‘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.”
They rose to their feet in ecstatic surprise, shouting “heydar, heydar” – a Shia victory chant.
This was the first public appearance of their supreme leader since Israel began attacking their country.
He emerged during evening prayers in his private compound. He said nothing but looked stern and resolute as he waved to the crowd.
He has spent the last weeks sequestered in a bunker, it is assumed, for his safety following numerous death threats from Israel and the US.
His re-emergence suggests a return to normality and a sense of defiance that we have witnessed here on the streets of Tehran too.
Earlier, we had filmed as men in black marched through the streets of the capital to the sound of mournful chants and the slow beat of drums, whipping their backs with metal flails.
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Defiance on streets of Tehran
This weekend they mark the Shia festival of Ashura as they have for 14 centuries. But this year has poignant significance for Iranians far more than most.
The devout remember the betrayal and death of Imam Hussein as if it happened yesterday. We filmed men and women weeping as they worshipped at the Imamzadeh Saleh Shrine in northern Tehran.
The armies of the Caliph Yazid killed the grandson of the Prophet Muhammad in the seventh-century Battle of Karbala.
Shiite Muslims mark the anniversary every year and reflect on the virtue it celebrates, of resistance against oppression and injustice.
But more so than ever in the wake of Israel and America’s attacks on their country.
The story is one of prevailing over adversity and deception. A sense of betrayal is keenly felt here among people and officials.
Listen to The World with Richard Engel and Yalda Hakim every Wednesday
Many Iranians believe they were lured into pursuing diplomacy as part of a ruse by the US.
Iran believed it was making diplomatic progress in talks with America it hoped could lead to a deal. Then Israel launched its attacks and, instead of condemning them, the US joined in.
Death to Israel chants resounded outside the mosque in skies which were filled for 12 days with the sounds of Israeli jets. There is a renewed sense of defiance here.
One man told us: “The lesson to be learned from Hussein is not to give in to oppression even if it is the most powerful force in the world.”
A woman was dismissive about the US president. “I don’t think about Trump, nobody likes him. He always wants to attack too many countries.”
Pictures on billboards nearby draw a line between Imam Hussein’s story and current events. The seventh-century imam on horseback alongside images of modern missiles and drones from the present day.
Other huge signs remember the dead. Iran says almost 1,000 people were killed in the strikes, many of them women and children.
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Officially Iran is projecting defiance but not closing the door to diplomacy.
Government spokeswoman Dr Fatemeh Mohajerani told Sky News that Israel should not even think about attacking again.
“We are very strong in defence and as state officials have announced, this time Israel will receive an even stronger response compared to previous times,” she said.
“We hope that Israel will not make such a mistake.”
But there is also a hint of conciliation: Senior Iranian officials have told Sky News that back-channel efforts are under way to explore new talks with the US.
Israel had hoped its attacks could topple the Iranian leadership. That proved unfounded, the government is in control here.
For many Iranians, it seems quite the opposite happened – the 12-day war has brought them closer together.
To the sound of mournful chants and the slow beat of drums, they march, whipping their backs with metal flails.
It is an ancient ceremony going back almost 14 centuries – the Shia commemoration of Ashura.
But this year in particular has poignant significance for Iranians.
The devout remember the betrayal and death of the Imam Hussein as if it happened yesterday.
Iranians gather ahead of Ashura
We filmed men and women weep as they worshipped at the Imamzadeh Saleh Shrine in northern Tehran.
The grandson of the Prophet Muhammad was killed by the armies of the Caliph Yazid in the seventh century Battle of Karbala.
Shia Muslims mark the anniversary every year and reflect on the virtue it celebrates – of resistance against oppression and injustice. But more so than ever this year, in the wake of Israel and America’s attacks on their country.
The story is one of prevailing over adversity and deception. A sense of betrayal is keenly felt here by people and officials.
Men and women weeped as they worshipped at the Imamzadeh Saleh Shrine
Many Iranians believe they were lured into pursuing diplomacy as part of a ruse by the US.
