For LGBT Ugandans, Foreign Aid is Life-Saving
In many developing countries, foreign aid is a lifeline for vulnerable communities, providing essential healthcare services local governments fail to provide. In Uganda, where LGBT people already face severe discrimination and legal barriers to healthcare, US foreign assistance has played a crucial role in funding HIV/AIDS treatment, mental health services, and community outreach programs. However, upon taking office on January 20th, 2025, US President Donald Trump issued an executive order halting all foreign aid for 90 days, requiring a review to ensure that aid programs aligned with American interests. This order effectively disrupted funding to many organisations supporting LGBT individuals in Uganda and elsewhere, exacerbating an already fragile healthcare system. By the numbers, this aid moratorium will hurt millions of people. If it were to become permanent, or a tool for enforcing ideological litmus tests or personal loyalty, its impact could be devastating.
Prior to this executive order, the US was the single largest provider of aid globally. In 2023 alone, it disbursed $72 billion in assistance — a drop in the ocean of the American federal budget ($6.75 trillion in 2024), but life-changing for communities around the world. The US funds at least 80% of all projects in Uganda through the United States Aid for International Development (USAID). USAID’s work in Uganda focuses on HIV/AIDS, tuberculosis, malaria prevention and treatment, healthcare, family planning, nutrition, water, sanitation, health infrastructure, and emerging pandemic threats. This includes specific programs that provide healthcare for LGBT people such as HIV/AIDS initiatives, mental health services, and general health care access. This has been done through specific programs with funding from the US such as PEPFAR for HIV/AIDS and various non-governmental organisations such as Uganda Key Populations Consortium (UKPC), Chapter Four Uganda, and Rainbow World Fund.
Since its 2003 launch by President George W. Bush, PEPFAR, the US President’s Emergency Plan for AIDS Relief, has trained hundreds of thousands of healthcare workers, treated tens of millions, and ensured that millions of babies who would otherwise have been infected were born HIV-free. At the end of 2024, it was providing life-saving antiretroviral treatment to nearly 21 million people across 55 countries, including sub-Saharan African nations such as Uganda. PEPFAR is also responsible for delivering pre-exposure prophylaxis (PrEP) that prevents people from contracting HIV, and funds HIV testing, treatment, and intervention in Uganda. More than 1.5 million Ugandans are estimated to be living with HIV and AIDS. In 2021, key populations, including gay and bisexual men, accounted for 51% of new HIV cases in sub–Saharan Africa. In Uganda, 13% of gay and bisexual men are living with HIV. About 54% are aware of their HIV status and 66% are receiving antiretrovirals.
Many of these statistics, however, are either somewhat dated or incomplete. Due to the criminalisation of LGBT people in Uganda through the Anti-Homosexuality Act, it has become more difficult to collect demographic data about LGBT people. Worse still, researchers from aidsmap found that draconian anti-LGBT laws lead to more LGBT people contracting HIV/AIDS because it hinders their access to healthcare services. This is where USAID comes in to provide assistance without discrimination towards sexual minorities via PEPFAR and NGOs.
Uganda has one of the most hostile legal and social environments for LGBT people in the world. The country’s laws criminalise same-sex relationships with severe penalties, including life imprisonment. In 2023, Uganda escalated its anti-LGBT stance by enacting the Anti-Homosexuality Act, which introduced the death penalty for “aggravated homosexuality” and lengthy prison sentences for individuals engaging in same-sex behavior or promoting LGBT rights. Socially, LGBT people face widespread discrimination, fuelled by deeply entrenched conservative religious beliefs. Homophobic rhetoric is common in political and religious discourse, leading to violence, evictions, job losses, and denial of healthcare. Many LGBT Ugandans rely on foreign-funded organisations for legal aid, medical care, and safe shelter, but these services have been impacted by international funding cuts and restrictive domestic laws.
Source: OurWorldInData
The White House’s foreign aid pause, while framed as an effort to improve efficiency, has disproportionately impacted essential healthcare initiatives, particularly those supporting some of the most marginalised groups in the world, such as LGBT people in Uganda. Organisations relying on USAID and PEPFAR funding were forced to scale down or end programs, leaving many LGBT people without critical medical and social services in an already dangerous environment.
Ideologically, this executive order reflects a broader right-wing populist agenda emphasising nationalist policies, opposition to abortion rights, and a rejection of progressive social programs abroad. By restricting aid, the Trump administration has reinforced a stance that indirectly supports anti-LGBT policies in countries like Uganda.
This case illustrates the dangerous intersection of US foreign policy and human rights, where funding decisions driven by political ideology can have life-or-death consequences for vulnerable populations. It may not be said enough, but the healthcare aid provided by Western democracies does tremendous good in parts of the world where extreme poverty, systemic political corruption, and regressive social views converge to neglect or persecute people who have little opportunity to provide for or protect themselves. Moving forward, however, it is essential for international aid policies to be insulated from partisan agendas to ensure that healthcare access, particularly for threatened groups, is not compromised by shifting political landscapes and culture wars. Global institutions, human rights organisations, and donor nations should work collaboratively to create sustainable, non-politicised funding mechanisms that protect access to healthcare for all regardless of sexual orientation or geographic location.
To most Americans, it may seem as though their tax dollars are largely wasted. But when it comes to foreign healthcare aid, nothing could be further from the truth. US foreign aid saves lives. For many, it’s their last line of defence.
Published Apr 9, 2025
