QUEER SURVIVAL AMID PEPFAR’S COLLAPSE

In January 2025, just four days after returning to the White House, Donald Trump’s administration officially pulled the plug on PEPFAR, the US President’s Emergency Plan for AIDS Relief. Daniel Anthony outlines the resulting impact on the Global South.

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For over two decades, PEPFAR was the world’s largest and most effective global health initiative in the fight against HIV/ AIDS, credited with saving more than 25 million lives. The programme funded access to antiretroviral therapy (ART), reduced mother-to-child transmission, and supported critical community-based healthcare for marginalised groups like LGBTQ+ people and sex workers.

The sudden defunding of PEPFAR isn’t just a political move. It’s a trigger for what could become a catastrophic HIV resurgence, one that will hit queer and trans people in the Global South the hardest. Across Uganda, Nigeria, Kenya, and Ghana, where anti-LGBTQ+ laws are tightening by the day, the loss of PEPFAR is a death sentence for many. Clinics are shutting their doors. Life-saving medications are disappearing.

For so many, these services weren’t just healthcare, they were lifelines. Outreach programmes that once offered HIV testing, PrEP, and antiretroviral treatment in safe, judgment-free spaces are vanishing. For countless queer and trans people, these were the only places where they could access care without the fear of arrest, exposure, or violence. Now, as those doors close, so do their chances of survival.

But this isn’t simply the fallout from a budget cut, rather, it’s the result of a calculated political move. To understand how we got here, we need to look at the ideological forces that transformed a global health lifeline into a battleground for culture wars.

PEPFAR was never controversial. Launched in 2003 by Republican President George W. Bush, it was one of the most ambitious public health responses in US history, with bipartisan support. The programme went ahead and invested billions in combating HIV/AIDS in low and middle-income countries, particularly across sub-Saharan Africa. Over the years, PEPFAR provided over $100 billion in funding, saved more than 25 million lives, and built vital infrastructure—clinics, trained healthcare workers, stocked clinics with ART, and funded grassroots programmes that reached the world’s most vulnerable, including LGBTQ+ people, sex workers, and people who inject drugs.

PEPFAR became a model for global health response, symbolising America’s commitment to global health and humanitarian aid. But that legacy has steadily eroded under the weight of political agendas. During Trump’s first term, his administration began dismantling global health efforts by reinstating the “global gag rule,” slashing reproductive health funding, and empowering anti-LGBTQ+ groups through policy and appointments. Yet, PEPFAR endured.

What changed in Trump’s second term was the aggressive influence of far-right evangelical groups within US foreign policy. These groups pushed a global agenda grounded in Christian nationalism, viewing LGBTQ+ people, sex workers, and even contraception as moral threats. Backed by this ideology, the Trump administration began funnelling global health funds into “pro-family” programmes, a dog-whistle policy designed to erase LGBTQ+ people and roll back sexual and reproductive rights. PEPFAR, once a lifeline, became a target, not for failure, but because it served the very communities the far-right wanted to be erased.

The final blow came days after Trump’s 2025 inauguration, when his administration announced it would not renew key funding agreements for PEPFAR, citing vague concerns about “woke ideology” and “misuse of taxpayer dollars.” In truth, no evidence supported either claim.

Instead, it was a calculated move to reframe life-saving HIV treatment as a cultural battleground, erasing decades of progress in one stroke.

The message was clear: global health is no longer neutral. In today’s climate, saving queer lives is a controversial threat to the status quo, making them expendable.

The impact of PEPFAR’s defunding is already being felt on the ground across sub-Saharan Africa, where the HIV/AIDS epidemic remains a critical health challenge. For queer and trans people in these regions, the loss of PEPFAR-funded services is more than just a setback—it’s an existential threat. As anti-LGBTQ+ laws tighten and healthcare systems falter, the withdrawal of PEPFAR represents a devastating blow to public health infrastructure.

“PEPFAR was a safety net,” says Bitalo, a healthcare worker at a PEPFAR-funded clinic in Kampala. “Losing it was devastating. It’s heartbreaking to turn away clients we’ve known for years because we’ve run out of supplies and lost funding. If we can’t find new donors soon, this clinic will shut down.”