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Life for Mike Elvis Tusubira, a motorcycle taxi rider living with HIV in Uganda, has been turned upside down since US President Donald Trump halted foreign aid last month.
The 35-year-old, who relies on life-saving antiretroviral (ARV) drugs, now fears for his survival. But beyond his own health, he is grappling with the reality that his marriage may not survive either. His wife, who is HIV-negative, depended on PrEP, a medication that significantly reduces the risk of contracting the virus. Without it, they can no longer have safe sex.
“Even my marriage will end,” he said. “Without preventive measures, she’s not going to stay. No condoms, no [anti-HIV] lubricants, no PrEP—nothing. We can’t stay in a marriage without intimacy. It means I have to stay single.”
Until recently, the couple had access to essential medicines and contraceptives through funding from USAID, the US government’s primary overseas aid agency. However, since the sudden aid freeze—news he first learned about on social media—their supplies have dwindled. His wife has completely run out of PrEP, and the remaining condoms they have are not enough to feel safe.
On his first day back in office, Trump ordered a 90-day pause on foreign aid, triggering stop-work orders for USAID-funded organizations. Though waivers were later granted for humanitarian projects, the damage had already been done. The HIV programme Tusubira depended on—operating out of Marpi Clinic in northern Kampala—had shut its doors.
Seeking answers, he called his counsellor at Kiswa Health Centre III. The response was disheartening.
“My counsellor was in the village. He told me he’s no longer at the clinic.”
Tusubira, a father of one who tested positive for HIV in 2022, has already missed a crucial test to check his viral load and immune system strength.
“I’m moving in darkness. I don’t know if my viral load is suppressed. I’m traumatised.”
Financially, he does not see a way forward. Some people have suggested that ARVs might be available at private pharmacies, but as a boda-boda rider, he doubts he can afford the costs.
The impact of the USAID shutdown extends beyond his own family. His wife previously received PrEP from an NGO operating at Marpi, while their five-year-old son benefited from a programme providing school and food for vulnerable children.
“My child is no longer in school now,” he said.
Uganda’s health sector is heavily dependent on donor funding, with 70% of its HIV/AIDS programmes supported by external aid. The country ranks among the top 10 African recipients of USAID funds. In 2023, Uganda received $295 million in health funding from the agency, trailing only Nigeria ($368 million) and Tanzania ($337 million).
USAID funds also support programmes for malaria, tuberculosis, and leprosy, as well as maternal and child health services. The aid freeze has disrupted thousands of healthcare jobs.
Dr. Shamirah Nakitto, a clinician with Reach Out Mbuya (Rom)—a faith-based organization supporting people living with HIV—was one of many health workers affected. Based at Kisenyi Health Centre IV, which serves a densely populated slum in Kampala, she attended to an average of 200 HIV/AIDS and tuberculosis patients daily. When the stop-work order came, all Rom-supported staff were dismissed.
“We’re waiting for the 90 days,” she said. “This compulsory leave—I hadn’t prepared for it. It was so abrupt. We didn’t have a proper handover. We just stopped working.”
The Ugandan health ministry says it is exploring ways to minimize disruptions. Dr. Diana Atwine, the ministry’s top civil servant, has urged affected staff to volunteer in the spirit of patriotism.
Further south, in Malawi, USAID-funded health activities have also ground to a halt. The country, which received $154 million in USAID health funding last year, is struggling to cope.
In Mzuzu, a key HIV clinic has shut its doors. Vehicles sit idle, and workers have been sent home. Even though a US State Department waiver on January 28 permitted the delivery of ARVs, distribution remains a challenge without the personnel who coordinated USAID’s activities.
Many contracts remain in limbo, leaving health workers uncertain about what they can or cannot do. The Trump administration plans to slash USAID staff by more than 90%, reducing the agency’s workforce from 14,000 to just 294—only 12 of whom will be assigned to Africa.
In Malawi, more than 30 NGOs have been severely affected. Among those left in limbo is Eddah Simfukwe Banda, a 32-year-old subsistence farmer who has been receiving ARVs since 2017 from a clinic supported by NGOs. With only a three-week supply left, she is growing desperate.
“We have to pray as Malawians,” she said “Those of us who believe depend on a God who opens doors when one is closed.”
She also acknowledged a hard truth: “As Malawians, we depend too much on aid. At times, we are lazy and squander resources, relying on other countries to help us. Let this be a lesson—we must be independent.”
Yet, self-sufficiency remains difficult for one of the world’s poorest and most aid-dependent nations. According to the World Bank, Malawi is highly vulnerable to external shocks, including droughts and cyclones. The healthcare system is now facing an unprecedented crisis.
For decades, the US has been Africa’s most significant public health partner, primarily through its President’s Emergency Plan for AIDS Relief (PEPFAR), launched in 2003. The programme has saved over 25 million lives. According to the Africa Centres for Disease Control and Prevention (Africa CDC), USAID provided $8 billion in aid to Africa last year—73% of which went to healthcare.
Health experts warn that replacing this funding will be incredibly difficult. Some African nations have made strides toward reducing aid dependency—Kenya now funds nearly 60% of its HIV response, while South Africa covers almost 80%. But for many low-income countries, economic shocks, climate disasters, and debt burdens make self-reliance nearly impossible.
Amref Health Africa, one of the continent’s leading health NGOs, warns that without urgent action, global health security is at risk.
“This would require African governments and Africa CDC to increase their own funding, which is almost impossible under current debt distress conditions,” said Amref CEO Dr. Githinji Gitahi. “With accelerating outbreaks from climate change and human-environmental conflict, the world would be left fragile and unsafe—not just Africa, but everyone.”
Globally, in 2023, there were 630,000 AIDS-related deaths and 1.5 million new infections. The USAID freeze threatens to reverse years of progress.
“If you remove this major contribution from the US, we expect an additional 6.3 million AIDS-related deaths over the next five years,” warned UNAIDS head Winnie Byanyima. “There will be 8.7 million new infections and 3.4 million additional AIDS orphans.”
Médecins Sans Frontières (MSF) has also sounded the alarm.
“HIV medicines must be taken daily, or people risk developing resistance and severe health complications,” said MSF’s Tom Ellman.
Back in Uganda, Tusubira sees no way forward. With just 30 days of ARVs left, he is contemplating leaving Kampala for his village.
“At least it will be simpler. If I die, they just bury me there, instead of troubling my people in the city. Because without ARV services, I have no way to live.”
