Women bear the brunt of Trump’s devastating aid cuts

Welcome to the Impact newsletter – your guide to the feminist revolution. This week, we bring you an investigation into the consequences of Donald Trump’s cut to the US aid budget. Pressed for time? Here’s the newsletter in brief:

🌎 Back in February, we warned that Donald Trump’s cuts to foreign aid would be devastating for women
🇺🇬 Now, we have the proof. Journalist Andrew Green has been tracking the effects of the cuts to AIDS programmes in Uganda.
❗ We bring you the stories of women who have lost their lives, their access to healthcare, their support or their livelihoods due to the actions of the far-right US government.

To stay up to date on all that’s making news in the world of gender equality, follow us on Instagram and LinkedIn.

You can read this newsletter online here: https://lesglorieuses.fr/forsaken

‘Patients are missing treatment’: women bear the brunt of Trump’s devastating aid cuts

by Andrew Green

One of Donald Trump’s first acts as president was to freeze aid funding. In the months since, he has wound down the US’s development agency, USAID, and purged the vast majority of its programmes.

In February, the Impact newsletter ran an interview with a leading global development expert that predicted that the consequences of these attacks on aid funding would be devastating for women and girls. But back then, we could not know what the true toll would be.

One programme that was supposed to have been mostly spared the cuts is the President’s Emergency Plan for AIDS Relief, or PEPFAR, which is credited with saving 26 million lives since it was launched in 2003. Secretary of State Marco Rubio recently told the US senate that the program is mostly functional. But the reality on the ground is very different.

For the past three months, journalist Andrew Green has been reporting from countries that receive support from PEPFAR. His ongoing project, Forsaken, documents the impact of the funding chaos through interviews with the people most affected – people who are receiving HIV treatment and prevention services, health workers and activists.

Green’s reporting shows that the suspension of aid funding and the uncertainty about the future of the global HIV response are indeed having a devastating impact, one that is disproportionately affecting women. Today, we bring you the stories of three Ugandan women who have been affected by the cuts to PEPFAR, presented in collaboration with the Forsaken project.

Lydia Nabirye

Lydia Nabirye is dead because of Donald Trump’s cuts to US aid programmes.

Nabirye ran a roadside restaurant with her mother in eastern Uganda. She was living with HIV, and so was her son, who is also disabled. Her mother, Saida, said diners were drawn in by her daughter’s laughter.

She was so happy. She used to bring so, so many customers.

But when Nabirye’s son was three, and the family struggled to get support for his disabilities, Nabirye fell into a depression. She began to refuse her HIV treatment. It could have killed her. But the staff at the HIV clinic Nabirye attended, a 20-minute drive away over rough roads, noticed her absence. They contacted a local organization, who started sending a care worker, Fatuma Bilibawa, to Nabirye’s house.

Three photos of the same woman. She is Black and has short hair. In one, she wears a yellow dress, in the middle photo, she wears a blue dress and has her hand on her hip, leaing forward. In the photo on the right, she stands next to a colleague, wearing a green and white apron. Both women have their hands in their pockets.

Lydia Nabirye. Photo courtesy of Saida Nabirye.

Bilibawa arrived on a motorcycle taxi each morning to observe Nabirye taking her medication and to talk about the opportunities that day might hold for her.

I told her there’s still time for everything. It’s a long life. I told her she would not be neglected, to continue with the drugs so she would be stable.

This service was a crucial lifeline in a country with virtually no mental health support. After a few months, Nabirye was feeling better, and began to pepper Bilibawa with questions about whether there was still a chance that she could become a nurse one day. She was building a future for herself again.

She told me she wanted to treat people in the community.

Then, on January 24, the Trump administration suspended Bilibawa’s program. A few weeks later, U.S. officials eliminated it entirely. Bilibawa was forced to abandon the people she had been supporting, including Nabirye.

I didn’t have enough support. They just called me that she’s sick. She didn’t want to meet any other worker. She was tired of everything.

Nabirye stopped taking her HIV medicine. Her decline was rapid. She died on March 26.

Saida has now taken over her grandson’s care. The boy requires all of her attention, which means she has had to close the restaurant she used to run with her daughter.

