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LGBTQ groups question US health agreements with African countries

Community could face further exclusion, government-sanctioned discrimination

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The White House commemorates World AIDS Day in 2023. Health agreements the U.S. has signed with Uganda, Kenya, and other countries have sparked concern among queer rights groups. (Washington Blade photo by Michael Key)

Some queer rights organizations have expressed concern that health agreements between the U.S. and more than a dozen African countries will open the door to further exclusion and government-sanctioned discrimination.

The Trump-Vance administration since December has signed five-year agreements with Kenya, Uganda, and other nations that are worth a total of $1.6 billion. 

Kenyan and Ugandan advocacy groups note the U.S. funding shift from NGO-led to a government-to-government model poses serious risks to LGBTQ people and other vulnerable populations in accessing healthcare due to existing discrimination based on sexual orientation.

Uganda Minority Shelters Consortium, Let’s Walk Uganda, the Kenya Human Rights Commission, and the Center for Minority Rights and Strategic Litigation note the agreements’ silence on vulnerable populations in accessing health care threatens their safety, privacy, and confidentiality.

“Many LGBTQ persons previously accessed HIV prevention and treatment, sexual and reproductive health services, mental health support, and psychosocial care through specialized clinics supported by NGOs and partners such as USAID (the U.S. Agency for International Development) or PEPFAR,” Let’s Walk Uganda Executive Director Edward Mutebi told Washington Blade.

He noted such specialized clinics, including the Let’s Walk Medical Center, are trusted facilities for providing stigma-free services by health workers who are sensitized to queer issues.    

“Under this new model that sidelines NGOs and Drop-in Centers (DICs), there is a high-risk of these populations being forced into public health facilities where stigma, discrimination, and fear of exposure are prevalent to discourage our community members from seeking care altogether, leading to late testing and treatment,” Mutebi said. “For LGBTQ persons already living under criminalization and heightened surveillance, the loss of community-based service delivery is not just an access issue; it is a full-blown safety issue.”

Uganda Minority Shelters Consortium Coordinator John Grace said it is “deeply troubling” for the Trump-Vance administration to sideline NGOs, which he maintains have been “critical lifelines” for marginalized communities through their specialized clinics funded by donors like the Global Fund and USAID. 

USAID officially shut down on July 1, 2025, after the White House dismantled it.

Grace notes the government-to-government funding framework will impact clinics that specifically serve the LGBTQ community, noting their patients will have to turn to public systems that remain inaccessible or hostile to them.

“UMSC is concerned that the Ugandan government, under this new arrangement, may lack both the political will and institutional safeguards to equitably serve these populations,” Grace said. “Without civil society participation, there is a real danger of invisibility and neglect.” 

Grace also said the absence of accountability mechanisms or civil society oversight in the U.S. agreement, which Uganda signed on Dec. 10, would increase state-led discrimination in allocating health resources.

Center for Minority Rights and Strategic Litigation Legal Manager Michael Kioko notes the U.S. agreement with Kenya, signed on Dec. 4, will help sustain the country’s health sector, but it has a non-binding provision that allows Washington to withdraw or withhold the funding at any time without legal consequences. He said it could affect key health institutions’ long-term planning for specialized facilities for targeted populations whose independent operations are at stake from NGOS the new agreement sidelines.

“The agreement does not provide any assurance that so-called non-core services, such as PrEP, PEP, condoms, lubricants, targeted HIV testing, and STI prevention will be funded, especially given the Trump administration’s known opposition to funding these services for key populations,” Kioko said.

He adds the agreement’s exclusionary structure could further impact NGO-run clinics for key populations that have already closed or scaled down due to loss of the U.S. funding last year, thus reversing hard-won gains in HIV prevention and treatment.  

“The socio-political implications are also dire,” Kioko said. “The agreement could be weaponized to incite discrimination and other LGBTQ-related health issues by anti-LGBTQ voices in the parliament who had called for the re-authorization of the U.S. funding (PEPFAR) funding in 2024, as a political mileage in the campaign trail.”

Even as the agreement fails to safeguard specialized facilities for key populations, the Kenya Human Rights Commission states continued access to healthcare services in public facilities will depend on the government’s commitment to maintain confidentiality, stigma-sensitive care, and targeted outreach mechanisms.