Iran believed it was making diplomatic progress in talks with America, which it hoped could lead to a deal. Then Israel launched its attacks and, instead of condemning them, the US joined in.
“Death to Israel” chants resounded outside the mosque in skies that for 12 days were filled with the sounds of Israeli jets.
There is a renewed sense of defiance here.
One man told us: “The lesson to be learned from Hussein is not to give in to oppression, even if it is the most powerful force in the world.”
‘I don’t think about Trump. Nobody likes him,’ one woman tells Sky News
A woman was dismissive about the US president.
“I don’t think about Trump. Nobody likes him. He always wants to attack too many countries.”
Pictures on billboards nearby link Imam Hussein’s story and current events. They show the seventh century imam on horseback alongside images of modern missiles and drones from the present day.
Other huge signs remember the dead. Iran says almost 1,000 people were killed in the strikes, many of them women and children.
Officially Iran is projecting defiance, but not closing the door to diplomacy.
Government spokeswoman Dr Fatemeh Mohajerani told Sky News that Israel should not even think about attacking again.
“We are very strong in defence, and as state officials have announced, this time Israel will receive an even stronger response compared to previous times. We hope that Israel will not make such a mistake.”
Dr Fatemeh Mohajerani said it would be a mistake for Israel to attack again
But there is also a hint of conciliation. Senior Iranian officials have told Sky News back-channel efforts are under way to explore new talks with the US.
Israel had hoped its attacks could topple the Iranian leadership. Those hopes proved unfounded. The government is in control here.
For many Iranians it seems quite the opposite happened – the 12-day war has brought them closer together.
World
Two security workers injured after grenades thrown at aid site, Gaza Humanitarian Foundation says
Two American security workers in Gaza were injured after grenades were thrown during food distribution in Khan Younis, the Gaza Humanitarian Foundation (GHF) has said.
In a statement, the US and Israeli-backed aid group said a targeted terrorist attack was carried out at one of its sites in southern Gaza on Saturday morning.
The two Americans injured “are receiving medical treatment and are in stable condition,” it said, adding that the delivery of aid was “otherwise successful” and that “no local aid workers or civilians were harmed”.
GHF didn’t say exactly when the incident happened but claimed Hamas was behind the attack, adding: “GHF has repeatedly warned of credible threats from Hamas, including explicit plans to target American personnel, Palestinian aid workers, and the civilians who rely on our sites for food.
“Today’s attack tragically affirms those warnings.”
Later, the aid group posted a picture on social media, which it said showed “fragments of a grenade packed with ball bearings” that was used in the attack.
Asked by Sky’s US partner network, NBC News, whether the two injured individuals were responsible for handing out aid or were responsible for providing security, GHF said they were “American security workers” and “two American veterans.”
The aid group did not provide specific evidence that Hamas was behind the attack.
The US and Israeli-backed group has been primarily responsible for aid distribution since Israel lifted its 11-week blockade of the Gaza Strip in May.
Read more:
Hamas gives ‘positive’ response to ceasefire proposal
Outcry as Israeli strike hits school
94 killed in Israeli strikes in Gaza, health staff say
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It comes after Sky News analysis showed GHF aid distributions are associated with a significant increase in deaths in Gaza.
According to Gaza’s health ministry, 600 Palestinians have been killed while seeking aid from GHF sites as of 3 July, which charities and the UN have branded “death traps”.
Meanwhile, the Associated Press has reported that Israeli-backed American contractors guarding GHF aid centres in Gaza are using live ammunition and stun grenades.
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Contractors allege colleagues ‘fired on Palestinians’
GHF has vehemently denied the accusations, adding that it investigated AP’s allegations and found them to be “categorically false”.
Israel’s military added that it fires only warning shots and is investigating reports of civilian harm.
It denies deliberately shooting at any innocent civilians and says it’s examining how to reduce “friction with the population” in the areas surrounding the distribution centres.
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