Malawi’s LGBTIQ+ Intervention Reels under USAID Shutdown

In Mzuzu, Malawi’s third-largest city in the northern region of the country, Sarah, who was using an alias to maintain anonymity, is now out of work, and her clients have lost essential services provided by the drop-in centre she coordinated. 

"This drop-in centre was more than a facility. It was a safe haven for many individuals," Sarah told FairPlanet. 

That facility has since shut down. 

Established by the Centre for the Development of People (CEDEP), a local human rights organisation, the centre provided Anti-Retroviral Treatment, Pre-Exposure Prophylaxis (PrEP) and mental health support to LGBTIQ+. The centre was also crucial to what the Global Fund terms ‘Key Populations’, who are people that – due to several factors – are socially marginalised, limiting their access to health care and also increasing their vulnerability to HIV.  

In Malawi, LGBTIQ+ are outlawed, liable to 14 years imprisonment and subjected to stigma and discrimination. The World Population Review’s Global Acceptance Index, which measures the overall tolerance towards LGBT, ranks Malawi among the top 11 countries in the world with the worst LGBT rights. 

Against such an environment, these drop-in centres – staffed with nurses, counsellors and outreach officers – serve as shelters in which LGBTIQ+ can seek protection from physical and emotional abuse. These also offer a client-friendly clinic space that provides vital medical care, which many would struggle to access in mainstream public health systems. 

During times of supply shortages in drop-in centres, caregivers have been collecting vital provisions, such as ARVs (antiretroviral drugs) used to prevent and treat infections from retroviruses like HIV, from public health facilities on clients' behalf.

"Every day, I woke up with a purpose. I had a duty to support my clients. They were my family. But the centre has closed and I am powerless about it," said Sarah. 

Sarah’s job and the services her centre provides are casualties of the sweeping US funding withdrawal that has affected the broader health sector. In Malawi, the national budget for public health is heavily donor-dependent, with external funding alone accounting for an estimated 60 per cent. Between 2015 and 2024, the US provided nearly $1.6 billion to Malawi’s health sector, covering areas such as HIV/AIDS, malaria, maternal health, COVID-19, children’s vaccination, and the overall strengthening of healthcare. 

The Unmaking of a Key Populations Infrastructure

By April 2025, Malawi had suffered a 59 per cent decline in US foreign aid, following the dismantling of the US Agency for International Development (USAID), a key agency for US funding of programmes around the world. 

Civil society is counting its losses.      

At the time the US government announced aid suspension in January 2025, the Malawi Consortium of Key Populations Organisations was implementing a US-funded programme that was providing medical care to men who engage in sexual activity with men, female sex workers, transgender individuals and people who use or inject drugs. 

By 2024, the coalition’s Malawi Key Populations Programme had established 18 drop-in centres spread across key locations in Malawi, according to a report evaluating the impact of funding withdrawal.

Through the programme, Malawi had built a backbone of more than 10 organisations that have been conducting advocacy and policy engagement, providing social support services and undertaking community monitoring for accountability in HIV service delivery.

Then came the USAID shutdown, resulting in the abrupt loss of $6.9 million in funding, according to a report shared internally under the Diversity Forum. This shutdown scuppered activities such as HIV clinical services, community-based testing, condom and lubricant distribution and PrEP provision (pre-exposure prophylaxis), which is a medicine taken by HIV-negative people to significantly reduce their risk of contracting HIV.

According to the report, the loss of funding has led to the closure of nearly half of the drop-in centres, the scaling down of services in others that are still operating, and the collapse of essential community systems. 

"Malawi’s [key populations] HIV response is currently surviving on fragmented remains of what was once a comprehensive system providing a package of core clinical and behavioural services necessary to identify people at risk of HIV infection and link them and their partners with biomedical and structural prevention services," reads the report. 

With the closures of the drop-in centres and funding uncertainties, organisations in the sector have lost their voice in national HIV planning forums. Systems like community feedback loops and inclusive planning and monitoring have diminished, particularly at the district level.  

