Caro (not real name), one of the affected women, shared with DailyExpress her distressing ordeal, explaining how stigma is driving a silent health crisis.
Gulu, Uganda: Hundreds of sex workers across Uganda are being forced to choose between their health and dignity after the closure of USAID-funded drop-in centers that once offered them private, stigma-free access to sexual and reproductive health (SRHR) services.
Caro, a pseudonym we adopted for one of the affected women, painfully narrated how she has gone for over two months without taking her antiretroviral (ARV) medication due to fear of public humiliation at a government facility.
“I used to get medication privately at the drop-in center. Now, I have to queue with everyone at the OPD where people stare, whisper, and mock. It’s unbearable,” Caro said, wiping tears from her face.
Caro’s story reflects a broader crisis affecting an estimated 130,000 female sex workers in Uganda, the country’s largest key population group. With the termination of USAID’s health programs in January 2025, triggered by a 90-day foreign aid freeze issued by U.S. President Donald Trump, support systems that previously shielded this vulnerable group have collapsed.
Before the shutdown, programs such as PEPFAR (President’s Emergency Plan for AIDS Relief) ensured sex workers could access ARVs, condoms, post-exposure prophylaxis (PEP), and SRHR counseling with privacy and dignity. These services were offered discreetly through trained peer outreach workers and mobile clinics.
“USAID was our last beacon of hope,” she says. “Now we’re being pushed to public facilities where we face stigma and a lack of privacy. I had to stop treatment.”
Numbers Tell a Grim Story
According to data from a Gulu-based health facility, 630 sex workers received SRHR services between January and March 2025. That number jumped to 688 in April, despite the strain on resources and staffing. Previously supported by about 20 peer outreach workers, the program now operates with just seven due to funding cuts.
Dr. Cana Kenneth, the District Health Officer for Gulu, confirmed the challenge during an exclusive interview with DailyExpress. “We now rely on a focal point person to escort health workers to where these women gather. It’s not sustainable,” he said.
“We need to increase outreach and introduce mobile services to minimize exposure to stigma.”
Dr Cana also acknowledged that the Ministry of Health is assessing alternative funding models to sustain services for marginalized groups.
Consequences await
Without reliable access to treatment, condom supplies, and private consultation, Gulu health workers warn that HIV infections among sex workers are likely to rise.
An official who preferred to stay anonymous with this report, but works for an organization that supports such groups, told this publication that the shortage of reproductive services has resulted in increased barriers to access, leading to a surge in HIV cases.
“Access to reproductive healthcare is not just a matter of policy, but a fundamental human right – the denial of which can have far-reaching and devastating consequences, including the spread of preventable diseases like HIV,” said the official.
She adds that the unavailability of condoms and PEP, exacerbated by stigma, has significantly contributed to this issue. Currently, the official says, they are distributing condoms and other items individually, which is proving costly due to transportation challenges, and as a result, many sex workers have discontinued their treatment out of fear of stigma.
She emphasized the need to address the issues of stigma, which could help reduce the spread of diseases by providing a safe and dedicated space for treatment, as sex workers often feel uncomfortable seeking care at general OPDs due to fear of judgment and stigma
Parliament urged to intervene with Policy Reforms
Gulu City MP and former Leader of Opposition, Hon. Betty Aol Ocan (FDC), spoke to DailyExpress over the matter and pledged to raise the issue on the floor of Parliament, stressing the need to protect targeted populations from health-related discrimination.
“The gaps left by USAID must be filled by the government and partners. Everyone deserves access to health services, without fear or shame,” Hon Ocan said. She also appealed to religious and political leaders to set aside moral biases and focus on public health needs.
As Uganda braces for post-PEPFAR realities, experts warn that without urgent intervention, many sex workers will continue to suffer silently, unseen and unsupported.
“Health care is not a privilege, it’s a right,” Gulu DHO Cana emphasized. “We must stop treating sex workers as an afterthought. Their well-being affects the entire public health system.”
If you would like your article/opinion to be published on Uganda’s most authoritative anews platform, send your submission on: [email protected]. You can also follow DailyExpress on WhatsApp for realtime updates.
