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US Aid Cuts and their Impact on Uganda’s HIV Community

The US government has signed a Memorandum of Understanding (MOU) with Uganda, injecting USD 2.3 billion (approximately UGX 8.09 trillion) into the country’s health sector. This bilateral agreement has sparked controversy, particularly regarding data privacy concerns. The deal comes shortly after a similar agreement was temporarily halted by Kenya’s High Court. 

Uganda is likely aware of these concerns, but they seem unlikely to derail the deal, given the health sector’s struggles following USAID’s closure. With over 60% of health funding coming from the US agency, priority areas like HIV funding have been severely impacted. Implementing this MOU could be the reprieve the sector has long needed. 

Having been recognized as a leading country in the global fight against HIV/AIDs, Uganda with a population of 1.5 million people living with the virus is facing setbacks. While the country’s HIV prevalence rate stands at 4.9 percent from 5.8 percent in 2020, the Uganda Aids Commission records show the country recorded 37,000 new HIV infections in 2024. This, coupled with an abrupt funding crisis that has exposed the country’s fragile health system.

Across the vast landscape of northern Uganda, the green plains of Acholi, the fertile farmlands of Lango, to the semi-arid ridges of Karamoja and the bustling borderlands of West Nile, the sound of white USAID trucks rolling through dusty roads was not just noise, it was a promise of life. These trucks carried HIV test kits, cartons of antiretroviral drugs, gloves, and medical forms, that connected remote communities to a global network of care. Now, the bustling villages have gone silent, clinics stand half-stocked, community shelters remain closed, and outreach vans sit idle. At a health center in Gulu, a nurse opens an empty storage cupboard and sighs. We used to hear the trucks before sunrise.” She says softly, “That sound meant life, it meant the sick could rest knowing help was on the way. Now we just tell them to wait.”

The numbers in Northern Uganda tell a worrying story. HIV prevalence remains at 7.2% in Acholi, 6.1% in Lango, and 3.1% in West Nile, compared to the national average of 4.9%.  “We used to go out every week,” says a clinician in Pakwach, “testing people at markets, landing sites, and truck stops. Now, we sit and wait for those who can find their way here, but some never do.”

These harrowing realities are not unique to Northern Uganda. Eleven Kilometers out of Fort Portal town in Western Uganda, is a small, narrow, and winding murram road off the tarmac that leads you to Bukuuku Health Centre IV, a government-aided health institution overlooking the foothills of Mountain Rwenzori. Ensconced in the far-right extreme corner of this health centre is the clinic that has served the HIV community of both Kabarole and Bundibugyo districts, for close to two decades and now has 1,514 active clients.

HIV patients slowly trudge in and occupy the area in the shade that is reserved for them. One by one, their names are called out as they receive their medicine portions for the month, and unhurriedly, like they came, they make their way out. These men and women who periodically walk into this clinic for medicines and other HIV-related support are all oblivious of the chain of support that ensures they can always walk to that little dispensing window and be handed free medicines uninterrupted. 

Kengonzi Vicky (not real name) has been living with HIV and receiving ARVs for the last 18 years. She is a mother of two and works in one of the tea factories in Fortportal. Her job barely earns her enough to keep body and soul together and would be unable to afford Antiretrovirals (ARVs) if they were not free. Vicky mentioned that they had been informed by the clinic administration in late January 2025, that some changes were due to happen and this was because of funding cuts that had been triggered by the donors. She didn’t pay much attention to this because she had no idea who these donors were. 

The changes Vicky was alluding to, can be traced back to January 21, 2024, when Donald Trump was inaugurated as United States president for a second term. Within the first few days of his assumption of office, he issued a flurry of Executive Orders which resulted into the closure of USAID, a US government aid agency that was responsible for approximately 60% of Uganda’s health sector budget. They reverberated across the globe, trickled down and could be felt by even the most nonchalant person in this small community of Bukuuku, thousands of miles away from Washington, where the decision had been made. The Uganda AIDS Commission (2024) warned that over 300,000 patients could default from treatment if funding gaps persist. “Once someone stops taking their medicine,” notes a counsellor in Gulu, “they don’t just get sick, they lose the will to fight. Hope is the first casualty.”

