Donald Trump’s aid cuts have helped fuel rising violence against trans people, as well as denials of health care and access to justice, research by Physicians for Human Rights (PHR) has found.
One trans woman living with HIV in Tanzania said a hospital worker had told her: “‘Trump has made changes; because of that, what’s left for you is death, so you should repent.’”
After Trump took office in January and subsequently cut more than 80 per cent of foreign aid spending, services supporting people with HIV were first stopped – before being resumed on a more limited basis, excluding a lot of support for LGBT+ communities and other groups at increased risk from the virus.
Advocacy group PHR conducted interviews with 39 people in Tanzania and Uganda living with HIV, as well as with doctors, nurses, counsellors and NGOs, in April this year.
Those interviewed reported “dramatically increased levels of stigma, denial of health and criminal justice services, and physical and verbal abuse in the wake of the disruptions,” especially against LGBT+ people.
Emily Bass, global health expert and co-author of the research said she had found instances of “rising violence against LGBTQ+ people, with assailants citing Trump. The accounts we documented in Tanzania and Uganda are harrowing”.
Another trans woman, also in Tanzania, linked her experience of being attacked to the emboldening effect of Trump’s anti-trans messaging. “The soldiers caught…me, they beat me and put me in their car, handcuffed me and took me to the station,” she said, where she was locked in a cell for two days. “Everything that is happening is as a result of Trump’s messaging. It has fanned the flames.
“His messaging has become a weapon in [our] country. [A weapon] for our religious leaders, our government, the military to use, in the sense that there is no place for people like me to run to, because even the US doesn’t accept or want us.”
A trans man and human rights advocate in Tanzania said HIV-affected people he worked with now felt unsafe going to collect their medication and have been met with the message: “If [the] president of the world has denied you…what are you going to be now?”. Some people have stopped going to healthcare centres as a result.
By the time the interviews were conducted, some US-funded services under its flagship HIV programme the President’s Emergency Plan for AIDS Relief (Pepfar) had been partly restored, including access to antiretroviral medication (ARVs).
But in May, The Independent found that nevertheless LGBT+ people in Uganda and elsewhere were not reliably able to access this medicine safely.
US policy has excluded LGBT+ people from HIV prevention programmes while specialist treatment centres have been hit hard, forcing vulnerable populations into mainstream clinics where they face discrimination. Both Tanzania and Uganda criminalise same-sex relationships, making it harder for people to get safe healthcare.
A clinical officer in Uganda told Physicians for Human Rights they had received calls from patients trying to access Pre-exposure prophylaxis (PrEP) who had been sent away from facilities saying: “‘Please, you’re not supposed to come here unless you want us to call the police.’”
A young man living with HIV in Uganda said that the thoughts of using mainstream HIV clinics caused anxiety and so he avoided going to them to pick up medication.
This had led to people skipping doses out of fear their medicine will run out, the PHR research found.
In extreme cases, the research found losing access to medication was leading people to feel they couldn’t have children for fear of transmitting HIV to them. One interviewee reported having an unwanted abortion because of these fears.
Clinicians also reported seeing women who had lost reliable access to their HIV medication giving birth to HIV positive babies since the cuts.
Since the interviews took place, some of the immediate disruption to HIV treatment has been temporarily resolved. But despite moves by Congress to save Pepfar, reports in US media suggested that the Trump administration is defying lawmakers and withholding half the money they have allocated for this financial year. The future of the programme next year and beyond remains uncertain.
“While the damage to date has been acute, there is still a narrow window to salvage Pepfar and save lives,” said Emily Bass. “Congress must act now to preserve what has been the most impactful global health programme in history.”
