Community Health Worker Stays Committed Despite Salary Cuts

Harerimana Ismail has gone without a paycheck since the start of last year, but he hasn’t stopped working.

Following a pause in foreign aid by the Trump Administration in January 2025, nearly all U.S. overseas assistance projects were halted. This included Ismail’s role as a community health worker at the Kabale Regional Referral Hospital in Uganda, where his small salary, around $50 a month, was funded by a U.S. grant. Ismail had dedicated eight years to this job.

Despite losing his income, he continues his efforts, going door-to-door to ensure that children living with HIV are adhering to their treatments and have the necessary support.

Ismail, 32, who contracted HIV at birth from his mother, acknowledges, “There is not any stipend or salary that I’m paid. It’s just because I understand the pain young people living with HIV pass through — that’s why I remain.” Without a salary, he relies mainly on vegetables from his garden and has had to sell Irish potatoes to cover his rent. He’s also lost about 15 pounds over the past year.

Recent data indicates that the efforts of individuals like Ismail to keep people on HIV treatment have proved significant. Thankfully, forecasts predicting a major collapse in HIV/AIDS treatment following the cuts have, at least for now, not materialized. Preliminary figures from the U.S. suggest that global HIV treatment levels are approximately the same as before the disruptions, with a minor decrease of just 100,000 people reported over the past year, despite the U.S. supporting over 20 million individuals in treatment.

“The most severe outcomes that we were concerned about haven’t come to pass,” notes Jeff Imai-Eaton, an associate professor at Harvard’s T.H. Chan School of Public Health.

Some Positive Developments, Yet Challenges Remain

On one hand, this is good news. On the other, significant issues in the realm of HIV persist.

The U.S. has played a pivotal role in combating HIV/AIDS globally, investing over $110 billion and saving millions of lives. It has also historically provided valuable data on the epidemic, tracking various metrics to ensure programs are effective. Ramona Godbole, a former U.S. Agency for International Development official, highlighted the importance of this data in guiding informed decision-making.

This past year, however, the U.S. government ceased reporting on HIV data due to the cuts, leading to a lack of transparency in an area where timely information is crucial. Recently, preliminary figures about U.S. HIV efforts were briefly posted online before being removed, with the State Department offering no explanation for their deletion. Experts suggest that these numbers closely align with findings from other organizations.

As specialists analyze the latest data, it seems that the predicted massive drop-off in individuals receiving HIV treatment hasn’t materialized.

Improves Conditions Amid Cuts

In early 2025, Charles Kenny, a researcher at a Washington think tank, assessed the potential repercussions of the aid cuts. The recent brief glimpse of government figures has given him a sense of optimism, indicating U.S. support for those on HIV treatment might be holding better than expected.

“If this data is right, we are in a better place than I thought we would be, even though we’re still in a really bad place,” he stated, referring to an analysis he conducted on the data. The State Department confirmed that HIV treatment levels at the end of 2025 were roughly equivalent to the previous year. Although treatment numbers initially saw a 23% decrease in March 2025, they rebounded by September, with only a 2% decline reported.

The State Department stated that any perceived decline in treatment levels stemmed from temporary reporting challenges rather than actual disruptions in care, also assuring that regular data reporting would resume when accuracy is confirmed.

Imai-Eaton observed that the recovery in treatment numbers likely stemmed not from incorrect forecasts but from a global spirit of cooperation.

Three Key Factors in Maintaining Treatment Levels

He identified three factors that contributed to the uptick in treatment levels. Firstly, the Trump Administration did restart some lifesaving programs. Secondly, countries receiving U.S. aid took proactive measures to fill service gaps. Lastly, community health workers like Ismail kept their efforts alive, often without payment. Ismail, for instance, has borrowed a bike to navigate the countryside and check on patients since he can no longer afford transportation.

Mahy noted the resolve of individuals and communities, saying, “They just kept reaching out to ensure people were getting their medications.” Other HIV specialists have echoed the sentiment, emphasizing the dedication of frontline workers as a crucial factor in preventing a steeper drop in treatment levels.

Concerns About the State of HIV Services

However, a closer examination reveals troubling aspects in HIV care. The number of people accessing HIV testing and counseling through U.S. support dropped from over 80 million at the end of 2024 to just below 70 million a year later. Advocates express concern over the quality of treatment services, highlighting how many related programs, including prevention initiatives, have been discontinued.

Ismail reported that some of his patients receive expired medications due to supply chain issues, coupled with long wait times—sometimes between 4 to 9 hours—at hospitals. He also noted that the distribution of condoms to combat HIV has significantly declined, affecting education and care for high-risk groups.

Emily Bass, who has been closely monitoring the situation, articulated a fundamental issue: “The entire treatment ecosystem was sort of shredded.” She questioned whether providing merely the bare minimum is acceptable.

Rising Concerns of New Cases and Deaths

The aid cuts also pose questions about new HIV transmission rates and deaths within the population. The State Department has pushed back against any claims of widespread treatment loss, labeling them misleading. However, experts like Kenny and Mahy believe it’s too soon to determine whether an increase in new HIV cases or AIDS-related deaths is evident.

Reflecting on the last year, Ismail mentioned a concerning trend he observed: “I was seeing very many people dying.” One story particularly haunts him—a 14-year-old girl with dreams of becoming a nurse who became increasingly isolated due to her circumstances. Despite her family’s efforts to find the funds to get her to the hospital, it was too late. “She reached the hospital and she died in my hands,” Ismail shared, an experience that has deeply impacted his resolve to continue his work.

Still, Ismail is realistic about his limitations and acknowledges he can’t keep working without pay forever. He is focused on reaching out to as many former patients as possible but knows that eventually, he will have to confront the reality of his financial situation.