Launching its 2025 World Aids Day Report in November, UNAIDS warned that due to the abrupt funding cuts, the global response to HIV is facing its most serious setback in decades. This, in addition to a deteriorating human rights environment that has disrupted prevention and treatment services across dozens of countries. Uganda inclusive, the UNAIDS noted that the impact has been immediate and severe, especially in low- and middle-income countries highly affected by HIV. 

In the wake of those orders, on February 7, 2025, the Permanent Secretary of the Ministry of Health Uganda issued official communication, phasing out all stand-alone HIV/AIDS and Tuberculosis (TB) clinics, integrating their services into general outpatient and chronic care units within hospitals and lower-level health facilities. For those unfamiliar with them, famously known as ‘ART’ clinics, these were established in the late 1990s, establishing safe spaces for HIV testing, counselling and treatment.   

Many of the health centers in Mbarara and Kabarole still maintain and operate ART clinics albeit some with reduced staff. Mbarara Municipal Council Health Centre IV, which according to the ART clinic in charge, Dr. Mugalula Alfred, is the biggest HIV clinic in the Ankole region. Over 6,500 active clients come in for different services. The key services offered here are screening and testing for HIV & TB, pregnancy testing and sexually transmitted infections (STIs) screening for women of different age groups, condom distribution, cervical cancer screening, and early infant diagnosis. 

Health workers are now bearing the weight of the collapsing health system. Dr. Mugalula says that they still maintain the clinic although with reduced staff. “With the support of donors, we had 35 staff with 18 of those among critical staff but all these were affected by the stop-work orders.” He also notes that the ART clinic doesn’t have any local government staff. With a persistent shortage of staff, only 28 of the expected 130 serve the at the local government health centre, representing a 22% staffing level. These staffing gaps according to Dr. Mugalula have slowed down the clinic’s activities. They have thus taken on volunteers from the community. “These are very important especially in data collection and we hope they can be assimilated into the system,” Dr. Mugalula noted.  In Lango, Northern Uganda, a health officer explains, “Donor funding gave structure,” he says. “They supported monitoring, follow-up, and accountability. Without that, we’re running the same marathon barefoot.”

In response to the treatment disruptions, the Ministry of Health issued reintegration orders for all services to maximize resources. Kabarole District Health Officer, Dr. Stephen Kalyegira said re-integration had its advantages. It allows for the onsite staff to complement the already existing ones in the ART clinics and HIV patients are now being tested for other underlying comorbidities like diabetes and hypertension which weren’t being previously handled. He hopes that the reintegration will reduce stigma and isolation faced by HIV patients. However, Abaas Omari, a health worker at the ART clinic located at the Kicwamba HC III doesn’t seem to agree with the DHO on the effects of reintegration. He argues that integration has increased stigma for the 803 active clients they serve. Patients visiting ART clinics in Mbarara and Kabarole district expressed some reservations about the integration system. “The integration brings us into proximity with the rest of the patients which makes us very easily noticeable and likely to be stigmatized by the community”, one of the patients at Kicwamba HC III observed.  

Uganda lost over UGX 604 billion in funding cuts within the health sector. The HIV/AIDS programs lost UGX 243.2 billion. Dr. Kalyegira in an appeal says, “We must build systems that can withstand the shocks of such incidents.” He adds, “The withdrawal of donor funding should act as a wakeup call that ignites our interest in developing localized solutions for our challenges.” 

Back in Northern Uganda, Apac district, a group of women gather beneath a mango tree every Friday. “We started saving again,” their leader says, “each of us puts in two thousand shillings. When someone is sick or beaten, we use it to help her. The donors taught us unity, that’s what keeps us going.” In Lira, a youth-led initiative called Stay Alive rides through villages on borrowed bicycles, checking on patients and sharing HIV prevention messages. “We’re not paid,” one volunteer explains, “but silence would kill us faster.”

There, however, may be a ray of hope on the horizon. Should the MOU that was signed between the Ugandan and US governments kick off in 2026, many of the gaps in the sector could potentially be plugged. It is still unclear how much will be allocated towards the HIV/AIDS fight, but what is certain is that this remains a priority area for the government that they will quickly be trying to address. 

Countering Disinformation

Disinformation or false information spread deliberately to cause harm undermines trust in institutions like the media, political parties, etc. In this video series, AGORA talked to different actors about what can be done to counter it.

