Harerimana Ismail is a community health care worker in Kabale District, Uganda, who supports children and teens living with HIV. He lost his salary as part of the U.S. aid cuts but continues doing his job.
Ben de la Cruz/NPR
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Ben de la Cruz/NPR
Harerimana Ismail has not received a paycheck since early last year, yet he continues to work.
In January 2025, the Trump Administration halted foreign aid and issued stop work orders, causing almost all U.S. foreign aid projects to cease. This led to the end of Ismail’s role as a community health worker at Kabale Regional Referral Hospital in Uganda, where he earned approximately $50 monthly through a U.S. grant. Despite this setback, he has continued to visit homes to ensure children with HIV are taking their medications, receiving medical care, and feeling supported.
“I don’t receive any stipend or salary,” says Ismail, 32, who was born with HIV. “I understand the hardships young people with HIV face, which is why I continue.”
Without an income, he relies on vegetables from his garden and sells Irish potatoes to cover rent. He has lost 15 pounds over the past year.
Recent data indicates that Ismail’s efforts, along with those of others, have significantly impacted HIV treatment continuity.
So much so that dire predictions of a collapse in HIV/AIDS treatment efforts due to foreign aid cuts have not materialized, at least for now. Preliminary U.S. government figures suggest global HIV treatment levels remain stable, with the U.S. supporting over 20 million people on treatment. The number of people treated decreased by just 100,000 between the end of 2024 and a year later.
“The worst outcomes we feared haven’t occurred,” says Jeff Imai-Eaton, an associate professor of epidemiology at Harvard T.H. Chan School of Public Health.
While this is positive news, challenges remain in the fight against HIV.
A brief flash of data
Over decades, the U.S. has been a leader in combating HIV/AIDS globally, investing over $110 billion and saving 26 million lives. It has also provided high-quality data on various aspects of the disease, helping ensure programs meet their goals.
“The U.S. set a gold standard for collecting and transparently sharing data and using it to inform decisions,” says Ramona Godbole, who helped manage the global health data hub at the U.S. Agency for International Development, now defunct. Recently, as foreign aid has been reduced, the U.S. halted data reporting.
“It’s been a black box with no new data,” Godbole says.
However, preliminary data on the U.S.’s HIV work appeared briefly on a government website before being removed. The State Department did not comment on the removal. Despite this, experts note that the numbers align with findings from other organizations.
“It complements the data we receive from countries,” says Mary Mahy, director of data and evidence at UNAIDS. While specialists examine the latest figures, they realize that the feared drop in treatment numbers hasn’t occurred.
“In a better place”
Last year, Charles Kenny, a senior fellow at the Center for Global Development, estimated the impact of aid cuts, issuing dire warnings. However, the preliminary government data gives him hope that U.S. support for HIV treatment is stronger than he anticipated.
“If this data is accurate, we’re in a better place than expected, though it’s still challenging,” says Kenny, who wrote a blog post analyzing the data.
In a statement to NPR, the State Department confirmed that treatment levels at the end of 2025 were similar to the previous year. Although treatment levels dipped by 23% in March 2025, they rebounded and were only down by 2% by September.
The State Department attributed any perceived decline to reporting challenges rather than actual care disruptions. They stated, “Data release has been delayed due to reporting issues. We will resume regular data reporting when confident in its accuracy.”
Imai-Eaton believes the recovery in treatment numbers resulted from global cooperation. The potential loss of life spurred action worldwide at three levels.
Three types of action
Initially, the Trump Administration restarted some life-saving programs. “The U.S. government recognized the potential impact of the stop work order,” explains Mahy. “They communicated the need to distribute drugs to countries.”
Secondly, recipient countries filled the gaps. “Ministries of Health reprioritized and maintained services heroically,” says Imai-Eaton.
The third factor involves individuals like Ismail in Uganda, who continued their work despite challenges, borrowing a bike to visit children in remote areas since he could no longer afford transportation.
“Communities decided not to let lack of payment stop them from helping people get their medications,” Mahy says. Several specialists highlighted the dedication of community health workers and frontline medical professionals in maintaining treatment levels.
“Providing the absolute bare minimum”
Despite high treatment levels, specialists are concerned about the broader HIV landscape. U.S. support for HIV testing and counseling decreased from over 80 million to just under 70 million between 2024 and 2025.
Advocates say the quality of treatment services has declined, with many related programs, such as prevention and peer support groups, shutting down.
Ismail notes that some patients have expired drugs due to supply chain issues, and others face long waits at hospitals—between 4 to 9 hours for medications.
Furthermore, the distribution of condoms has dwindled, according to Imai-Eaton. Efforts to support high-risk populations, like sex workers and men who have sex with men, have also suffered.
Dr. Caspian Chouraya, who oversees work for the Elizabeth Glaser Pediatric AIDS Foundation, says funding cuts have ended many support groups for teenagers with HIV. Similarly, funds for phone minutes, needed for clinic employees to remind patients about appointments, have dried up.
Emily Bass, author of To End A Plague, has been closely monitoring the situation. She believes the events of the past year raise important questions about the U.S. response to HIV/AIDS.
“The treatment ecosystem was severely disrupted,” she says. “Are we satisfied with providing the bare minimum?”
“She died in my hands”
Concerns also exist about new HIV cases and deaths among the HIV-positive population. The State Department told NPR that claims of widespread treatment loss and related deaths are inaccurate. Experts like Kenny and Mahy say it’s too early to determine if there is an increase in HIV spread or AIDS-related deaths.
Ismail has an idea of what the data will eventually show.
“I saw many people dying,” he says of the past year.
He recalls a 14-year-old girl who wanted to be a nurse and always greeted him warmly. Ismail used to bring her medications, but after losing his transportation funds, he couldn’t visit her. Without a way to the hospital, she went without her HIV medications.
In June, her family managed to bring her to Ismail’s village for hospital treatment. “She died in my hands,” Ismail says.
The girl’s death devastated him and motivated him to continue his work.
However, Ismail admits he cannot work without pay indefinitely. He aims to reach as many former patients as possible before he can no longer sustain himself from his garden.