“The agreement requires compliance with applicable U.S. laws and foreign assistance policies, including restrictions such as the Helms Amendment on abortion funding,” the Kenya Human Rights Commission said in response to the Blade. “More broadly, funded activities must align with U.S. executive policy directives in force at the time. In the current U.S. context, where executive actions have narrowed gender recognition and reduced certain transgender protections, there is a foreseeable risk that funding priorities may shift.”

Just seven days after Kenya and the U.S. signed the agreement, the country’s High Court on Dec. 11 suspended its implementation after two petitioners challenged its legality on grounds that it was negotiated in secrecy, lacks proper parliamentary approval, and violates Kenyans’ data privacy when their medical information is shared with America. 

The agreement the U.S. and Uganda signed has not been challenged.

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Egypt

Egyptian authorities refuse to allow gay cruise to dock in country

Scarlet Lady earlier this week blocked from visiting Turkey

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Alexandria, Egypt (Photo by javarman/Bigstock)

Egyptian authorities have refused to allow a gay cruise to dock in the country.

The Scarlet Lady, a Virgin Voyages ship that Atlantis Events chartered, was to have docked in Alexandria, a port city on the Mediterranean Sea. The Washington Blade obtained a letter that Atlantis Events President Rich Campbell sent to passengers on Thursday, hours before the cruise was to have arrived.

“Early this morning, we were informed that Scarlet Lady has been denied entry into Egyptian waters and, as a result, will no longer be able to call in Alexandria today,” he wrote.

“I know how much this visit meant to so many of you,” added Campbell. “We successfully sailed a similar itinerary last year, so we were surprised by this unfortunate decision.”

Campbell noted “both the Atlantis and Virgin Voyages teams worked tirelessly to make this call in Alexandria a possibility.”

“This news came as a surprise to all of us, and we’re just as disappointed as you are,” he said.

The 10-day cruise left Athens on July 5. It is scheduled to end in Trieste, Italy, on July 15.

The ship had been scheduled to dock in Kusadasi, a Turkish resort town on the Aegean Sea, and Istanbul earlier this week. Turkish authorities refused to allow it in the country.

Former Tempe, Ariz., Mayor Neil Giuliano, who is an LGBTQ+ Victory Institute board member, is among those on the cruise.

“Just a few hours before arriving in Alexandria, Egypt — a city founded by and named for one of the ancient world’s best-known homosexuals — government authorities rescinded permission for our ship of 2,000 gay men to enter Egypt,” wrote Steve May, who is also on the ship, on Thursday in a Facebook post.

Alexander the Great founded Alexandria in 331 B.C.

“As with Turkey, we have been sent away not because of what we did, but because of who we said we are,” said May. “‘I am what I am’ is too much liberty for some to bear. So it was in the United States as well not long ago, where even I ended up as a convicted homosexual after a military trial in 2001 for saying ‘I am gay.’ This is just a reminder that for all the progress we have made, our freedom is never secure — for any of us, regardless of who or how we love. Back to Europe!”

Discrimination and persecution based on sexual orientation and gender identity is commonplace in Egypt. The Egyptian Football Association, along with the Football Federation Islamic Republic of Iran, objected to playing in the World Cup’s “Pride Match” that took place in Seattle on June 26.

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Egypt

Iran, Egypt play in World Cup ‘Pride Match’

FIFA allowed Pride flags inside Seattle stadium

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(Screen capture via KOMO News/YouTube)

Iran and Egypt on Friday faced off during the World Cup’s “Pride Match” in Seattle.

Iran is among the handful of countries in which consensual same-sex sexual relations remain punishable by death. Discrimination and persecution based on sexual orientation and gender identity is commonplace in Egypt.

Friday’s match coincided with Pride weekend in Seattle. The Egyptian Football Association and the Football Federation Islamic Republic of Iran both objected to playing in the “Pride Match.”

Egypt and Iran tied 1-1.

FIFA, for its part, allowed Pride flags inside the stadium during the match.

“The FIFA World Cup 2026 is an inclusive event that welcomes people from all backgrounds,” a FIFA spokesperson told the Washington Blade in a statement. “Fans of all sexual orientations and gender identities are welcome at matches and events. General statements of human rights, including rainbow flags and other flags representing sexual orientation and gender identity, are permitted under the FIFA World Cup 2026™ Stadium Code of Conduct and may be displayed inside stadiums provided they are used in a manner consistent with the code.”