Expert tips on countering disinformation as 2026 electioneering take shape

22 Videos

Part 1: Kiteezi: One year after the tragedy, serious concerns emerge

A year after a section of Uganda’s largest garbage dump site at Kiteezi near the capital Kampala collapsed killing dozens of people and displacing hundreds, the smell of rot may have faded from the air, but for survivors and relatives of the dead and missing, the stench of injustice lingers.

The Kiteezi garbage dump, 13 kilometers from Kampala City center, was until the August 9, 2024 disaster, the only official dumpsite serving Kampala and much of the metropolitan region. Established on 29 acres in 1996 with World Bank funding and expanded with an additional six acres in 2007, it received an estimated 2,500 tonnes of waste daily under the auspices of the Kampala City Authority (KCCA).

By the time of the collapse, it had exceeded its design capacity by years. Internal KCCA memos show officials had received multiple warnings in the months leading up to the disaster, citing slope instability, blocked drainage, and the risk of fatalities.

The disaster

It began with a sound few in Kiteezi will ever forget— a deep, rumbling groan that seemed to rise from beneath the earth. Seconds later, the towering heap of tonnes of waste shifted, then lunged forward like a breaking wave, and came tumbling down.

Grace Kyandia, a waste picker who was seven months pregnant at the time, was picking plastics that morning.

“Run! Run! The rubbish is burying us!” Kyandia recalls hearing loud screams.

When she looked up, she said, she saw a waste truck being swallowed by a crack, then a whole section of rubbish just sliding.

“I jumped over a crack behind me, felt a sharp pain in my belly, but I kept running,” Kyandia told Agora, “People were falling behind me.”

The description of a male resident who rushed to the site as the disaster was unfolding is even more haunting.

“You could see people fall like mangoes off a tree, then disappear under the waves of waste,” he said, “We heard cries from under the rubbish, but within hours… they stopped.”

In minutes, the Kiteezi landfill, once a bustling hub where 300 registered waste pickers combed through garbage for plastics, metals, and other recyclables daily and other small businesses flourished, had turned into a graveyard. 

Locals say the first rescue excavator reached the scene at midday, and a second excavator at around 3pm.

Before then desperate residents had used hoes, pick axes and any tool they could find to dig up people whose cries could be heard, some of whom were making frantic phone calls to those on the outside.

But the heat soon got to them, and local rescuers eventually stopped hearing from them.

By nightfall, rescue excavators stopped digging due to lack of lighting. Residents who spoke to Agora in the days following the waste slide noted their disappointment at the inadequacy in the government efforts which possibly cost the lives of their loved ones awaiting help underneath the waste. 

Notably, the government deployed hundreds of heavily armed police who far outnumbered rescue workers. Reports by residents also established that the police disrupted local rescue efforts and cordoned off the area yet excavators arrived several hours later, losing precious time to save lives.

Prize Tayembwa, the Manager of Kampala East Branch for the Uganda Red Cross, told us that two days after the tragedy, only four people had been pulled out alive.

The rain had hampered rescue efforts, turning the waste into a heavy, sucking sludge that trapped rescuers up to their knees.

Officially, 35 people were killed and dozens were injured. Over 300 residents were displaced, with eleven victims still missing, their bodies believed to be buried under more than 50 feet of compacted garbage.

Some of the residents interviewed by AGORA contest these numbers, pointing out that while over 90 houses were buried, only 10% of the affected area was excavated.

Criminal charges against top KCCA officials 

Nearly a year after the collapse, the search for accountability moved from internal memos to the highest political and judicial levels. The findings of the Inspector General of Government (IGG) were blunt: senior leaders at Kampala Capital City Authority had failed to act on clear warnings, and their negligence had directly contributed to the loss of life at Kiteezi.

In what State House called a “decisive response in the public interest,” President Museveni sacked three top KCCA officials: Mrs. Dorothy Kisaka, then Executive Director, Engineer David Luyimbazi, then Deputy Executive Director and Dr. Daniel Okello, then Director of Public Health.

The IGG’s report described “severe oversight and negligence” by the trio, citing their failure to implement urgent safety measures despite repeated technical warnings about the landfill’s instability.

The President also directed the Criminal Investigations Department (CID) and other law enforcement agencies to pursue a criminal case, with a particular focus on criminal negligence.

