‘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:
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.”
World
Trump criticises Putin after potentially ‘historic’ meeting with Zelenskyy before Pope’s funeral
Donald Trump has criticised Vladimir Putin and suggested a shift in his stance towards the Russian president after a meeting with Volodymyr Zelenskyy before the Pope’s funeral.
The Ukrainian president said the one-on-one talks could prove to be “historic” after pictures showed him sitting opposite Mr Trump, around two feet apart, in the large marble hall inside St Peter’s Basilica.
The US president said he doubted his Russian counterpart’s willingness to end the war after leaving Rome after the funeral of Pope Francis at the Vatican.
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In a post on his Truth Social platform, he said “there was no reason” for the Russian president “to be shooting missiles into civilian areas, cities and towns, over the last few days”.
The two leaders held talks before attending the Pope’s funeral
He added: “It makes me think that maybe he doesn’t want to stop the war, he’s just tapping me along, and has to be dealt with differently, through ‘Banking’ or ‘Secondary Sanctions?’ Too many people are dying!!!”
The meeting between the US and Ukrainian leaders was their first face-to-face encounter since a very public row in the Oval Office in February.
Mr Zelenskyy said he had a good meeting with Mr Trump in which they talked about the defence of the Ukrainian people, a full and unconditional ceasefire, and a durable and lasting peace that would prevent the war restarting.
Other images released by the Ukrainian president’s office show Sir Keir Starmer and French President Emmanuel Macron were present for part of the talks, which were described as “positive” by the French presidency.
Mr Zelenskyy‘s spokesman said the meeting lasted for around 15 minutes and he and Mr Trump had agreed to hold further discussions later on Saturday.
The world leaders shared a moment before the service
Donald Trump and Volodymyr Zelenskyy meet in the Basilica
But the US president left Rome for Washington on Air Force One soon after the funeral without any other talks having taken place.
The Ukrainian president’s office said there was no second meeting in Rome because of the tight schedule of both leaders, although he had separate discussions with Mr Starmer and Mr Macron.
The French president said in a post on X “Ukraine is ready for an unconditional ceasefire” and that a so-called coalition of the willing, led by the UK and France, would continue working to achieve a lasting peace.
There was applause from some of the other world leaders in attendance at the Vatican when Mr Zelenskyy walked out of St Peter’s Basilica after stopping in front of the pontiff’s coffin to pay his respects.
Donald Trump and the Ukrainian president met for the first time since their Oval Office row. Pic: Reuters
Sir Tony Brenton, the former British ambassador to Russia, said the event presents diplomatic opportunities, including the “biggest possible meeting” between Mr Trump and the Ukrainian leader.
He told Sky News it could mark “an important step” in starting the peace process between Russia and Ukraine.
Professor Father Francesco Giordano told Sky News the meeting is being called “Pope Francis’s miracle” by members of the clergy, adding: “There’s so many things that happened today – it was just overwhelming.”
The bilateral meeting comes after Mr Trump’s peace negotiator Steve Witkoff held talks with Mr Putin at the Kremlin.
They discussed “the possibility of resuming direct negotiations between Russia and Ukraine”, Kremlin aide Yuri Ushakov said.
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Russia and Ukraine have not held direct talks since the early weeks of the war, which began in February 2022.
Mr Trump has claimed a deal to end the war is “very close” and has urged Mr Zelenskyy to “get it done” in a post on his Truth Social platform.
He has previously warned both sides his administration would walk away from its efforts to achieve a peace if the two sides do not agree a deal soon.
Meanwhile, the Polish armed forces said a Russian military helicopter violated its airspace over the Baltic Sea on Friday evening.
“The nature of the incident indicates that Russia is testing the readiness of our air defence systems,” they said in a post on X.
On an extraordinary day, remarkable pictures on the margins that capture what may be a turning point for the world.
In a corner of St Peter’s Basilica before the funeral of Pope Francis, the leaders of America and Ukraine sit facing each other in two solitary chairs.
They look like confessor and sinner except we cannot tell which one is which.
Leaning forward hands together in their laps, Donald Trump and Volodymyr Zelenskyy stare at each other in one photo.
In another, the Ukrainian president seems to be remonstrating with the US president. This is their first encounter since their infamous bust-up in the Oval Office.
The two leaders held talks before attending the Pope’s funeral
Other pictures show the moment their French and British counterparts introduced the two men. There is a palpable sense of nervousness in the way the leaders engage.
We do not know what the two presidents said in their brief meeting.
But in the mind of the Ukrainian leader will be the knowledge President Trump has this week said America will reward Russia for its unprovoked brutal invasion of his country, under any peace deal.
Mr Trump has presented Ukraine and Russia with a proposal and ultimatum so one-sided it could have been written in the Kremlin.
Kyiv must surrender the land Russia has taken by force, Crimea forever, the rest at least for now. And it must submit to an act of extortion, a proposed deal that would hand over half its mineral wealth effectively to America.
The world leaders shared a moment before the service
Afterwards, Zelenskyy said it had been a good meeting that could turn out to be historic “if we reach results together”.
They had talked, he said, about the defence of Ukraine, a full and unconditional ceasefire and a durable and lasting peace that will prevent a war restarting.
The Trump peace proposal includes only unspecified security guarantees for Ukraine from countries that do not include the US. It rules out any membership of Ukraine.
Ukraine’s allies are watching closely to see if Mr Trump will apply any pressure on Vladimir Putin, let alone punish him for recent bloody attacks on Ukraine.
Or will he simply walk away if the proposal fails, blaming Ukrainian intransigence, however outrageously, before moving onto a rapprochement with Moscow.
If he does, America’s role as guarantor of international security will be seen effectively as over.
This could be the week we see the world order as we have known it since the end of the Second World War buried, as well as a pope.
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