Community Health Workers Help Sustain HIV Treatment Amid Cuts
Harerimana Ismail continues his vital work for HIV patients in Uganda despite losing his salary due to U.S. aid cuts. His dedication has helped mitigate a predicted drop in treatment levels.
Harerimana Ismail, a community health worker in Kabale District, Uganda, supports children and adolescents living with HIV. Although he lost his salary due to U.S. aid cuts, he remains committed to his role.
Ismail has not received a paycheck since early last year, but he continues to work diligently. Following the Trump Administration's suspension of foreign aid and the issuance of stop work orders in January 2025, many U.S. foreign aid projects were halted, including Ismail's position at the Kabale Regional Referral Hospital, where he earned approximately $50 per month. Despite these challenges, he perseveres, visiting families to ensure that children with HIV are adhering to their medication regimens and receiving necessary care.
“I am not receiving any stipend or salary,” says Ismail, 32, who contracted HIV at birth. “I continue to work because I understand the struggles faced by young people living with HIV.” Without a formal income, he relies on vegetables from his garden and sells Irish potatoes to pay his rent, having lost 15 pounds in the past year.
Recent data indicates that the efforts of Ismail and others in similar roles have significantly bolstered HIV treatment continuity. Initial projections of a severe decline in HIV/AIDS treatment following the aid cuts have so far proved inaccurate. Preliminary figures from the U.S. government show that global HIV treatment levels remain relatively stable, with only a slight decrease of 100,000 patients among the 20 million receiving U.S. support.
According to Jeff Imai-Eaton, an associate professor of epidemiology at Harvard T.H. Chan School of Public Health, “The most severe outcomes that we were concerned about haven't come to pass.”
Despite this positive news, challenges remain in the global fight against HIV. The U.S. has historically played a crucial role, investing over $110 billion in the battle against HIV/AIDS, contributing to the saving of 26 million lives. It has also provided vital data on HIV testing and treatment, which has guided program goals and strategies.
Ramona Godbole, the former deputy director of policy, planning, and programs at the now-defunct U.S. Agency for International Development, noted that the U.S. has been a benchmark for data collection and transparency. However, with the recent cuts, the government has ceased to publish data regarding HIV efforts, resulting in a significant lack of information.
A few weeks ago, preliminary data on U.S. HIV initiatives briefly surfaced on a government website before being removed, and the State Department has not provided comments regarding this disappearance. Although the data is not officially released, experts believe it aligns with findings from other organizations.
As health specialists analyze the latest figures, they recognize that the anticipated significant drop in HIV treatment numbers has not occurred. Charles Kenny, a senior fellow at the Center for Global Development, previously warned about the potential impacts of the aid cuts but expressed optimism after seeing preliminary data indicating stronger support for HIV treatment than expected.
The State Department confirmed that treatment levels at the end of the 2025 reporting period remained similar to the previous year, despite a reported decline of 23% in March 2025, which later rebounded to a 2% decrease by September. They attributed these fluctuations to temporary reporting issues rather than actual disruptions in care.
Imai-Eaton believes that the recovery in treatment numbers stems from global cooperation rather than the initial fears being unfounded. Key factors included the resumption of certain U.S. programs identified as life-saving, proactive measures by recipient countries to maintain services, and the dedication of community health workers like Ismail who have continued their outreach despite financial setbacks.
However, while treatment levels are holding steady, there are signs of concern in the HIV landscape. The number of individuals receiving HIV testing and counseling has decreased from over 80 million at the end of 2024 to just under 70 million a year later. HIV advocates highlight that the quality of treatment services has declined, with many related programs, including prevention initiatives and peer support groups, shutting down.
Ismail noted that some of the patients he assists are receiving expired medication due to supply chain issues, and many face long wait times of 4 to 9 hours at hospitals to receive their prescriptions. Furthermore, the distribution of preventative measures, such as condoms, has diminished.