“My wife is afraid of sex, I’m afraid of death”

The life of Mike Elvis Tusubi, a motorcycle motorcycle with HIV motorcycle in Uganda, was turned upside down after US President Donald Trump stopped foreign help last month.

Not only the 35-year-old fear of his own survival, as he accepts life-saving antiretrovirus (ARV) drugs-but he says he will have to part with his wife as they can no longer have safe sex.

His partner is HIV-negative and relies on Prep, a medicine that reduces the risk of HIV infection.

“This means that even my marriage will end, because in fact, without preventative measures, it will not remain,” he told the BBC.

“Without condoms, not (anti-hire) lubricants, no preparation, nothing. We cannot be married without meeting. This means that I have to remain single.”

All medicines and contraceptives of the couple were delivered thanks to funding from USA USAID overseas agency.

After the sudden exclusion, which he heard about on social media, they failed to fill in their deliveries. His wife is already completely exhausted, and they both fear that they rely only on condoms – they are left – is too risky.

Trump ordered a 90-day pause for foreign assistance on his first day back to office, after which the stopping orders began to be issued to USAID-funded organizations.

Subsequently, the refusals were issued for humanitarian projects, but at that time the HIV program was part of the Marpe Clinic in the northern part of the capital, the Campal was closed.

He called his advisor at the Kiswa III health center in the city to find out what was going on.

“My advisor was in the village. He told me he was no longer in the clinic.”

The father of one who tests positively for HIV in 2022 has since missed a test to determine how much a virus is in his blood and the power of his immune system.

“I move in the dark, in the dark. I don’t know if my viral load is suppressed. I’m injured.”

He does not think that his work, driving by motorcycle fees – known at the local level as a “stitch -pain” – will be able to help his family overcome the obstacles they are now confronted with.

“Some other people say that the medicines will be in private pharmacies … as a rider of the stitch-pain I don’t know if I can raise the money to maintain my treatment.”

They were also influenced by the loss of services provided by non -governmental organizations (NGOs) who received funding from USAID, he says.

His wife was preparing through a non -governmental organization in Marpi, and his five -year -old son took advantage of the one who provided school and food for vulnerable children.

“My child is no longer in school,” he said.

Uganda’s health sector is highly relying on donor financing, which supports 70% of its AIDS initiatives.

The East African nation is among the first 10 recipients of USAID funds in Africa. According to the US government, the country has received $ 295 million (234 million British pounds) for health funding from the agency in 2023 – ranked third after Nigeria, which received $ 368 million and Tanzania with $ 337 million.

USAID also supports its malaria, tuberculosis and leprosy programs – as well as funding for maternal and children health services and emergency health care.

Thousands of health workers have been influenced by freezing US funding.

Dr Shamira Naki, Clinician with Reach Out Mbuya (ROM) – Community organization based on faith providing medical and psychosocial support for people living with HIV in Ugand Quarter in Campala.

On average, she visits 200 patients with HIV/AIDS and tuberculosis daily. But after the stop-work order, all health workers supported by ROM were fired.

Its tuberculosis unit is now silent and its orphan section and vulnerable children are also closed in sour.

“We are expecting the 90 days. So, this mandatory leave, I have not prepared for him,” she told the BBC.

“It was so sharp. We didn’t have the right broadcast at the facility. We just stopped working.”

Uganda Health Ministry says it is exploring ways to minimize interruptions.

Diana Atwin, the best civil servant at the ministry, called on the staff “wishing to continue working in the spirit of patriotism as volunteers” to connect.

South in Malawi, USAID -funded activities are also doing.

The country received $ 154 million from the USAID health budget in 2023, making it the 10th largest recipient in Africa.

In the northern city of Mzuzu, the gates are closed in a clinic, which is a key HIV service provider in the region. Vehicles sit empty; There are no signs of activity in the Macro Mzuzu clinic. The workers locked the doors, turned off the lights and returned 18 days ago.

Despite the refusal of the US State Department on January 28, allowing the supply of medicine such as ARVS, many clinics have closed themselves as without critical staff that coordinates USAID activities, drug distribution is a challenge.

Even when the services are allowed to resume technically, many contracts remain in the limbs. Health workers are not sure what they can and cannot do.

The Trump administration plans to reduce USAID staff by more than 90%.

Atul Gavend, the former administrator of the USAID global health assistant, has published on X that the agency’s workforce will be reduced from 14,000 to 294 – with only 12 employees appointed in Africa.

More than 30 NGOs in Malawi were also heavily affected by the freezing of funding.

Edda Simfukve Band, a 32-year-old maintenance farmer, receives ARV from 2017 from the macro clinic, where various NGOs provide HIV programs.

She is worried about her own fate-and that of her daughter-in-law, who also relies on donor-funded medicines-and says they are a small option, except to pray.

“We have to pray as Malawi. Those of us who believe depend on God who opens the doors when a person is closed,” she told the BBC.

The mother of the three, who has a three -week supply to ARV, also said that system failures are to blame: “Like Malawians, we depend on too much on getting help. Sometimes we are lazy and rely and rely on other countries to help us help the US.

“Let this be a lesson that we must be independent,” she said.

But this is difficult for one of the poorest and most dependent on the auxiliary countries in the world. According to the World Bank, Malawi is vulnerable to external shocks – including prolonged sushi, cyclones and chaotic rainfall.

The interruption of this scale in its health system is a huge challenge.

For decades, the United States has been the most significant partner for public health in Africa.

In particular, through its innovative program to counteract the global distribution of HIV, which launched in 2003, called the US Emergency President plan for AIDS relief (PEPFAR), it saved more than 25 million lives.

According to African Head of African Centers for Disease Control and Prevention (Africa CDC), USAID provides $ 8 billion in assistance to Africa in the last year.

“The seventy -three percent went to healthcare,” Jean Cassea told BBC Newsday last month.

Health experts warn that replacing this funding will be extremely difficult.

African governments have made progress in reducing addiction on help. Kenya now funds nearly 60% of her HIV response. South Africa covers almost 80%.

But for many low -income countries, the load of debt, climate disasters and economic shocks make almost the impossibility of self -sufficiency.

Amref Health Africa, one of the leading health NGOs on the continent, warns that without urgent action, global health security is at risk.

“This will require African governments and Africa CDC to increase their own funding, which is almost impossible under the current debt disaster,” CEO D -R Githinji Gitahi told the BBC.

“With the acceleration of outbreaks by climate change and conflict between man and the environment, it will leave the world fragile and dangerous – not only for Africa, but for everyone.”

Globally, in 2023, there were 630,000 AIDS -related deaths and 1.5 million new infections.

While the infection rate decreases in the worst affected countries, the effect of stopping USAID can cancel these profits.

“If you take this major contribution from the United States Government, we expect that in the next five years there will be an additional 6.3 million deaths related to AIDS,” Sword Bayanima, UNAIDS leader, told BBC Africa Daily Podcast This week.

“There will be 8.7 million new infections, 3.4 million additional orphans with AIDS. I do not want to sound like a prophet of doom, but I have an obligation to give the facts as we see them.”

The Médecins Sans Frontières (MSF) Medical Charity has also warned of HIV treatment hazards.

“HIV drugs should be taken daily or people risk the development of resistance or deadly health complications,” said Tom Elman of the South Africa in a statement.

In Uganda, he feels gloomy for the future.

He has about 30 days left of his ARV medicines – and can choose to leave the Campal and return to his village afterwards.

“At least it will be a little more. If I die, they just bury me there instead of disturbing my people here in the Campal.

“Because I have no way of living here without ARV services.”