I am all alone because the services have stopped. There are no services to help me.

An older Black woman wearing a black harinet and a pink dress sits on the ground holding a small child, her grandson. In the foreground are two photos of her daughter being held by two hands. In one photo, she wears a blue dress and has her hand on her hip, leaning forward. In the other, she waers a green and white apron.

Saida Nabirye and her grandson. Photo: Andrew Green.

Nassa Michelle Mich

When the Trump administration issued its funding freeze, most HIV services in the northern town of Gulu stopped. That included the specialized HIV clinic that Nassa Michelle Mich has been relying on for years for her life-saving anti-retroviral treatment, or ART.

Mich was diagnosed with HIV in 2015 when she was just 13, and has religiously adhered to her treatment ever since. She found the services so helpful, she actually joined the clinic as a peer educator to assist young people with HIV.

But now there is uncertainty around where she and other people living with HIV can access their medicine. They have been told the only option is to pick up the drugs from the outpatient clinic, or OPD, at Gulu’s main government-run hospital.

Our OPD is very crowded. The time I went there to get services and I spent the whole day without really getting treatment. The people who work there are very, how can I say, not nice. They’re very angry all the time. So they’re unable to have the courtesy to deal with you as a patient, as a client.

And they really announce people’s results openly. So just imagine you’re there waiting for your ART and someone stands there, “Ah, Michelle, come and get your ART.” And everyone is looking. That would definitely kill me.

The [person] in charge of the clinic was telling me that she’s worried that this is going to cause an increase in the number of unsuppressed clients. Even the ones already suppressed are going to become unsuppressed.

A young Black woman wearing glasses sits a table with a blue plastic table cloth. Her t-shirt says Chicken Tracks. Her hair is braided and tied in a bun. She holds her hands one on top of another and her nails are painted pink.

Nassa Michelle Mich. Photo: Andrew Green.

HIV patients become unsuppressed when they stop taking the drugs to keep the virus in check, and can develop resistance to their previous treatment. Eventually, if they do not restart ART, they will die.

The young people are going to disappear into thin air.

Florence Amito

Florence Amito is in charge of the treatment clinic at Bardege Health Center III, a small government facility on the outskirts of Gulu. It’s the kind of place that’s popular with patients who live outside of the city, because it’s not as intimidating as the hospital.

A US-funded program stationed seven community health workers at Amito’s clinic, but the Trump administration eliminated their jobs, which means that Amito is almost single-handedly running a program responsible for providing HIV treatment to 540 people.

Amito says she is struggling just to deal with the clients who show up at the clinic. There is no possibility of trying to follow up with those who do not.

We have some patients who are far, far, far away and cannot reach the facilities, because of the bad roads. And then some are too elderly, they cannot come.

We would carry the clinic to the community. We would go and do all those services that the patient needs from the community.

The distances are very far. You cannot go there on foot. You need to go there in a vehicle. In some circumstances, when we go, the vehicle also cannot reach. Sometimes we park the vehicle two kilometers away from the homes, and then we just walk and go and give those services.

We have not been able to go to the community. And I’m afraid to tell you that those patients are still missing treatment.

A Black woman with short hair and glasses leans her elbow on a desk. She wears a pink dress and a denim jacket.

Florene Amito. Photo: Andrew Green.

It is overwhelming for Amito to watch the collapse of years of effort to ensure that the most vulnerable, the most remote Ugandans would have access to HIV services.

People will die. People are going to die. That is a sad thing to note. People are going to die.

— Andrew Green is a reporter who specialises in global health and inequality. His project, Forsaken, will continue to document the impacts of the Trump administration’s PEPFAR cuts. You can sign up for the weekly newsletter or follow the project on Instagram to stay updated.

Book launch

The editor-in-chief of the Impact newsletter, Megan Clement, is launching her debut book, Desire Paths, in Paris on June 17th at 7pm at Le 18. She will be in conversation with Katy Lee, host of the award-winning The Europeans podcast. Megan will be talking about her work, and selling and signing copies of Desire Paths on the night. RSVP by relying to this email!