In October 2024, the Director of Public Prosecutions (DPP) filed 34 counts of manslaughter and 21 counts of causing harm through negligent acts against the officials. The charges alleged that their inaction — despite knowledge of the imminent risk — amounted to a breach of duty so grave that it constituted criminal liability. Survivors and bereaved families welcomed the move but remained skeptical about whether convictions would follow. In July 2025, the DPP dropped charges against Dr. Okello.

The criminal cases remain in progress, overshadowed by procedural delays and questions about whether the full truth will emerge in court. But the charges have already served as an acknowledgment — at least on paper — that the deaths at Kiteezi were not an “act of God,” as claimed by the Prime Minister Robina Nabbanja in the days following the tragedy, but the product of decisions, omissions, and neglect by those in power.

Danger signs ignored

Months before the collapse, waste pickers were warned by the management at the landfill of cracks developing.

 “The site engineer had told us that on the side of the landfill there was a crack, we shouldn’t go there,” recalled a waste picker in an interview with Agora in October 2024, “The crack had appeared about three months ago.”

 A few weeks to the disaster, vapour from the crack would even make visibility hard.

 “You were unable to see the person next to you,” revealed another waste picker, “When we would leave our stuff in one place, we would find that it had shifted by the next day as the rubbish slowly slid.”

A memo of dated August 19, 2024 and marked “Internal Investigation Regarding the Kiteezi Landfill Incident” was sent from KCCA’s Director of Legal Affairs to the Executive Director.

It acknowledges, in plain terms, that the landfill was “way past its design life and long overdue for closure.” It also notes this was the second collapse of its kind — the first, in December 2015, destroyed part of the leachate collection system but claimed no lives.

The Legal Affairs memo concludes with a stark warning: “In light of risks to life, of property and the injuries to the few survivors… both civil and criminal liability might accrue against both KCCA and its staff.” It is a damning admission.

Over the last year, AGORA has conducted dozens of interviews with affected residents, waste pickers, bereaved families, government officials, rescue workers, and church leaders. We have also combed through internal government documents and environmental assessments to piece together what happened, why it happened, who was responsible, and what measures could be taken to avoid a similar disaster in future.

 Today, a year after the tragedy, dozens of families still live in limbo, their homes gone and their names lost on shifting compensation lists. Promised reforms have been slow, uneven, and in some cases, dangerously reminiscent of the very practices that caused this disaster.

Amidst all this, an investigation by AGORA reveals serious concerns emerging about another Kiteezi-like disaster in the making.

Part 2: KCCA moves from Kiteezi tragedy to Buyala disaster

In the weeks after a section of Uganda’s largest garbage dump site at Kiteezi near the capital Kampala collapsing and killing dozens of people and displacing hundreds, Kampala’s streets began to choke under the weight of uncollected garbage. 

With the Kiteezi garbage dump closed, the garbage was hastily diverted to temporary dumping points but these too quickly reached their limits.

By February 2025, KCCA announced what it called a turning point: the acquisition of 230 acres for a new landfill in Buyala, in Mpigi District near Kampala. At a reported price of 70 million shillings per acre, the deal came with bold assurances.

“Our waste management solutions are going to resonate with current times,” the Executive Director, Sharifah Buzeki, said.

The promise, however, was troubled from the outset as the Buyala site was immediately engulfed in controversy. Environmentalists and residents protested that the designated area lay squarely in a wetland called Mayanja. Soon, a National Environmental Management Authority (NEMA) report confirmed the worst fears: it said the vast majority of the land was a wetland, with only 1.5 acres deemed suitable for a dumpsite.

At the point of announcement of the Buyala land purchase, according to KCCA’s Director of Public Health, Dr. Sarah Zzalwango, only 15% of the purchase price had been paid. Despite the findings and warnings about environmental damage by NEMA and others, however, the purchase was completed and waste disposal began almost immediately.

New landfill, old habits

Dr. Zzalwango admits the move to Buyala bore all the hallmarks of crisis management rather than careful planning. “The way we moved to Buyala was in an emergency state,” she told Agora. “So we continued to do the same dumping style as in Kiteezi.”

