Lessons from India’s sex worker activists on surviving USAID freeze

US President Donald Trump’s cost-cutting army sent the world’s foreign aid infrastructure reeling last month with its stop-work order for all programmes funded by the US Agency for International Development.

Despite a dizzying series of further announcements and reversals, including a “humanitarian waiver” for certain “life-saving” services, the ensuing chaos has been widespread and devastating.

One major effect is on HIV/AIDS, programmes which made up 14.7% of all US foreign aid spending in 2023. The US government has allowed agencies to apply for waivers for specific types of HIV programmes, but confusion and uncertainty has meant a lethal suspension of services. UNAIDS estimates that a permanent halt to PEPFAR would result in an additional 6.3 million AIDS-related deaths by 2029.

Yet, Indian HIV programmes have been affected in a more moderated way. “It did not send shock waves among recipient organisations or engaged organisations significantly,” said AIDS expert Dr Sundar Sundararaman. “It has been shocking, but it is not posing a difficulty.” Why is India’s HIV programming more resilient in the face of Trump’s bluster?

One reason is India’s relative financial independence. Since George W Bush inaugurated PEPFAR – the President’s Emergency Plan for AIDS Relief – in 2003, it has provided some $120 billion globally. In its main partner countries, it accounts for 46% of national HIV budgets (and that’s not including US contributions to the…

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