Uganda sees spike in disease-related deaths after elimination of USAID

[0:00] Soon after taking office 15 months ago, the Trump administration dismantled the $40 billion U.S. Agency for International Development. [0:08] Days later, Secretary of State Marco Rubio issued an exemption for what he described as life-saving humanitarian assistance. [0:15] But what that exemption covered was never clearly defined, and in practice, funding for health programs has been sharply reduced. [0:22] Our Fred DeSam Lazaro begins a two-part report from the East African nation of Uganda. [0:27] It's near the start of another day for Dr. Otem Pias in the HIV clinic of Mokono Hospital. [0:38] We used to have about four doctors working in the clinic, but right now I am alone. [0:45] We have about 3,200 patients. It is impossible for me to see all of them. [0:53] His patients are among millions across Africa who have received treatment and life-saving antiretroviral drugs for HIV. [1:01] under PEPFAR, a program begun in 2003 by the George W. Bush administration. [1:07] It all ground to an abrupt halt at the start of the second Trump administration. [1:12] It shut down USAID and issued a stop work order across all aid programs. [1:19] Dr. Pias says HIV incidence and mortality rates more than doubled. [1:23] For both HIV and also HIV-associated illnesses like TB, like meningitis, close to 15 percent of the clients dying of malaria and TB. [1:37] It is very painful to lose someone of a treatable disease. [1:43] The numbers began to trend downward, closer to 10 percent, after an exemption was issued for certain life-sustaining programs. [1:53] These included various HIV drugs. [1:56] It is still high, but it is lower than during that time. [2:00] That's because even though many, though not all, formulations of HIV medications were replenished, [2:06] programs to actually get them to patients were not restored. [2:09] Having HIV drugs available at the health center does not necessarily mean they're accessible, [2:16] especially for patients in isolated rural communities, so-called last mile. [2:21] Transportation, even if it's just $10 a month, is out of reach for many people here. [2:26] The poverty levels are high in our communities. [2:29] These are fishing communities. [2:30] They don't have stable incomes, yeah. [2:33] So one of the reasons why the girls sell their bodies is to be able to earn a living. [2:38] Marjorie Namale runs a non-government enterprise that was supported by USAID, [2:43] serving remote villages near Lake Victoria, [2:46] counseling young women on safe sex, offering training in basic work skills, [2:51] and critically, making sure they got testing and medicines for HIV prevention or treatment [2:57] and transportation money to get to a health center. [3:01] All of that is now gone. [3:03] All that is gone. [3:04] She took me to visit some of her now former clients. [3:07] These women, in their early 20s, shared similar worries. [3:11] They used to give us family planning. [3:14] That's my anxiety right now. [3:15] How do I protect myself from getting a child? [3:18] I can't access condoms. [3:21] I was just learning how to do hair braiding, [3:23] but halfway through the journey, the fund was closed. [3:26] I didn't learn much. [3:27] I don't have anything. [3:33] I was very hopeful that I'm going to learn hairdressing. [3:36] At least I would have something to do to earn a living. [3:39] But when Trump closed everything, that hope was gone. [3:44] All of these women are considered at high risk for HIV, Namale says, [3:48] but none have been tested. [3:50] Many of her former HIV-positive clients are no longer taking their medications. [3:56] Fifty-three-year-old grandmother Catherine had been off them four months when we visited. [4:01] Unable to afford transport to the regional health center, she tried a private clinic. [4:06] I had also been getting pills for high blood pressure. [4:10] I went to a nearby clinic, and it was 180. [4:14] They told me to come back with 10,000 shillings, which I don't have. [4:18] That's about $3, and roughly the subsidy that Namale's clients received for transportation [4:24] to health centers, where care is provided at no charge. [4:28] 23-year-old Joan has been off and on her regimen of HIV drugs, causing several side effects. [4:37] In her case, Namale discovered, even when Joan was getting transportation money, [4:46] she sometimes spent it on food for her siblings. [4:49] So money was diverted. [4:51] A stark measure of many patients' predicament, she says, choosing between food and medicines. [4:57] Two months off the drug, six months off the drug, when they feel they are doing badly, [5:02] then they will find a way of how to maybe get borrowed from neighbors, transport. [5:06] So the patients crowding clinics like Dr. Pius' come in sicker. [5:11] The workers, a lot of the workers in HIV clinics were paid by Americans. [5:17] The fall-up and the community systems, those were quite badly affected, and I think they have not recovered. [5:24] Peter Waiswa, health researcher at Makarrera University, says the USAID cutbacks were a painful reminder [5:31] of the heavy dependence on foreign aid. [5:33] He says many African governments long ago pledged to spend at least 15 percent of their national budget on health care. [5:41] Most have fallen way short. [5:43] Anywhere between four, five, at most six or seven, and sometimes actually dropping. [5:48] It's time for African governments to really step up and finance their systems. [5:54] True assistance is self-sustainability. [5:57] That echoes a message from the Trump administration, which is revamping the U.S. approach to health care assistance. [6:03] It requires African countries to chip in an increased share of the costs in exchange for grants from the U.S. [6:11] Several countries have signed agreements under what's called the America First Global Health Strategy. [6:17] That story in our next report. [6:20] For the PBS NewsHour, I'm Fred de Sam Lazaro in Mukono, Uganda. [6:38] Support journalism you trust. [6:40] Support PBS News. [6:43] Donate now, or even better, start a monthly contribution today. 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