Reporter's Notebook: Meet the trans Africans hit by US aid cuts

WINDHOEK/WALVIS BAY - It was a hot Tuesday morning and we were sweating as we filmed a mobile clinic that set up shop in a township in the Namibian capital Windhoek to deliver HIV prevention and sexual health services to some of the city's most vulnerable people.

"Some people might not know that using flavoured condoms for sexual activity like penetration could cause yeast infection for the lady or for their partners," said Beatrix Akuake, who comes to marginalised neighbourhoods like this one on behalf of Namibia's Planned Parenthood Association.

"I didn't know that," I acknowledged, remembering the shame I used to feel asking questions about safe sex as a gay teenager in school and thinking that after 32 years in this world, several of them covering sexual health as a journalist, I could still use a lesson or two.

"You are learning today!" Akuake said with a smile, as she turned to a group of young Namibians asking questions they would never have dared to ask in front of friends and family.

Akuake also handed out condoms and lubricants and offered HIV and pregnancy tests to the steady stream of people arriving at the clinic, which like many HIV services offered in Namibia has been funded by foreign aid, much of it from the United States.

For those who come here, discretion is vital. Not having to sit in a public waiting room in a doctor's office to get a condom or take an HIV test means less risk of relatives or neighbours learning about your private life - a big concern in a country where LGBTQ+ people face much stigma.

"It is very important for each and every Namibian to have access to health care," Akuake said.

But that often is not the case in Namibia.

Brihana, a 28-year-old trans woman we met in Windhoek, told us how she stopped going to the doctor after she was laughed at by medical staff as she sat waiting for treatment for a bleeding gash in her forehead.

That's until she discovered there was an alternative offered by very different clinics.

How U.S. aid changed everything

Namibia might be one of Africa's most progressive countries when it comes to LGBTQ+ rights, but that doesn't mean queer people have the same experiences going to school, getting jobs or seeing doctors as do their straight, cisgender fellow citizens.

The decriminalisation of male same-sex relations last June was followed by a political backlash - mirroring the anti-LGBTQ+ wave sweeping parts of Africa - that saw parliament pass several bills restricting the rights of queer people.

U.S. President Donald Trump's decision to freeze aid funds, including for the President's Emergency Plan for AIDS Relief (PEPFAR), has dealt another blow to a beleaguered community.

Since 2003, PEPFAR has poured $110 billion into fighting HIV around the world, saving some 26 million lives.

The results in Namibia have been staggering. Between 2010 and 2022, new HIV infections fell by 54%, according to UNAIDS, the United Nations' main agency working against the pandemic.

For Brihana, this support meant she could find healthcare workers who treated her with respect and helped her access HIV prevention drugs - critical for trans individuals who are 14 times more likely to be HIV-positive than are their fellow citizens.

Now all of that is on life support because of Trump's aid cuts.

A global crisis

Around the world, the U.S. State Department, which manages PEPFAR, has stopped providing Pre-exposure Prophylaxis or PrEP, an HIV prevention medicine, to gay and bisexual men as well as to trans people despite their greater risk of infection.

In Namibia, the Walvis Bay Corridor Group (WBCG), which runs trans-friendly clinics, has shut down three of eight clinics where sex workers, men who have sex with men and trans people, among other vulnerable groups, could find medical attention.

These clinics are precarious already, with minimal facilities. But for people like Ruann, a trans sex worker in the port town of Walvis Bay, they are a sort of second home and the only place she can safely go for checkups and get PrEP, which she needs because of the risks inherent in her work.

Now she is afraid the clinics, and nurses, that changed her life will disappear if the aid money stops flowing.

"It's going to be terrifying for me if I can't access health services," she said.

"Where will I go?"

You can watch Context's short documentary on Ruann and Brihana's story on our YouTube channel.

(Reporting by Enrique Anarte and Sadiya Ansari; Editing by Ellen Wulfhorst.)