And despite assurances by Buzeki that KCCA would introduce waste management solutions that resonate with current times, the KCCA approach at Buyala mirrors exactly the very operational patterns that contributed to Kiteezi’s collapse: no segregation of waste, no leachate treatment, and no methane management. Authorities have continued to go about waste management in a careless manner, sparking concerns another Kiteezi-like disaster could unfold.

By the time the Kiteezi landfill collapsed on August 09, 2024, the authorities responsible for Kiteezi management had long known about the impending danger, according to government internal memos seen by Agora.

The memos shared with Agora by officials at KCCA reveal a chain of warnings stretching back months before the disaster happened.

In one memo of April 19, 2024, the Acting Supervisor for Landfill Management formally warned the Manager of Solid Waste Management of the “critical nature” of Kiteezi. By then, the Minister of State for Kampala, the area MP, the Lord Mayor, and the Mayor of Kampala Central had all visited the site. Senior KCCA management had also been briefed. His memo listed visible dangers including instability of waste mounds, erosion of road embankments, damage to underground pipes, and risks of “fatalities in cases of bag instability.”

The memo recommendation was unequivocal: decommission Kiteezi, upgrade leachate treatment, capture landfill gas, and close final cells with relocation to new land for future use.

On June 30, 2024, the Officer for Landfill Management reported that there was “critical waste mass movement, a blocked main drainage channel and a depleted area of work.”

By then, Shs3.71 billion of the landfill’s budget allocation had already been spent on stop-gap measures; warning signs, extra equipment, murram backfill, and culvert construction.

On July 02, 2024, the Director of Public Health and Environment took the emergency to KCCA’s top management, requesting an additional Shs1 billion.

A parallel report from the Deputy Director of Strategy confirmed cracks had developed, prompting what was described as “budget-neutral interventions.” These included a public awareness campaign to alert waste pickers and nearby residents. But the Legal Affairs memo admits: “No evidence was availed.”

Chronic funding gaps

Today, as in the days leading to the Kiteezi disaster, KCCA officials are bickering with the Ministry of Finance over funding shortfalls. 

KCCA’s Director of Gender, Dr. Sarah Zzalwango, told Agora this month that the city this year requested Shs30 billion for waste management and Shs9 billion for decommissioning Kiteezi but they have gone unanswered by the Ministry of Finance. The central government, she says, insists KCCA first prepare detailed statements of requirements for competitive bidding. The authority has long lacked a budget line for decommissioning Kiteezi, she said.

Today, as in the past, the central government appears determined to leave the KCCA garbage handling budget to donors. In July, KCCA announced a new $1 million (Approx. Shs3.1 billion) UN-Habitat grant from the Government of Japan to stabilise seven acres of the high-risk landfill. The work, meant to last the next eight months, targets methane-heavy, leak-prone areas at risk of eruption.

KCCA has a history of underfunding its waste management. Annual requests for Shs150 billion in 2019/2020 FY were met with allocations as low as Shs2.96 billion. Even in 2023/24, Parliament approved only Shs3.03 billion of a requested Shs305.5 billion — with Kiteezi’s closure repeatedly deferred.

Internal planning documents had long confirmed the site had exceeded its design capacity and that new facilities in Ddundu, Mukono district were suggested. Yet, Ddundu remained on paper, and no action for an alternative landfill was taken until it was too late.

In a maze of bureaucracy and delay, KCCA had even contracted Price Water Coopers back in 2002 to develop a disaster management plan. As of the collapse, only a “draft report” existed.

 “Financial constraints and other impediments” had hampered its completion according to internal memos.

Meanwhile, the landfill continued to operate, cracks widening and risking the lives of hundreds of waste pickers and community members in the neighbouring settlements.

KCCA told Agora that its long-term vision for Buyala includes: a material recovery facility to sort and add value to recyclables, dumping only the residue, waste segregation at the source — encouraging households to separate organic, recyclable, and residual waste before it leaves the home and partnerships with mapped entrepreneurs who will buy segregated waste for processing.

But for now, the reality is far from the promise. Waste continues to arrive mixed and unprocessed, dumped on contested land that environmentalists argue should never have been sold for landfill use.

Part 3: Compensation woes for Kiteezi victims

For months after the disaster at Kiteezi, the death toll was disputed, with residents and local authorities reporting different numbers. KCCA public health director Dr. Sarah Zzalwango confirmed to Agora this August that the official records put the missing and the dead at 11 and 35 respectively.

