By Slashing Foreign Aid, Trump Is Fueling the Spread of HIV in Uganda – The Intercept

Impact of U.S. Policy Changes on HIV/AIDS Prevention and LGBTQ+ Health in Uganda

Introduction

Since the election of President Donald Trump in 2024, significant challenges have emerged for sex workers and key populations (KPs) in Kampala, Uganda, particularly concerning HIV/AIDS prevention and LGBTQ+ health. This report highlights the consequences of funding cuts to essential health programs and the broader social and political context affecting vulnerable groups, with a focus on the Sustainable Development Goals (SDGs).

Background: HIV/AIDS and Public Health in Uganda

• Uganda has an HIV prevalence rate of approximately 5%, ranking tenth highest globally.
• Previously, condoms and sexual lubricants were widely available, primarily funded by U.S. aid programs such as USAID and PEPFAR.
• These resources were distributed in various community settings, supporting SDG 3 (Good Health and Well-being) by slowing disease transmission.

Effects of U.S. Funding Cuts and Policy Shifts

Reduction in Access to Essential Commodities

• Post-2024, funding cuts led to a scarcity of condoms and lubricants, critical for safe sex practices.
• Lubricants became stigmatized and were no longer classified as essential health commodities by Uganda’s Ministry of Health.
• Commercial availability of these products became limited and expensive, undermining SDG 3 targets.

Economic Barriers for Sex Workers

• Condoms cost more than the income earned from safe sex, creating economic disincentives to use protection.
• Sex without condoms yields higher pay, increasing HIV transmission risk.
• This situation exacerbates poverty and inequality, conflicting with SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities).

Impact on Key Populations and LGBTQ+ Communities

• Key populations, including sex workers, men who have sex with men, transgender individuals, and people who inject drugs, face increased stigma and reduced access to healthcare.
• Anti-homosexuality laws and government persecution have intensified, limiting healthcare access and violating human rights, contrary to SDG 5 (Gender Equality) and SDG 16 (Peace, Justice and Strong Institutions).
• Many clinics serving KPs have closed or operate under severe resource constraints.

Healthcare System Challenges

Clinic Closures and Resource Shortages

• USAID funding cuts led to the closure of numerous HIV/AIDS and tuberculosis clinics.
• Staff reductions and salary cuts have demoralized healthcare workers and reduced outreach services.
• Essential medications and testing kits have become scarce, threatening SDG 3 targets.

Barriers to Treatment and Prevention

• Pre-exposure prophylaxis (PrEP) is now restricted to pregnant and nursing mothers, excluding high-risk groups.
• Birth control pills and other reproductive health services have become unaffordable.
• Fear of persecution discourages many from seeking care, increasing the risk of untreated infections.

Social and Political Context

Government Policies and Election Climate

• President Yoweri Museveni’s long tenure includes policies that have marginalized LGBTQ+ communities.
• The 2023 Anti-Homosexuality Act criminalizes LGBTQ+ identities, leading to arrests, violence, and human rights abuses.
• Political repression and moral panic have intensified social stigma, undermining SDG 16.

Community Responses and Resilience

• LGBTQ+ activists and healthcare providers strive to produce domestic lubricants and maintain services despite obstacles.
• Community clinics and peer educators continue outreach, although with reduced capacity.
• Efforts to secure new funding and innovative treatments, such as injectable PrEP, are ongoing but face distribution challenges.

Implications for Sustainable Development Goals

1. SDG 3 (Good Health and Well-being): Funding cuts and stigmatization have reversed progress in HIV/AIDS prevention and treatment.
2. SDG 5 (Gender Equality): Discrimination against LGBTQ+ individuals impedes access to healthcare and social inclusion.
3. SDG 10 (Reduced Inequalities): Economic barriers prevent vulnerable populations from accessing essential health services.
4. SDG 16 (Peace, Justice and Strong Institutions): Criminalization and persecution of key populations undermine human rights and social justice.
5. SDG 17 (Partnerships for the Goals): The disruption of international aid highlights the need for sustainable, locally-led health initiatives.