Human Rights Watch welcomed FIFA’s decision to allow Pride flags inside the stadium. Outright International, a global LGBTQ and intersex rights group, distributed Pride flags in Seattle on Friday, which was Pride Match Day.

“Visibility matters,” said Outright International Executive Director Maria Sjödin. “Pride is now being celebrated in more than 100 countries, including this weekend in Seattle. For many LGBTIQ people, seeing a Pride flag in public is a reminder that they are not alone, and that their rights and dignity are recognized.”

FIFA President Gianni Infantino earlier this year told Die Weltwoche, a Swiss magazine, that “there will be no ‘Pride Match’ at the (FIFA) World Cup.”

“There will be a FIFA World Cup match in Seattle, and on the same day, events organized by external organizations will be taking place in the city,” said Infantino. “But that has nothing to do with the match itself.”

Peter Tatchell, a long-time LGBTQ activist from the U.K. who is director of the Peter Tatchell Foundation, was among those who traveled to Seattle for Friday’s match. Tatchell accused FIFA of not vetting World Cup teams — specifically Iran, Egypt, Saudi Arabia, Ghana, Senegal, Qatar, Tunisia, Morocco, Iraq, Uzbekistan, and Algeria — over whether they would allow gay players.

“FIFA is protecting LGBT+ visibility in the stands while failing to protect LGBT+ players on the pitch,” said Tatchell.

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South Africa

White House to end PEPFAR funding for South Africa

State Department says country failed to respond to 2025 executive order demands

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(Photo by Rarraroro via Bigstock)

The Trump-Vance administration will end PEPFAR funding for South Africa.

A State Department spokesperson on Wednesday told the Washington Blade the State Department “will begin a phased drawdown of PEPFAR programming in South Africa, with most programs ending by Sept. 30, 2026, and critical personnel support continuing through March 31, 2027.”

Semafor last week reported South Africa has received more than $8 billion in PEPFAR funding since President George W. Bush created the program to combat the global HIV/AIDS pandemic in 2003.

President Donald Trump on Feb. 7, 2025, issued an executive order that addressed what it described as “egregious actions of the Republic of South Africa.” The State Department spokesperson with whom the Blade spoke noted the directive included five specific requests:

• South African government provides exemptions or alternatives for U.S. companies to Broad-Based Black Economic Empowerment laws and other race-based mandates. 

• Senior government officials (e.g., president, deputy president, or minister of justice) unequivocally condemn all race-based incitement to violence, including the “Kill the Boer” song, more frequently. 

• The South African government prevents the implementation of measures that would allow expropriation without fair compensation and due process under the Expropriation Act of 2024. 

• South African Police Service designates rural crime a “priority crime” and increases resources dedicated to high-crime rural areas. 

• South Africa refrains from actions that would significantly interfere with the implementation of the refugee program, within the confines of South African law. 

“The United States communicated to the government of the Republic of South Africa multiple times at many levels that PEPFAR funding was likely to be terminated in the absence of progress on the five asks,” said the State Department spokesperson.

The State Department spokesperson further noted South Africa is “one of the largest economies in sub-Saharan Africa” and “has funded the vast majority of its own HIV response, estimated at 76 percent of the total, including procurement of all treatment commodities.”

“South Africa will continue to be supported by the Global Fund, including for the introduction and scale up of lenacapavir through Global Fund Resources,” the spokesperson told the Blade.

Lenacapavir is groundbreaking HIV prevention drug that users inject twice a year. Eswatini, which borders South Africa, is among the African countries that have received doses of the drug through PEPFAR.

HIV/AIDS service organizations in the U.S. and around the world have sharply criticized the Trump-Vance administration over plans to not fully fund PEPFAR and to cut domestic HIV/AIDS funding.

Secretary of State Marco Rubio shortly after the current White House took office issued a waiver that allowed PEPFAR and other “life-saving humanitarian assistance” programs to continue to operate during a freeze on nearly all U.S. foreign aid spending. HIV/AIDS service providers around the world with whom the Blade has spoken say PEPFAR cuts and the loss of funding from the U.S. Agency for International Development, which officially closed on July 1, 2025, has severely impacted their work.

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