Dunker Kamba, chairperson of Diversity Forum, an alliance of key population-led organisations, explained via email to FairPlanet that without adequate support, research and advocacy are at risk of crumbling and "the voices and experiences of key populations may no longer inform national HIV and human rights responses."

"The momentum we have built toward inclusion, policy reform, and service accessibility could be lost and regaining that ground will take years," wrote Kamba. 

The current situation compounds an already difficult environment for many LGBTIQ+ in Malawi who rely on community-driven programs for health services and psychosocial support. 

Donor withdrawal also sends an unintended message that LGBTIQ+ lives and health are not a priority, a situation Kamba noted, which could fuel discrimination. 

The disruption, wrote Kamba, has implications for the wider HIV fight in Malawi. 

"The fight against HIV in Malawi is a collective effort that depends on reaching all populations, including those most at risk. When key population programming weakens, the country’s overall progress toward epidemic control is also threatened," he told Fair Planet. 

The Diversity Forum now hopes for renewed, swift engagement among the government, donors and civil society to explore solutions and restore hope among the LGBTIQ+ community in Malawi. 

"Restoring hope means reaffirming that inclusion and dignity are non-negotiable and that every Malawian, regardless of sexual orientation or gender identity, has the right to health, safety, and opportunity," Kamba said. 

Malawi is currently benefiting from a $535 million grant from the Global Fund to fight AIDS, tuberculosis, and malaria for the period from 2024 to 2027. On HIV, the grant supports services such as HIV and syphilis testing, condom distribution and PrEP provision. These services, according to The Global Fund, are being brought to communities, including key Populations, adolescent girls and young women.     

Care Interrupted

Reacting to the US funding loss in April, the government indicated that it would not be possible for it to fill the gap. A senior official of the preventive health services department, on condition of anonymity, explained to FairPlanet, "In simple terms, it’s either we have to find alternative sources of funding to continue the services or scale them down to the most critical ones that we can manage within our budget, an option which looks more likely in the immediate term." Finding an alternative source of funding, they noted, cannot be achieved overnight. 

"Even for funds that were used for service delivery, it is crucial to assess whether they supported cost-effective interventions and whether they were utilised through cost-effective delivery channels," Sam Mndolo, secretary for health, told local media. 

Mndolo said the government had since taken steps such as improving efficiency in resource utilisation and exploring financial health reforms to navigate the funding loss.

The disruption of the services under the Malawi Key Populations Programme has affected people like Chisomo [who used a pseudonym], a young MSM also living in Mzuzu City. 

In 2020, he tested HIV positive, and after two years of denial and fear of stigma and discrimination, during which his health deteriorated, a CEDEP-trained caregiver approached and helped him to start Antiretroviral therapy (ART) through a government hospital in the city. 

The caregiver has been collecting drugs for him and several others from the hospital, but in June this year, he stopped working following the closure of his drop-in centre. 

"Now I can’t access my treatment anymore," Chisomo told FairPlanet, explaining he was yet to gather the courage to visit the hospital himself. 

"I know there are people who care there, but the system in general is hostile. I just wish for a day when I can walk into such places without fear of judgment and be treated with dignity," Chisomo explained.

For Sarah, whatever measures are taken for the restoration of funding, reopening drop-in centres is crucial in ensuring that LGBTIQ+ people have access to vital services. Dedicated to the cause, Sarah continues to make time to support some of her clients, particularly in counselling. But says that it’s not the same without the drop-in centre.

"I can’t provide all the care they need," she explained. 

Gift Trapence, Executive Director for CEDEP, said every story of loss by the caregivers and their clients highlights the importance of support systems for those who are facing health challenges amid stigma and discrimination.

"Even in this darkness [of funding challenges], there are individuals who embody hope and resilience, demonstrating the profound impact of compassion and community."

"We must acknowledge that the struggle for health equity and human rights continues. We need to listen, advocate, and take decisive action to foster an inclusive environment where everyone can live free from fear and discrimination," Trapence told FairPlanet.

Image by Nappy.