In central Nepal, along a dimly lit highway, Rubi Lama stands motionless. The light from passing trucks briefly highlights her painted face. She knows every transaction could be dangerous, risking both her safety and health. Yet the money she earns is crucial for her survival.
Previously, Lama worked as an aid worker, devoted to HIV outreach among Nepal’s marginalized LGBTQ+ communities. However, after the United States reduced its foreign aid funding last year, Lama and over 280,000 other aid workers lost their jobs globally. The focus has often been on the impact of aid cuts on beneficiaries, but the effects on aid workers themselves, like Lama, have been equally devastating.
In Nepal, a country with limited options for openly transgender individuals, the absence of foreign aid support has led approximately 100 LGBTQ+ aid workers, including Lama, to turn to sex work for survival. This transition is stark for those who once served as allies in prevention services.
“I would give anything to return to the nonprofit where I once provided care to society’s most vulnerable,” Lama shares.
Their situation grows more dangerous with dwindling access to HIV prevention medication. The cessation of U.S. support has cut off supplies of HIV prevention drugs, inducing fears of increased HIV rates among sex workers and the LGBTQ+ community.
The loud highway is filled with aggressive drivers and persistent noise. Lama, 28, cautiously navigates this risky environment. Her fears extend beyond health issues to personal safety, reflecting upon past violent encounters in her current line of work.
The Broader Implications of Aid Cuts
In a desolate office nearby, remnants of the U.S. Agency for International Development’s (USAID) presence still remain, despite the agency’s closure following funding freezes under President Donald Trump. Friends Hetauda, Lama’s former organization, once provided critical health services to Nepal’s LGBTQ+ community.
The cessation of USAID funds in January 2025 left thousands jobless and cut off crucial services for vulnerable populations. The Trump administration had asserted its focus on efficiency and urged more global participation, yet this dismantling has had profound effects.
The impacts are especially harsh in Nepal, where the unemployment rate was already high. With a lack of alternatives, nearly half of the Blue Diamond Society’s former employees, a key NGO for LGBTQ+ rights and support, have resorted to sex work to endure.
Consequences for Public Health
The reduction in health services has left many without essential medication. Transgender individuals, avoiding healthcare facilities due to discrimination, face increased health risks. Unaffordable prevention methods contribute to unsafe practices, compounding health concerns.
Dr. Sarbesh Sharma from Nepal’s National Centre for AIDS and STD Control warns of the broader threat, noting the interconnectedness due to international movement and an open border with India.
“Viruses know no borders,” Sharma cautions. “The decline in global aid impacts not only Nepal but poses a potential global challenge.”
The United Nations reported a 22% drop in HIV testing in high-infection regions, with drastic cuts in prevention funding, highlighting the severity of the situation.
Struggling for Survival
On her first night as a sex worker, Lama sat, overwhelmed by fear and hesitation. Despite her reluctance, the dire need for survival pushed her to work on the streets. Raised in poverty and having faced personal adversities, she entered the aid sector with the determination to mitigate similar hardships for others.
But the abrupt funding end left her with no support. Attempts to re-enter the workforce were met with prejudice and harassment, forcing her into sex work, a choice dictated by necessity rather than desire.
For others like Princy Tamang, a former HIV outreach worker, the transition to sex work comes with increased vulnerability and fear of disease transmission. Being transgender in a conservative society, they experience extreme discrimination and violence.
Many of Lama’s former colleagues echo these sentiments, sharing stories of violence and legal dangers. Despite their training and attempts at self-preservation, their new lives are fraught with threats from clients, authorities, and social stigma.
Without viable alternatives and with increasing desperation, Lama and her peers remain bound to an uncertain future. For them, the street remains the only viable workplace for survival.
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