Mausami Gurung used to receive a regular health checkup every three months. If she felt unwell, a volunteer would take her to the hospital. Now she is on her own.
Gurung, 30, is a transgender sex worker originally from Illam, a district in eastern Nepal, and is among thousands of people whose access to healthcare has eroded following the suspension of the United States Agency for International Development (USAID) last year. “It was very easy back then,” Gurung told Annapurna Express. “We used to get regular checkups every three months. If we didn’t feel well, volunteers would take us to the hospital.”
The USAID froze funding to a wide range of programs on 26 Jan 2025, disrupting HIV prevention and community health services across Nepal, particularly those serving sex workers and LGBTQ+ communities. Outreach workers have been pulled back, preventive supplies have become harder to access, and community-based support systems have weakened, raising concerns among experts over the potential of rising infection rates.
Organizations such as the Blue Diamond Society, which had long provided Gurung and others with free HIV testing, condoms, lubricants, counseling, and preventive medicines, including pre-exposure prophylaxis (PrEP), have been forced to scale back. For many sex workers and LGBTQ+ individuals who face stigma and discrimination in hospitals, such community services were often their only accessible option.
Gurung recalls how outreach workers helped bridge the gap between them and formal healthcare systems. “When we used to go alone, it was very difficult. The process was long, and people looked at us differently. It made us feel uncomfortable,” Gurung said. “Before, outreach workers used to regularly follow up with us. When we went for HIV testing, they would track our reports and explain whether our condition was improving.”
USAID has operated in Nepal since 1951, playing a central role in supporting the country’s public health infrastructure through partnerships with government agencies and community-based organizations.
According to the Ministry of Health and Population and the National Center for AIDS and STD Control (NCASC), HIV cases declined by about 76 percent between 2010 and 2024. In 2024, an estimated 614 people were newly infected, compared to 2,557 cases in 2010.
The decline was even more striking among children: new infections among those aged 0–14 fell by about 86 percent, dropping from around 260 cases in 2010 to an estimated 37 in 2024.
Outreach campaigns, peer education, and community networks improved awareness, encouraged safer sexual practices, and increased testing among high-risk groups.
“It’s not an overhaul. It’s destruction,” Former USAID Global Health Director, Atul Gawande in February last year told CBS News, warning that disruptions to global HIV programs—serving tens of millions of people worldwide—are leaving many without access to life-saving medication and reversing years of progress in controlling the epidemic.
Experts warn that reduced testing and limited access to preventive services could lead to undetected infections and increased transmission rates. At the same time, stigma and criminalization continue to push sex workers and sexual minorities away from public health institutions, further compounding barriers to care.
In Dec 2024, the WHO warned that the global HIV response is at a critical turning point as funding declines threaten decades of progress. The agency said HIV services are being disrupted—particularly in fragile settings—and community-led programs that serve marginalized groups are being deprioritized. WHO cautioned that without urgent action, new infections and deaths could rise again, putting health systems under pressure and jeopardizing the goal of ending AIDS as a public health threat by 2030. While HIV is now a manageable chronic condition with treatment, WHO stressed that this progress depends on sustained investment.
However, domestic funding remains insufficient, and the response continues to rely heavily on shrinking external support. Lok Raj Pandey, information officer at the National Center for AIDS and STD Control, said that condoms are available, but they might not be distributed for free. Pandey added, “There is a shortage of lubricants and PrEP. The government needs to allocate a budget for this, but at the moment, it is unable to do so due to limited resources and other priorities. With a current budget, it won’t be possible to bring these supplies.”
“Funding cuts have disrupted programs across nearly 20 districts, where community-based support once played a crucial role,” said Pinky Gurung, Advisor at the Blue Diamond Society. “Earlier, we used to actively reach out to people in the community, but now we are unable to do much.”
“We even tried continuing services through online platforms, but that has also stopped because it was not effective in meeting people’s needs,” Pinky said. “In the past, our staff would conduct follow-ups every six months—checking on health, nutrition, and providing counseling support. Now, all of those services have been halted.”
Government officials offered a different assessment.
“There are no specific problems as described,” Pandey said. “Testing and treatment services have not been hampered. But counseling and outreach—where volunteers used to visit communities—have been affected.”
“Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis,” a research published in The Lancet warns that major reductions in USAID funding and the agency’s dismantling could lead to more than 14 million additional deaths worldwide by 2030, highlighting the potentially devastating impact on global health and humanitarian systems.