These numbers remain highly contested by residents who spoke with Agora, with some accusing KCCA and the Office of the Prime Minister (OPM) which handles disasters of threatening waste pickers from revealing the true death toll to the media.

But Joshua Ariho spoke out. He lost both his wife and child and when we met in late September last year, he was already one of the leading voices calling for accountability. But his resolve appeared shaken.

 “I have no hope of the government recovering the bodies of my wife and child since it has been two months now,” he told us, “Even the bodies recovered two days later had no skin anymore. They were all white. Imagine what the heat from the waste does to a body two months later.”

Two weeks later, at a church service in their memory, he stood surrounded by friends, family, and other residents from Kiteezi. The congregation sang, prayed, and clung to words of comfort drawn from the biblical book of Ruth and the story of Lazarus.

“Your pain will birth something greater,” the pastor preached. “This pain and suffering will turn for good.”

The pastor extended his hands over the grieving man. “Turn the Kiteezi name which is now a bad name because of the landslide and loss of lives, into a name for good.”

The service was also a call to action. The church had already helped 25 displaced families with rent and distributed food to more than 1,500 people in partnership with Phaneroo Ministries. But the emotional needs were as great as the physical ones.

“I personally knew seven waste pickers who died that day,” another woman waste picker told us. Many of those lost women were mothers from distant upcountry villages, drawn to Kiteezi by the promise of a daily income without needing capital.

Compensation woes

Today, relatives of the dead and missing are still overwhelmed by grief. Some grieving family members who lost several people also told Agora of serious struggles with their mental health. A man who lost 3 family members had fallen physically and mentally ill as the one year anniversary approached. A mother who lost a daughter and grandchild has since struggled with chronic depression and psychosis. Yet, as if this was not enough trauma, in the months that followed the collapse, survivors had a second ordeal—- chasing financial compensation from the government for their loss. They battled this ordeal in endless queues, in government offices, and over handwritten compensation beneficiary lists that seemed to disappear as quickly as they were made.

Jack Otong, a Kiteezi resident, says on the day of the disaster, officials of KCCA called him asking for his land documents so he could be “added to the compensation list”. But by the time he followed up, his name had gone off the list.

Otong says his house had been deemed to be out of the danger when KCCA had marked out areas around Kiteezi for drainage expansion in June 2023, more than a year before the collapse. He says he was told the house was in the buffer zone. 

In 2024, his house survived but, he says, since the disaster, whenever it rains, dirty water pools around the houses, smelling like chemicals. He says residents suspect the pungent chemicals are released in timing with the rain. Otong and others are desperately poor.

“I had to sell my door to get something to eat, and my children don’t have anything to eat,” Otong says.
In July 2025, he says some of his neighbours received payouts — Shs48 million for the lowest amounts, up to Shs180 million for others — but he remains uncompensated.

Douglas, Otong’s neighbour of nine years, has had the same experience. His house, partially destroyed to channel water from the garbage slide, has been listed for compensation “two or three times” but never when it counts. 

“I don’t trust the government to compensate us. They’re trying to defraud us,” he says.

Layers of loss and complex land rights

According to Godfrey Balukku, a Kiteezi resident acting as liaison to KCCA and the Office of the Prime Minister, compensation has been split into three categories: Houses torn down by excavators following the disaster, bereaved families, and damaged or submerged houses.

Owners of houses torn down by excavators in the days and weeks following the disaster to make way for water from the landfill were to be compensated as ordered by OPM. However, the other two categories was more complicated.

The bereaved families to be compensated were eleven, according to KCCA. But the process of compensation has been challenged by the absence of dead bodies which the government says is essential for issuing death certificates, and consequently compensation. The president previously promised to pay Shs5 million for each life lost. 

Meanwhile, KCCA listed 48 houses as damaged post-slide and  set a compensation amount of Shs8.1 billion following completion of valuation reports for the houses by the Ministry of Works in April 2025.

Balukku says given the tangled ownership system of leaseholders, landlords, and bona fide tenants, a deliberate decision was made that payments and valuations be made for houses, not land. But to date, the Ministry of Finance has pledged but not yet delivered the funds for homes damaged by mud, floods, and waste.