In Malawi, a year after the U.S. Agency for International Development (USAID) was shut down and funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) disappeared almost overnight, the real-world effects of Donald Trump’s America First withdrawal from combating HIV/AIDS are coming into stark relief.

“When the stop-work order came, all 1,921 PrEP [pre-exposure prophylaxis] clients lost structured service delivery overnight: refills, counseling, peer follow-up, everything stopped at once,” Gift Trapence, director of local health organization Center for People Development, told El Páis.

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“We were providing continuity, follow-up, mental health support,” she explained. It was “a whole ecosystem designed specifically for key populations.”

George Kachimanga, a program manager at another local health organization in the East African country of Malawi, Nyasa Rainbow Alliance, said that nearly every clinic dedicated to serving LGBTQ+ people in the nation has closed.  

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“Only a few are still operating,” he said, including “two urgent care centers in Blantyre and Lilongwe, using its own funds.”

“And since the funding freeze, none of the programs supporting the LGBTQ+ community in Malawi have resumed.”

According to advocates, PEPFAR funding allowed healthcare workers to reach a population that would otherwise not receive care in countries like Malawi, where there is undisguised hostility to LGBTQ+ people.

Drop-in centers functioned as community hubs offering HIV testing, PrEP, condoms, mental health support, and staffers to keep clients on schedule with life-saving antiretrovirals.

Malawi, a lush, landlocked, and mostly agricultural former British colony, is one of Africa’s most openly hostile countries to LGBTQ+ rights, ranking near the bottom in every category of acceptance worldwide.

The country earns 8 out of 100 on the Equaldex Equality Index. Homosexuality and same-sex acts there are punishable by 14 years in prison for the first offense.

Considering this, a story illustrating the personal impact of the loss of PEPFAR funding, shared by Chisomo Nkwanga, a 24-year-old HIV-positive young man, comes with little surprise.

At the central hospital in Mzuzu, not far from the country’s life-sustaining Lake Malawi, a nurse shouted at Nkwanga down a crowded corridor. He was there to collect his antiretrovirals, he said, the first time he’d visited the public hospital to do so after his PEPFAR-funded clinic closed.

He’d been waiting in line when he fell into an argument with the nurse.

“You are gay,” she said to him, “and now you are starting to patronize our hospitals because the whites who supported your behavior have left?”

She asked the question loudly enough for everyone nearby to hear. Nkwanga said he was too humiliated to respond — he left that day without his meds.

Recalling his previous experience at the drop-in clinic, Nkwanga said people knew his name and greeted him when he arrived. He was treated, he said, as “a patient, not a pariah.”

The young man learned he was HIV-positive six years ago, after he began falling ill frequently. Since then, he’s grown pale and thin.

“I am a living dead,” he said.

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