Another transgender sex worker, who requested anonymity and uses the pronoun Ze, offers a slightly different perspective. The 28-year-old from Humla has been engaged in sex work for nearly nine years and is currently pursuing a Bachelor’s degree in Education.
“Condoms are still available when we need them, but we don’t have access to lubricants,” Ze said. While her experience suggests that some services continue, access is far from consistent. Ze added, “Even when condoms are available in the market, the prices we face are often higher than for others.”
Yet activists and community workers warn that the loss of outreach and counseling is far from minor.
“These were not optional services—they were the backbone of prevention,” said Sunil Babu Pant, a human rights advocate and former member of parliament. Pant said the funding cuts have hit already marginalized groups the hardest, including sex workers, transgender people, and men who have sex with men.
“Due to the shortage, street-based sex workers cannot buy protection even if they want to because they earn very little,” Pant said.
The consequences are already visible on the ground. Babu Dumi Rai, a 23-year-old non-binary activist who previously worked at HIV Prevention and Human Fundamental Rights under USAID-supported programs, said the changes have been drastic. “The program was supposed to run until 2030, but it ended five years early,” Rai said.
In fiscal year (FY) 2024, around $212m in aid was obligated for Nepal, with a further $16.3m reported for FY 2025, according to USAFacts.
Nepal again secured a US$ 51.27m grant from the Global Fund to fight HIV, tuberculosis, and malaria, with a strong focus on migrant and other vulnerable populations in Feb 2025. The funding cycle (GC7), implemented through the Ministry of Health and Population in partnership with UNDP, was supposed to run from Feb 2025 to July 2027.
A portion of the grant was aimed at supporting Nepal’s goal of ending AIDS as a public health threat by 2030, including reducing HIV infections, preventing AIDS-related deaths, and addressing inequalities affecting high-risk groups such as migrant workers, people who use drugs, and their partners. The program is aligned with Nepal’s National HIV Strategic Plan (2021–2026), which prioritizes improved access to treatment, prevention, and service delivery for vulnerable communities.
The funding cuts have had economic consequences as well. Rai estimates that around 700 people—many of them transgender individuals—lost their jobs linked to HIV prevention and other sexually transmitted diseases and have been forced back into sex work.
Experts warn that these combined factors—reduced access to prevention tools, lack of counseling, and increased economic vulnerability—could reverse years of progress. “If this is not addressed in time, Nepal could go back to a situation where HIV cases rise again,” Pant said. Pant also questioned the country’s dependence on foreign aid. “The government has relied heavily on external funding,” Pant said. “Now the question is—what happens when that support disappears? Nepal needs to build its own sustainable system.”
The size of the sex worker population in Nepal varies widely. A report by Global AIDS Monitoring published in 2020 placed the number significantly lower, estimating between 43,829 and 54,207 female sex workers in the country.
Simran Sherchan, 39, a transgender sex worker activist working with the Federation of Sexual and Gender Minorities Nepal, said that access to essential services has declined significantly. “Services have been reduced, and people are no longer able to access them properly”. According to Sherchan, sex workers are now struggling to obtain basic prevention tools.
Yet amid uncertainty, one message remains consistent across all voices: access to health is not just about services being available, but about whether they are reachable, affordable, and free from stigma. As Nepal stands at this turning point, the future of HIV prevention among its most vulnerable communities may depend not only on funding but on whether those communities remain visible in policy, practice, and public attention.
According to the report from the 2025 National Center for AIDS and STD Control, Kathmandu, HIV cases declined from 5,545 in 2002 to 614 cases by 2024. In 2010, the number of deaths stood at 2,348, but by 2024, this had dropped to 569.
In the fiscal year 2024/25, a total of 169,991 females were tested for HIV, of whom 814 were found to be positive. Among males, 255,706 individuals were tested, of whom 1,397 tested positive. Meanwhile, 2,943 transgender individuals were tested, with 61 confirmed positive cases.
In the same year, a total of 12,794 sex workers were tested for HIV, with a positivity rate of 1.3 percent.
Among key populations, higher positivity rates were recorded. For men who have sex with men and transgender individuals, 6,366 people were tested, with 3.2 percent found to be HIV positive. Similarly, among clients of sex workers, 10,688 individuals were tested, with a higher positivity rate of 4.1 percent.
Now, Gurung hopes that funding and support programs similar to USAID will return or revive the same project, saying the program provided jobs, opportunities, and proper care. Gurung said, “The community now lacks opportunities and wishes for services that genuinely support and benefit them.”
