‘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”.
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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.”
Vladimir Putin told Donald Trump he “will not back down” from Russia’s goals in Ukraine during a phone call today, the Kremlin has said.
The Russian president spoke to his US counterpart for almost an hour, and Mr Trump “again raised the issue of an early end to military action” in Ukraine, Kremlin aide Yuri Ushakov told reporters.
In response, Mr Putin said “Russia will not back down” from its aims there, which include “the elimination of the well-known root causes that led to the current state of affairs,” Mr Ushakov said.
The phrase “root causes” is shorthand for Moscow’s argument that it was compelled to invade Ukraine in order to prevent the country from joining NATO.
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Trump and Putin’s latest call on Ukraine
Ukraine and its European allies say this is a pretext to justify what they call an imperial-style war, but Mr Trump has previously shown sympathy with Russia.
At the same time, Mr Putin told the US president that Russia is ready to continue negotiating, the aide said.
The Russian president said any prospective peace deal must see Ukraine give up its NATO bid and recognise his country’s territorial gains.
Volodymyr Zelenskyy, seen with Mr Trump in June, is pushing for Ukraine to join NATO. Pic: Reuters
He also briefed Mr Trump on agreements made last month, which saw Russia and Ukraine exchange prisoners of war and dead soldiers.
Specific dates for the third round of peace talks in Istanbul were not discussed – nor was the US decision to halt some shipments of critical weapons to Ukraine.
Mr Putin and Mr Trump’s call came after the Pentagon confirmed some weapons due to be sent to Ukraine have been held as it reviews military stockpiles.
The paused shipments include air defence missiles and precision-guided artillery, two people familiar with the situation have said.
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The decision led to Ukraine calling in the acting US envoy to Kyiv on Wednesday to underline the importance of military aid from Washington.
Kyiv also cautioned that the move would weaken Ukraine’s ability to defend itself against intensifying Russian airstrikes and battlefield advances.
Mr Putin and Mr Trump’s phone call was the sixth they have publicly disclosed since the US president returned to the White House in January.
Donald Trump’s ‘big beautiful bill’ has been passed by the US congress, sending it to the president to sign into law.
The controversial tax breaks and spending cuts package cleared its final hurdle as the Republican-controlled House of Representatives narrowly approved the bill with a 218-214 vote.
The bill delivers tax breaks Mr Trump promised in his 2024 election campaign, cuts health and food safety programmes, and zeroes out dozens of green energy incentives.
According to the nonpartisan Congressional Budget Office (CBO), it will lower tax revenues by $4.5trn over 10 years and add $3.4trn to the US’s $36.2trn debt.
But despite concerns over the 869-page bill’s price tag – and its hit to healthcare programmes – Republicans largely lined up in support, with just two rebelling on the vote.
House Speaker Mike Johnson is congratulated following the vote. Pic: Reuters
Every Democrat in Congress voted against the bill, blasting it as a giveaway to the wealthy that will leave millions of Americans uninsured.
House Speaker Mike Johnson made the Republicans’ closing argument for the bill, telling Congress: “For everyday Americans, this means real, positive change that they can feel.”
Earlier, the House’s Democratic leader Hakeem Jeffries gave a record-breaking eight-hour and 44-minute speech against it.
“The focus of this bill, the justification for all of the cuts that will hurt everyday Americans, is to provide massive tax breaks for billionaires,” he said.
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The bill’s spending cuts largely target Medicaid, the health programme that covers 71 million Americans on low incomes.
It will tighten enrolment standards, institute a work requirement and clamp down on a funding mechanism used by states to boost federal payments.
The changes could leave nearly 12 million people without health insurance, according to the CBO.
On the other side of the ledger, it will stave off tax increases that were due to hit most Americans at the end of the year, when tax cuts from President Trump’s first term were due to expire.
It also sets up new tax breaks for overtime pay, seniors and tipped income.
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The bill narrowly passed the US Senate on Tuesday after vice president JD Vance cast the deciding vote to break a 50-50 tie.
Mr Trump will sign it into law on Friday at 5pm local time (10pm in the UK), the White House said.
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