Conclusion and Recommendations

• Restoration and increase of international funding for HIV/AIDS programs are critical to regain lost ground.
• Ugandan government policies must align with human rights principles to ensure inclusive healthcare access.
• Support for community-led organizations serving key populations should be prioritized to enhance trust and service delivery.
• Innovative prevention methods, including equitable distribution of new medications, should be expanded.
• Efforts to combat stigma and discrimination are essential to achieving the SDGs related to health, equality, and justice.

1. Sustainable Development Goals (SDGs) Addressed or Connected

1. SDG 3: Good Health and Well-being
   • The article discusses HIV/AIDS prevalence, prevention, treatment, and the impact of funding cuts on health services in Uganda.
   • It highlights issues related to sexual and reproductive health, access to medication, and stigma affecting key populations.
2. SDG 5: Gender Equality
   • The article addresses discrimination and violence against LGBTQ+ individuals, including trans people and sex workers.
   • It discusses challenges faced by women, including forced pregnancies and lack of access to abortion.
3. SDG 10: Reduced Inequalities
   • Focus on marginalized groups such as sex workers, LGBTQ+ populations, and economically disadvantaged people.
   • Issues of discrimination, exclusion from healthcare, and economic hardship are highlighted.
4. SDG 16: Peace, Justice and Strong Institutions
   • The article describes persecution, criminalization, and human rights abuses against LGBTQ+ individuals under Uganda’s legal framework.
   • It mentions the impact of laws such as the Anti-Homosexuality Act and police harassment.

2. Specific Targets Under Identified SDGs

1. SDG 3: Good Health and Well-being
   • Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
   • Target 3.7: Ensure universal access to sexual and reproductive health-care services.
   • Target 3.b: Support the research and development of vaccines and medicines for communicable and non-communicable diseases.
2. SDG 5: Gender Equality
   • Target 5.2: Eliminate all forms of violence against all women and girls in public and private spheres, including trafficking and sexual and other types of exploitation.
   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.
3. SDG 10: Reduced Inequalities
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws and policies.
4. SDG 16: Peace, Justice and Strong Institutions
   • Target 16.3: Promote the rule of law at the national and international levels and ensure equal access to justice for all.
   • Target 16.6: Develop effective, accountable and transparent institutions at all levels.

3. Indicators Mentioned or Implied to Measure Progress

1. SDG 3 Indicators
   • Indicator 3.3.1: Number of new HIV infections per 1,000 uninfected population, by sex, age and key populations.
   • Indicator 3.3.2: Tuberculosis incidence per 100,000 population.
   • Indicator 3.b.1: Proportion of the population with access to affordable essential medicines and vaccines on a sustainable basis.
   • Indicator 3.7.1: Proportion of women of reproductive age (15-49 years) who have their need for family planning satisfied with modern methods.
   • Indicator related to availability and distribution of condoms, lubricants, PrEP, antiretroviral therapy adherence rates, and HIV-related mortality rates (implied).
2. SDG 5 Indicators
   • Indicator 5.2.1: Proportion of women and girls aged 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months.
   • Indicator 5.6.1: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care.
   • Indicators related to discrimination and violence against LGBTQ+ populations (implied).
3. SDG 10 Indicators
   • Indicator 10.3.1: Proportion of population reporting having personally felt discriminated against or harassed in the previous 12 months on the basis of various grounds including sexual orientation.
4. SDG 16 Indicators
   • Indicator 16.3.1: Proportion of victims of violence in the previous 12 months who reported their victimization to competent authorities or other officially recognized conflict resolution mechanisms.
   • Indicator 16.6.2: Proportion of the population satisfied with their last experience of public services.
   • Indicators related to arrests, harassment, and human rights violations against LGBTQ+ people (implied).

4. Table of SDGs, Targets and Indicators

Source: theintercept.com