US aid cuts: South Africa trans health worker describes HIV fear

• U.S. aid cuts hit HIV care in South Africa
• Healthcare workers lose jobs, services closed
• Trans health worker call for local funding

JOHANNESBURG - Since President Donald Trump gutted U.S. aid programmes this year, thousands of South African health workers, whose salaries were covered by U.S. funds, have not been able to monitor HIV patients and distribute medication.

South Africa has the world's highest burden of HIV, but has been praised for controlling the number of infections.

One-in-five adults, or 8 million people, live with HIV in South Africa, according to government data, and it is estimated that 78% of South Africans with HIV are receiving treatment.

But South African partners of the United States Agency for International Development (USAID) reported that, when comparing the first quarter of 2024 and 2025, HIV testing reduced by 8.5%, diagnosis by 31% and treatment by 30%.

The United States was funding 17% of the country's HIV budget until Trump slashed aid from January this year.

Patients who once sought care in U.S-funded clinics and community centres have been encouraged to go to state clinics instead, but certain groups, including transgender people and gay men, fear the stigma they could face.

This is a particular problem in Johannesburg where HIV prevalence among transgender women stands at 63%, according to research published in the Journal of the International Aid Society in 2022.

The fear is due to a range of social, economic and healthcare access factors, including stigma faced at many healthcare facilities, according to UNAIDS.

Context spoke to Odwa Mbane, a 38-year-old transgender community healthcare worker who worked at an HIV clinic in Johannesburg before the aid cuts forced it to close.

I could tell things were getting better for trans people in South Africa because young trans patients were coming to the clinic with their parents, who were supportive of them.

In the past, parents just said they didn't understand or (didn't) support you if were trans.

I led a team at a transgender clinic that was funded by USAID.

We did HIV prevention programmes, gave transgender women hormones with gender affirming services and provided primary healthcare services, including testing.

If you were positive, we initiated antiretroviral treatment. If you were negative, we initiated you on PrEP, which is Pre-Exposure Prophylaxis.

Our work included going into communities to help patients adhere to their medication. Some would come into our clinic. And we had a doctor and a psychologist coming in once a week.

I love my community and I loved the work because with the stigma that we would get at the other clinics, having our own clinic was quite fascinating. I got to interact with my trans community and to (share) what we go through.

It made me happy to see the number of virally suppressed trans patients.

That changed on Jan. 24 when we heard that the U.S. was cutting the funds. We were told we didn't have to go to the office anymore. It was so, so sad.

I was still shocked myself and then I started getting calls from other trans sisters who were taking medication within the project who didn't know what to do.

Even now they still phone.

I tell them to call the nearest clinic because we were told that information about the patient's details had been transferred to the Department of Health.

But their biggest fear is the stigma.

Because when you go into the clinic, (nurses) start looking at you funny if you don't identify with the same thing that is written on your ID. They make you a laughing stock.

In our project we had so many trans people from other African countries who were fleeing transphobia.

But when they get here, they face xenophobia. Some have told me they are already being turned away from clinics even though they are legally entitled to care.

I know I will have to sensitise people at these clinics about trans people. Some clinic staff, especially in government facilities, they're not sensitised.

If it takes me to teach them to so that they can learn, then I'll do it.

My advice to my trans sisters is just try, go to the clinics, you have to try, for the sake of your health. I tell them this on the phone to encourage them, but mostly I am doing nothing. I am sitting at home. It is very sad.

The South African government must in some way find funding for people who are at high risk of getting HIV.

Our government is not funding us. We had to be funded by people from the U.S., but we are not living in the U.S.

I keep praying and telling myself that it will pass. There's nothing that doesn't pass.

This first-person account has been edited for length and clarity.

(Reporting by Kim Harrisberg; Editing by Jon Hemming.)