advanced US aircraft carrier has travelled to the Caribbean Sea in what has been interpreted as a show of military power and a possible threat to Venezuela’s Nicolas Maduro regime.
The USS Gerald R Ford and other warships arrived in the area with a new influx of troops and weaponry on Sunday.
It is the latest step in a military build-up that the Donald Trump administration claims is aimed at preventing criminal cartels from smuggling drugs to America.
Since early September, US strikes have killed at least 80 people in 20 attacks on small boats accused of transporting narcotics in the Caribbean and eastern Pacific Ocean.
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Mr Trump has indicated that military action would expand beyond strikes by sea, saying the US would “stop the drugs coming in by land”.
The US government has released no evidence to support its assertions that those killed in the boats were “narcoterrorists”, however.
The arrival of the USS Gerald R Ford now rounds off the largest increase in US firepower in the region in generations.
With its arrival, the “Operation Southern Spear” mission includes nearly a dozen navy ships and about 12,000 sailors and marines.
Rear Admiral Paul Lanzilotta, who commands the strike group, said it will bolster an already large force of American warships to “protect our nation’s security and prosperity against narco-terrorism in the Western Hemisphere”.
Donald Trump said the US would ‘stop the drugs coming in by land’. Pic: Reuters
Admiral Alvin Holsey, the US commander who oversees the Caribbean and Latin America, said in a statement that the American forces “stand ready to combat the transnational threats that seek to destabilise our region”.
Government officials in Trinidad and Tobago have announced that they have already begun “training exercises” with the US military that are due to run over the next week.
The island is just seven miles from Venezuela at its closest point.
The country’s minister of foreign affairs, Sean Sobers, said the exercises were aimed at tackling violent crime in Trinidad and Tobago, which is frequently used by drug traffickers as a stopover on their journey to Europe or North America.
Venezuela’s government has described the training exercises as an act of aggression.
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They had no immediate comment on Sunday regarding the arrival of the USS Gerald R Ford.
The US has long used aircraft carriers to pressure and deter aggression by other nations because its warplanes can strike targets deep inside another country.
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Some experts say the Ford is ill-suited to fighting cartels, but it could be an effective instrument of intimidation to push Mr Maduro, who faces charges of narcoterrorism in the US, to step down.
Mr Maduro has said the US government is “fabricating” a war against him.
The US president has justified the attacks on drug boats by saying the country is in “armed conflict” with drug cartels, while claiming the boats are operated by foreign terrorist organisations.
US politicians have pressed Mr Trump for more information on who is being targeted and the legal justification for the boat strikes.
Elizabeth Dickinson, the International Crisis Group’s senior analyst for the Andes region, said: “This is the anchor of what it means to have US military power once again in Latin America.
“And it has raised a lot of anxieties in Venezuela but also throughout the region. I think everyone is watching this with sort of bated breath to see just how willing the US is to really use military force.”
Republican congresswoman Marjorie Taylor Greene has said she is ready to mend relations with Donald Trump after a high-profile row between the pair.
The former MAGA ally had accused the president of “coming after me hard” over her efforts to get more Jeffrey Epstein files released.
But writing on X on Sunday, she said forgiveness was a “major part” of her Christian faith.
“I’m here to show how it’s possible to settle our differences and move forward as Americans,” she wrote. “That’s why I’m always willing to go on shows with different viewpoints.
“I truly believe in forgiveness and I am open to moving forward with the President.”
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A day earlier, Ms Greene said she was facing threats after a barrage of criticism from Mr Trump – who has called her “wacky”, a “traitor” and a “ranting lunatic”.
Ms Greene claimed “a hotbed of threats” were “being fuelled and egged on by the most powerful man in the world”.
However, her attempt to build bridges appears to have fallen flat.
Mr Trump said on Truth Social on Sunday night that she was trying to portray herself as a victim and “nobody cares about this Traitor to our Country!”
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The row began when a petition to vote on the full release of the Epstein files received enough signatures – including Ms Greene’s – to bring it to a vote in the House of Representatives.
Despite his attacks, Trump said on social media on Sunday that “House Republicans should vote to release the Epstein files, because we have nothing to hide…”
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March 2025: Greene clashes with Sky correspondent
High-profile figures, including Mr Trump, have been referenced in some of the documents.
The president has called the Epstein files a “hoax” by the Democrats and has consistently denied any involvement or knowledge about Epstein’s sex trafficking operation.
The White House has said the “selectively leaked emails” are an attempt to “create a fake narrative” to smear Mr Trump.
Epstein took his own life in prison in 2019 while awaiting trial for sex trafficking charges.
Donald Trump has said he will sue the BBC for between $1bn and $5bn over the editing of his speech on Panorama.
The US president confirmed he would be taking legal action against the broadcaster while on Air Force One overnight on Saturday.
“We’ll sue them. We’ll sue them for anywhere between a billion (£792m) and five billion dollars (£3.79bn), probably sometime next week,” he told reporters.
“We have to do it, they’ve even admitted that they cheated. Not that they couldn’t have not done that. They cheated. They changed the words coming out of my mouth.”
Mr Trump then told reporters he would discuss the matter with Prime Minister Sir Keir Starmer over the weekend, and claimed “the people of the UK are very angry about what happened… because it shows the BBC is fake news”.
Separately, Mr Trump told GB News: “I’m not looking to get into lawsuits, but I think I have an obligation to do it.
“This was so egregious. If you don’t do it, you don’t stop it from happening again with other people.”
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BBC crisis: How did it happen?
The Daily Telegraph reported earlier this month that an internal memo raised concerns about the BBC’s editing of a speech made by Mr Trump on 6 January 2021, just before a mob rioted at the US Capitol building, on the news programme.
The concerns regard clips spliced together from sections of the president’s speech to make it appear he told supporters he was going to walk to the US Capitol with them to “fight like hell” in the documentary Trump: A Second Chance?, which was broadcast by the BBC the week before last year’s US election.
Following a backlash, both BBC director-general Tim Davie and BBC News chief executive Deborah Turness resigned from their roles.
‘No basis for defamation claim’
On Thursday, the broadcaster officially apologised to the president and added that it was an “error of judgement” and the programme will “not be broadcast again in this form on any BBC platforms”.
A spokesperson said that “the BBC sincerely regrets the manner in which the video clip was edited,” but they also added that “we strongly disagree there is a basis for a defamation claim”.
Earlier this week, Mr Trump’s lawyers threatened to sue the BBC for $1bn unless it apologised, retracted the clip, and compensated him.
The US president said he would sue the broadcaster for between $1bn and $5bn. File pic: PA
Legal challenges
But legal experts have said that Mr Trump would face challenges taking the case to court in the UK or the US.
The deadline to bring the case to UK courts, where defamation damages rarely exceed £100,000 ($132,000), has already expired because the documentary aired in October 2024, which is more than one year.
Also because the documentary was not shown in the US, it would be hard to show that Americans thought less of the president because of a programme they could not watch.
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Newsnight allegations
The BBC has said it was looking into fresh allegations, published in The Telegraph, that its Newsnight show also selectively edited footage of the same speech in a report broadcast in June 2022.
A BBC spokesperson said: “The BBC holds itself to the highest editorial standards. This matter has been brought to our attention and we are now looking into it.”
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