‘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.
Trump latest: President doubles down on Gaza plan
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:
What is USAID?
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.”
As they count the cost of this massive earthquake, the people of Myanmar will be hoping for a silver lining, that the disaster may hasten the fall of their despised dictator.
The catastrophe comes at a very bad time for General Min Aung Hlaing, who seized power in a coup four years ago.
The Myanmar junta is losing a civil war against an array of opposition forces, ceding territory now largely kettled into the country’s big cities. And some of the quake’s worst damage has been done in its urban strongholds.
The disaster is so bad that Hlaing has broken his government’s self-imposed isolation to appeal for help from the outside world. But the country’s inaccessibility will remain a huge obstacle to aid efforts.
Rescuers work at the construction site where a high-rise collapsed in Bangkok. Pic: AP
Making matters worse, President Donald Trump has decimated US aid operations in the country after shutting down the US Agency for International Development. For decades, American aid has provided as much as 40% of developmental aid worldwide. Not anymore.
The US president has promised Myanmar aid for the earthquake. On the same day, his administration was letting go of the last of USAID staff to lose their jobs.
In reality, Trump has fired most of the people most expert at organising help after this earthquake and the means to provide it. This will be the first major disaster to suffer the brunt of his devastating cuts.
Read more:
More than 1,000 killed in Myanmar earthquake
Moment building collapses in Bangkok earthquake
Myanmar is a deeply superstitious country. The generals who have ruled it since the end of colonial rule have consulted astrologers and use talismanic objects and animals, including white elephants, to protect their grip on power.
But earthquakes are thought to portend great change in Myanmar and sometimes the fall of leaders. That in itself may accelerate the toppling of its hated junta.
It remains powerful, supplied by ally China with advanced weaponry. It has used fighter jets to wreak havoc and carnage on opponents and civilians as the civil war has intensified.
But its enemies are gaining strength too, improvising with drones and other tactics to maintain momentum against a regime that lost all legitimacy. They will be encouraged in the belief that this disaster will bring closer their day of victory.
Bangkok felt like it erupted into chaos when the tremors hit.
No one knew what was happening and there was no warning.
In a city where lives are lived, there were suddenly incongruous sights in the sky – pools overflowing, high-rise walkways connecting expensive apartments broken apart, and huddles of confused and scared people outside offices.
The busy skytrain that millions rely on in Thailand‘s capital was shut down, bringing the city to a grinding halt and people struggling to move around.
Read more: Dozens die in Myanmar quake – as 100 missing in Bangkok
Please use Chrome browser for a more accessible video player
Mayhem in Thailand as Myanmar quake shocks
My producer Rachael and I had to share a motorbike to try and get to the scene of the worst building collapse – a slow route through gridlocked traffic.
On arrival, the devastation was clear. A mass of rubble, a sea of rescue workers, and panicked onlookers.
We were told that 90 construction workers were still trapped inside.
One of the men trying to rescue them told me he had heard some voices and was hopeful they would be able to pull people out alive.
But he acknowledged it was “very difficult” work and, as he spoke, we were engulfed with dust, the light already fading as specialist bulldozers were brought in.
Many of those inside, we were told, were Cambodians about to finish building the structure.
Please use Chrome browser for a more accessible video player
Moment building collapses in earthquake
Why no warnings?
As the rescue effort continued, Thailand’s Prime Minister Paetongtarn Shinawatra suddenly arrived.
I asked her why there were no warnings – in a nation that 20 years ago suffered a devastating earthquake.
She did not respond.
But many will no doubt continue to press her government on why there was no emergency alert system, no texts, nothing. Not for hours after, at least.
Read more from Sky News:
Latest updates on earthquake
Eyewitnesses describe quake hitting Myanmar and Bangkok
Rescuers at the site of a Bangkok skyscraper under construction that collapsed after an earthquake. Pic: AP
Pic: Reuters
On the ground, Bangkok felt like a city caught off guard.
There are now fears of aftershocks – as the government moves quickly to try and reassure its people there will be warnings next time.
But in a place where the skyline is dominated by high-rise apartments, buildings and offices, there is a feeling of vulnerability now.
And there are questions about the integrity of their structures and what can be done to protect a population of more than 17 million people.
“It’s cold as s*** here,” said the US vice president when he touched down in Greenland.
He meant it, both literally and metaphorically.
There was no warm welcome from islanders for JD Vance and the second lady.
A small US team with a list of engagements evolved into a large delegation and just one engagement.
Everything changed when the organisers of a dogsled race, an annual spectacle on the cultural calendar, said the Americans weren’t invited.
The scaled-up US delegation and scaled-down schedule did little to address the concerns of Greenlanders.
The White House didn’t just send the vice president, they sent embattled national security advisor Mike Waltz too.
Instead of being greeted by residents, they were greeted by their own troops manning an outpost tasked with warning them about long-range missile attacks.
And the vice president, who’s fast becoming the chief critic of Europe, made Denmark the focus of his attack.
But listen carefully to his speech and you’ll hear the same word twice: “think”.
“This is what we think is going to happen” re. their hopes islanders will vote for independence from Denmark and then engage with America.
“We do not think military action will be necessary,” he added, when asked about that potential.
Please use Chrome browser for a more accessible video player
Why does the US want Greenland?
There is a world of difference between thinking something and knowing something.
So, what happens if what JD Vance “thinks” will or won’t happen doesn’t come to pass?
Read more:
How Greenlanders view Trump’s threats
Why does Trump want to take over Greenland?
Russia and America’s Arctic plans another challenge for Europe
Back in Washington DC, the president of the United States gave the answer.
“It’s not a question about whether we can do without it (Greenland). We can’t,” he said.
And Donald Trump has never ruled out taking the island by force.
-
Sports2 years ago‘Storybook stuff’: Inside the night Bryce Harper sent the Phillies to the World Series
-
Sports12 months agoStory injured on diving stop, exits Red Sox game
-
Sports1 year agoGame 1 of WS least-watched in recorded history
-
Sports2 years agoMLB Rank 2023: Ranking baseball’s top 100 players
-
Sports4 years ago
Team Europe easily wins 4th straight Laver Cup
-
Environment2 years agoJapan and South Korea have a lot at stake in a free and open South China Sea
-
Environment2 years agoGame-changing Lectric XPedition launched as affordable electric cargo bike
-
Business3 years agoBank of England’s extraordinary response to government policy is almost unthinkable | Ed Conway