Raj Shrestha, age 20, currently living in Kathmandu, has been using sexual health services since last July, specifically for PrEP (pre-exposure prophylaxis), and visits the clinic monthly for routine STI (sexually transmitted infection) screening.

Pre-exposure prophylaxis (PrEP), a daily medication used to prevent HIV (human immunodeficiency virus) infection in people who are at high risk of exposure to the virus, consists of antiretroviral medications that block HIV from entering and replicating in the body. While it does not cure HIV, it can significantly reduce the risk of infection.

“The clinic was friendly and supportive, which made me comfortable accessing free health services.” Raj shares.

For Suvam, also age 20, Mero Sathi was incredibly helpful, since it provided counselling, condoms, lubes, PREP, etc., for free along with regular HIV/STI checkups.

Mero Sathi is an online reservation system that aims to provide the most convenient means to make reservations for HIV testing services while handling your data to ensure anonymity and privacy.

Screenshot from the Mero Sathi website

“They would even conduct meetups and awareness programs where they’d inform and counsel about topics like depression, mental health, sexual orientations, and gender identities.” He adds.

But the executive order President Donald Trump brought right after taking office shut off the funding for foreign aid programs. Hence, these services no longer operate. This sudden halt put Raj, Suvam, and many other people from the LGBTQIA+ community, especially those from the lower socio-economic background, at higher risk.

Nepal, as a developing nation, relies extensively on foreign donations and aid to advance its infrastructural and developmental projects. From building bridges in remote areas to making reproductive healthcare accessible, aid coming from beyond borders has been crucial in improving health, education, agriculture, and various other important components of a functioning society.

This far too long dependency had a fearsome question lurking behind it. What happens if there is an indefinite pause on the aids?

Well, the worst fear came true with the Trump presidency. Unfortunately, for a small nation like Nepal, the politics of a rather powerful country like the US from halfway across the world severely impact its lives.

The 90-day pause in almost all foreign aid has had an immediate and devastating impact on low-income countries like Nepal. As the Trump Administration’s stop-work order for foreign assistance goes into effect, it has ceased operations for existing USAID-supported projects as well as new aids.

There is no exaggerating the sheer reach of USAID globally. Around 141 countries relied on some form of USAID in 2024, worth $42.5 billion. Nepal, being one of such countries, had $695 million worth of USAID-supported projects; $411 million was committed alone in the last fiscal year.

However, with the abrupt aid cut by USAID, four ongoing projects in health, education, agriculture, and inclusive policies have been halted indefinitely.

Projects about LGBTQIA+ issues apparently do not align with the priorities of the new US administration. So the “widespread termination” of USAID funding has resulted in shock, confusion, and fear for the impacted groups.

“People are left without options, especially those who rely on free or low-cost testing and resources. Some might attempt to access these resources privately, but many simply can’t afford it.” Binod highlights the vulnerable groups within the community.

Binod, also age 20, used to visit Our Equal Access for STI testing, but the HIV testing centre in Suryabinayak, Bhaktapur, is permanently closed now.

These services targeting men who have sex with men (MSM), even when free, were not without challenges. There were and still are several unaware, if not battling, stigma to access them. These services were the most convenient, and organisations or service providers were informed.

“I had taken services many years prior through BDS and other clinics, but nowadays I do self-test kits every 3 months.” Maa, age 24, shares her experience. For her, the free health service and queer friendliness, along with confidentiality, made a real difference in accessing these services.

“The comfortability and affordability were the most important aspects of these sexual health services.” Arjun, 21, from Bhaktapur, echoes a similar sentiment.

Yet, since the closure of such services, no alternatives have emerged.

“I unfortunately haven’t found any alternatives as of yet. I’m not even sure that I ever will, especially one that is free and accessible and void of judgement.” Suvam strikes with reality.

He fears that all the progress made so far in terms of STI prevention, life-saving treatments, and STI awareness has become mercurial and might go downwards if the services aren’t restored soon enough.

One such fear is regarding the mitigation of HIV/AIDS. Trump’s foreign aid freeze has obstructed the President’s Emergency Plan for AIDS Relief (PEPFAR), an HIV program.

According to the Asia Region Operational Plan published in 2022, PEPFAR was part of a collaborative effort to ensure all needed HIV commodities are adequately quantified, timely procured, and sufficiently stocked for seamless implementation.

USAID/Nepal was also co-chair of the Global Fund and Country Coordinating Mechanism that enabled PEPFAR to ensure resource alignment and synergy of investments.

But all that was ensured is no longer guaranteed.

“The loss of such services will make our lives more miserable.” Maa expresses grimly.

In a study, 8.2% HIV prevalence was found among men who have sex with men (MSM) and trans women in Nepal, while the general adult population prevalence was 0.15%.

The free sexual and reproductive health services were key in lowering/stabilising the infected population. The vulnerable groups were slowly but steadily accessing the services, and that was helping tremendously in fighting the stigma as well as the AIDS-induced mortality.

Globally, HIV infections have been falling in recent years, with just 1.3 million new cases recorded in 2023, a 60% decline since the virus peaked in 1995. But is all that progress just to no avail?

The head of the U.N. AIDS agency said that the new HIV infections could rise more than six times by 2029 if American support is dropped. Similarly, an estimated 136,000 babies could be born with HIV, according to analysis by the Foundation for AIDS Research (amFAR).

This frightening estimation can turn into a stark reality, and Nepal simply cannot afford to be exempt from that. The nation neither has budgetary nor policy capabilities to replace all the programs funded by the US government.

So where do we go from here? Who should be responsible moving forward?

“The government should take more responsibility in supporting health initiatives for the LGBTQIA+ community to make up for the lack of adequate support and resources available.” Raj voices and adds. “Individuals might be able to find ways to navigate these challenges, but systemic issues will remain.”

Likewise, disheartened at the government’s dependency on other countries, Arjun thinks community efforts and local government initiatives are crucial and can help to solve the problem one step at a time.

“It’s imperative for these services to be accessible to everyone so people can take care of their health without fear of financial barriers. Having these services for free would make a huge difference in protecting the health and well-being of the LGBTQIA+ community.” Binod conveys.

Whether Binod, Maa, or Suvam, they are critical of the US government’s involvement in Nepal’s health policies, especially as folks belonging to a marginalised group who are directly impacted by the USAID budget cut.

Their words resonate a common message: the change in US politics should not hinder basic health rights for people in Nepal.