US Aid Cuts Hit HIV Care for LGBTQ+ Ugandans. Where to Get Help Now

Clinics that served gay and bisexual men, transgender people and sex workers in Uganda and Zimbabwe lost much of their work after the United States cut its HIV funding in 2025, and by March 2026 most of it had not come back. That is the finding of a study published in The Lancet Global Health on 5 October.

For LGBTQ+ Ugandans, who already have good reason to fear clinics, this is serious news. But HIV care is still available, including from a government clinic set up for key populations. Details are at the end of this article.

What the study found

Researchers from the London School of Economics and Duke University looked at service records from four organisations in Uganda and Zimbabwe that provide HIV care to key populations. They compared each month from January 2023 to March 2026 with the average for 2024, before the US stop-work orders.

After the funding stopped, the drop in services was steep:

Service	Fall compared with 2024
HIV testing	59% to 64%
PrEP (medicine that prevents HIV)	43% to 72%
Other prevention	37% to 63%
HIV treatment	22% to 32%

Treatment fell even after the US issued a waiver meant to protect life-saving care. “The safety net that was supposed to preserve life-saving treatment did not hold,” said the lead author, Dr Henry Cust.

The study covers four organisations, not every clinic in either country, and it does not give separate figures for Uganda. The authors say it should not be stretched beyond that. But the organisations it looked at are exactly the kind that LGBTQ+ people rely on: community clinics that understand their lives and protect their privacy. The authors note that general health services are unlikely to replace them.

Kampala’s own figures

The study does not stand alone. In August, Kampala Capital City Authority (KCCA) presented its own figures to the city’s HIV and TB stakeholders’ meeting. Of 649,570 people tested at health facilities in Kampala between July 2025 and June 2026, 11,241 were newly diagnosed with HIV. That is more than 200 people a week, or about 30 a day.

Women made up 62% of the new diagnoses, and the largest number were aged 30 to 39. The city is also falling short on treatment: of people in Kampala who know they have HIV, 78% are on treatment, against the UNAIDS target of 95%.

KCCA’s Care and Treatment Lead, Dr Douglas Tuhumwire, pointed to unregulated sex in massage parlours, spas and lodges, domestic violence, structural inequalities and social media as possible causes, and said they needed more investigation. KCCA’s HIV and TB focal person, Dr Christopher Oundo, said “stigma, discrimination and continuous new infections remain major obstacles”. Speakers at the meeting were alarmed that funding for HIV programmes was falling.

News reports of the meeting do not mention gay and bisexual men or transgender people at all. That silence is part of the problem. People who are afraid to be seen at a clinic are less likely to be tested, so they are less likely to appear in figures like these, and less likely to be treated.

A new prevention jab, but not enough of it

There is some good news. Lenacapavir, an injection that prevents HIV and is given only twice a year, nearly eliminated new infections among high-risk people in clinical trials. Uganda received its first 19,200 doses in February, and the injection is free. For people who struggle to take a daily pill, or to hide one, a jab every six months could make a real difference.

The problem is supply. By August, more than 100 health facilities were reported to have run out. Reporting by AP and Africanews published on 24 October found the few thousand doses available being rationed, and clinics in Mbarara often offering a different injection, given every two months, instead. Immaculate Nyamwija, who runs a community health group in Mbarara, said community outreach used to bring testing and PrEP to the places people meet, but “due to the funding cuts those activities are no longer happening.”

Why it hits LGBTQ+ Ugandans hardest

Since the Anti-Homosexuality Act was passed in 2023, many LGBTQ+ Ugandans have stopped going to clinics, afraid of being judged, reported or exposed. Community-led services were often the one place they still felt safe. When those services shrink, many people simply go without.

Going without care has consequences that reach far beyond one person. Fewer people tested means more people living with HIV without knowing it. Interrupted treatment means people become ill again, and can pass the virus on. HIV does not respect the law, and a health system that drives some people away is less healthy for everyone.

A minister’s words do not help

On 23 September, less than two weeks before the study was published, Uganda’s Health Minister, Chris Baryomunsi, posted on X during a United Nations event that homosexuality is “not African” and something Uganda “detests”. In the same post, he said gay people are not discriminated against when they seek health care.

Activists and the former MP Fox Odoi-Onywelowo criticised the post. Many Ugandans asked the obvious question: how are people supposed to feel safe in a clinic when the minister responsible for those clinics says he detests them?

The claim that homosexuality is foreign does not hold up either. It is the laws against it that were brought to Uganda, as we set out in our article on the colonial roots of Uganda’s anti-gay laws.

Where to get HIV care now

You still have the right to health care. In 2023, the Ministry of Health told health workers in public and private facilities not to deny or discriminate against anyone seeking care, and to protect their privacy. You do not have to tell anyone your sexuality to get tested or treated.

• MARPI, the government clinic for key populations. The Most At Risk Populations Initiative is run from the National STD/Skin Clinic, Ward 12, Old Mulago Hospital, Kampala. It offers HIV testing, self-test kits, PrEP, HIV treatment and STI care. It is open Monday to Friday, 8am to 5pm, and Saturday, 8am to 1pm. Its free line is 0800 300 450.
• MARPI drop-in centres outside Kampala. There are centres at the regional referral hospitals in Arua, Fort Portal, Gulu, Lira, Jinja, Hoima, Mbale and Mbarara, and at Malaba Health Centre IV in Tororo. Each has its own free line, listed on MARPI’s contact page.
• The six-monthly PrEP injection. In May, the Ministry of Health listed facilities offering lenacapavir, including MARPI, the AIDS Information Centre in Kampala, Naguru and Kiruddu hospitals. Supplies run out, so ask before you travel. If it is not available, ask about the two-monthly injection or daily PrEP tablets rather than going without.
• Government health facilities. HIV testing and treatment are available at public hospitals and health centres across the country.
• HIV self-test kits are sold in many pharmacies, if you are not ready to go to a clinic. A positive result needs to be confirmed by a health worker.
• PEP after a possible exposure. If a condom breaks or you are sexually assaulted, go to a health facility straight away and ask for PEP. It must be started as soon as possible, and within 72 hours.

If you are on treatment and your clinic has closed or run out, do not stop taking your medicine if you can avoid it. Go to MARPI or your nearest government facility before your supply runs out. Take your clinic card or your medicine packaging, so they can see what you are on.

If you are not sure where to go, contact us and we will try to point you to someone who can help.

What needs to change

The study’s authors call for emergency funding to protect HIV services for key populations, and for countries to build health services that include everyone. We agree. Donor money will come and go. A health system that treats LGBTQ+ Ugandans with respect, and a government that stops telling them they are detested, would protect far more people than any single grant.