By Patrick Murungi Ngasirwa
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.
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