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At a drop-in centre on Uganda’s border with Kenya, along a busy trucking route, groups of people gather to play Ludo and pick up their HIV medication. It’s a safe space for people from LGBT+ communities who have been turned away or harassed at other facilities.
But the centre is now quiet – three-quarters of its staff have had to be laid off after cuts to US aid. Stocks of drugs are running low and most of its regular clients have stopped showing up. Since January, when Donald Trump came into office for the second time, the centre has lost its funding.
"I have a friend who is taking ARVs [anti-retrovirals]. He has now gone a week without,” explains Shafiq, 24, who relies on the centre, putting him at risk of getting sick or infecting others. “It really tortures us so much”.
This comes in the wake of The Independent revealing that the US cuts have derailed the projected end of the Aids pandemic, which could lead to four million extra deaths by 2030.
Uganda faced international criticism for harsh anti-homosexuality laws passed in 2023 – punishing consensual same-sex relationships with penalties of up to life in prison. As a result, specialist services that help LGBT+ people access HIV care are generally run by charities and community organisations outside of the public health system.
The centre in the town of Busia, which is run by the Amalgamated Transport General Workers Union (ATGWU), started life when its founder observed how truckers would spend time there, creating a market for sex workers – and a hotspot for HIV transmission. Now it serves as a clinic and meeting place for LGBT+ people too. While it remains open at the grace of volunteers, supplies of pre-exposure prophylaxis (PrEP) – to reduce the risk of contracting HIV – condoms and anti-retroviral drugs (ARVs) for treatment have been dwindling. Staff pay and stipends for volunteers came from US funding – now all gone.
The hostile law makes it hard enough to reach these groups with prevention services, while also deterring people from seeking support and medication. Trump’s cuts are only making things worse. The Uganda Key Populations Consortium (UKPC), an NGO supporting vulnerable communities, confirmed to The Independent that it has recorded incidents of people being denied medical care in public hospitals because of their identities, since the US cuts were announced in January.
‘You are isolated’
Shafiq’s story is illustrative of this discrimination. He says found his way to the drop-in centre in Busia, having been denied antibiotics for a sexually-transmitted infection (STI) at a public hospital. He found a friendly place and started working there, helping others to access free medicines, testing and counselling. "It gives me a chance to talk about what I'm really going through,” Shafiq adds.
It allowed him to get supplies of PrEP to protect him from contracting HIV. But owing to the aid cuts, Shafiq took his last dose of PrEP five days ago, when stocks ran out.
He worries that without it, his next partner could infect him with the virus. More than one in ten gay men in Uganda are estimated to be living with HIV.
HIV testing and medication is supposed to be available to everyone in public hospitals and clinics. “The treatment is there, but they cannot give it to us just because they know what we are doing is illegal,” Shafiq says, speaking about being turned away for treatment when hospital staff found out he was gay.
“You are discriminated [against]. You are isolated and you feel like shying away. You also feel like you are unwanted within the community,” Shafiq adds.
In hospital facilities, he says: “They ask you so many questions. After asking you so many questions, they start judging you.”
“Most of our peers were suffering from such incidences,” he adds, referencing harassment while waiting in line at public hospitals or at times outright denial of services.
Hostile laws
Richard Lusimbo runs the UKPC, a leading organisation in the country supporting groups euphemistically referred to as “key populations”. This vague language is designed to ward off the hostility that can come with openly advertising you are helping LGBT+ people (and other vulnerable groups like sex workers).
Lusimbo has begun to hear reports from contacts around the country of trans people being turned away at hospitals.
“We saw some cases of increasing stigma and discrimination in health facilities.
"In eastern Uganda there's a facility where a trans person was turned away by a security guard saying Trump does not support you people, so leave”.
The Ugandan Ministry of Health said the allegations raised in this were “untrue”.
A spokesperson said: “As a government, we uphold a non-discriminatory policy in service delivery, ensuring equal access to healthcare for all. Despite the funding cut, we're reorganising our system to maintain continuity...Our clinics remain open to all patients, providing care without discrimination”.
But for Lusimbo, the US cuts have helped “send people back to spaces that where they've been discriminated against, they've been castigated, again making them more vulnerable”.
Withdrawal of health resources has a “serious and disproportionate impact on groups of people that are highly vulnerable to HIV," the UN Aids agency (UNAIDS) deputy director, Angeli Achrekar, says.
Not only does this first and foremost harm those vulnerable communities, it creates the risk that, “the progress made in the fight against HIV will go into reverse,” Achrekar.
“That would be a tragedy for global health," she adds.
This article was produced as part of The Independent’s Rethinking Global Aid project
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