The Current - HIV in Kenya is under control. Trump could change that

Episode Date: September 15, 2025

Nairobi native Ibrahim Lwingi is scared for his life and he’s not the only one. Decisions being made in the White House, halfway across the world, threaten to turn his world on its head. The proposed cuts to the US President's Emergency Plan for AIDS Relief or PEPFAR by the Trump administration had many in the international community rattled. CBC’s James Chaarani met with Ibrahim Lwingi — and others like him — in Nairobi, Kenya for this documentary, “Everything to Lose.”

Some stories don't knock. They kick the door in. They move fast. Break rules and haunt you. See the stories that don't ask permission. They demand to be seen. This fall on APTN, they're coming for you.

This is a CBC podcast. Hello, I'm Matt Galloway, and this is the current podcast. Ibrahim Luengi is scared for his life, and he's not the only one. Decisions being made in the White House halfway across the world threatened to turn his world in Nairobi on its head. The proposed cuts to the U.S. President's emergency plan for AIDS relief or PEPFAR by the Trump administration have many in the international community rattled. The CBC's James Sharani met with Ibrahim Luengi and others like him in Nairobi, Kenya,

and brings us this documentary, Everything to Lose. I get out of a taxi onto a busy street in Uptown Nairobi. I'm meeting Ibrahim at the building across the street, but I'm having trouble figuring out how to actually get into it. There's no signs outside. It's inconspicuous, but that's by design. The organization inside, which Ibrahim works for, doesn't want people to know what they're actually doing here. I finally find the entrance of the building and am asked to go through a metal detector.

I tell security I'm going to the fifth floor to a place called Transform, which actually has some pretty close ties to Canada. I decide to take the stairs. I'm a bit paranoid about getting caught in the elevator. I'm learning that the power of it just can be pretty random in the city. I go down a long hall, it's dim, and I find the door that says transform. How are you? That's Ibrahim. He's a small-framed man, thin, and he's got a piece of fabric tied around his head. I noticed a pride flag behind him and a hand-knit transgender flag to his side. This is a pretty special place for him.

Abraham, a gay man in a country where homosexuality is illegal. He feels safe here. But this place is at risk because of decisions being made halfway across the world. He takes me to a side room so we can talk, and he starts telling me about his childhood. By then, there was not much happening in my life. Just a normal life that a child goes on while growing up. School, home, then tomorrow again school, just like. that.

Ibrahim was born and raised in Nairobi mainly by his mom. His dad was around, but he was a truck driver. He'd only see him a handful of times each month. Ibrahim was a bit of a loner, too. He says that he still is. As we talk some more, he says that he started having sex when he was little, 13 years old, with guy friends. Even though being gay was illegal, he didn't struggle with it himself.

By the time he was 18, he knew he was gay. He accepted it. But it didn't mean he was open about it. So when I was still in the closet, I used to face a lot of challenges. And even getting someone to date was an issue. He remembers back to 2007. He was living with his brother in a corrugated iron sheet shack. When the morning around 10, there's too hot you cannot stay inside.

He spent time at the cinema in town to cool off. And there was this other guy who was always there too, who got his attention. Actually, I just approached him. or not, I told him I like him. So what this guy did, he went and mobilized his friends. So they came as they took me out. Come, let's go, walk. What happened next was horrific.

He says the friends took him to an alley and forced him to have sex with this man in front of them, and they beat him very, very badly. Like these people, they have a plan to kill me. So I don't know where I got the strength, but I happened to beat one and train away. When I reached the house, I would never, I was never even, I was not even able to move. So I was, I was came, I was carried, I was taken to the hospital.

But I had to create an story. I couldn't say I was beaten because I approached someone because I was gay. Instead, he told people that he got caught up in political violence. It was around election time. It was a reasonable explanation. Ibrahim learned to be wary, but that caution was not enough to protect him from what occurred years later. In 2015, Ibrahim learned he had contracted a sexually transmitted infection for the first time. He was showing symptoms, so we went to the public clinic to figure

out what was going on. So when I went to the clinician, now a clinician told me that this kind of STI, there's no need for us treating you. You have to come with a partner, because if we treat you, still go to the partner, and again, the reinfection will still occur. So this person, I had met this person online, this person that I did not know. So I happened to say that I don't know him. That was a mistake. They now knew he was gay. Ibrahim says that the doctor stopped abruptly.

He left the room. This all happened on a Friday. He was told to go and buy some medications for the STI and bring it back for them to administer on Monday. The way they had looked at me, I just asking myself, how will I go on my? Monday. When I go on Monday now, they're expecting me. Now, the all facility will know that there's a gay person who's coming now to receive the services. Come and see this gay person.

Another issue was that he didn't have any money to pay for this medication. And this is where Transform comes back in, this place on the fifth floor of this uptown Nairobi building. So I had a friend online who I usually, I had never met this friend, but we usually, we used to chat a lot. So he noticed that there's a problem. from the way I'm chatting, so I had to open up and tell him I'm feeling like this and I don't have money. So he referred me, he told me there's a clinic somewhere where you can go and you receive services for free. On Monday morning, I was here. I come at the reception.

They took me, they took my details. They took me to the counselor. I was tested. And then I went to see the clinician. Then I was given the medication. Transform is one of the 10 sexual health clinics in Nairobi run by the University of Manitoba. I know. The University of Manitoba in Nairobi?

Manitoba was working in Nairobi since the early 1980s. This is Larry Gilman. The clinics, like Transform, run by the University of Manitoba, they're called Swap. Swap stands for Sex Worker Outreach Program. Larry is the project director with the University of Manitoba on this program. He's got an office here in Nairobi at the university. He says that these clinics are for sex workers. Both male and female. But really this place is for anyone who needs it. That

includes men who have sex with men and transgender people. These are the high-risk populations in the city. We're not just doing sexually transmitted infections in HIV. We're also looking at tuberculosis. We're looking at nutritional issues. We're looking at psychosocial issues. And if a sex worker becomes pregnant, we provide antinatal care as well. So it's a one-stop shop for health care. It all started with a project from the University of Manitoba back in the 80s. According to the university, they help over 30,000 people in the city, and it's all for free. They started working with this population of sex workers studying sexually transmitted infections like gonorrhea and chlamydia. Then HIV AIDS happened. The first recorded

case of HIV was in the early 90s in the United States. It was known as a the gay plague back then because it only seemed to affect the gay community. It wasn't discovered in Kenya until 1984. Researchers here tried something different. In 1985, they tested some of their sex workers for HIV with the newly discovered HIV test and found to their shock that 65% of them were HIV positive. So their focus shifted to HIV. Larry has been working with his team in Kenya since 1993. He's been with them ever since.

Working in the HIV field, being in Eastern Southern Africa, was very much being in the center of the action. Over the next 10 years, the group in Nairobi, not just down Manitoba, but working with the University of Nairobi and other institutes like the University of Washington, discovered a lot of what we know about HIV transmission. The research team has made some huge breakthroughs around HIV since then. They were one of the first teams to figure out that it wasn't just gay men,

who could contract the virus. Women could be infected, too. And they figured out that mothers living with HIV could pass the virus to their unborn child. A lot of the early knowledge about HIV transmission came out of this group. So decades of life-saving research, a network of clinics serving thousands. These clinics worked their way into the fabric of Kenya's HIV prevention and treatment.

And then this happened. HIV prevention funding could be one of the next targets for the Trump administration's cuts. Dr. Sillian Gounder is here with me. So the problem with these clinics is that they're mostly funded by PEPFAR, the president's emergency plan for AIDS relief. And in a flash, the Trump administration proposed to cut PEPFAR as part of his so-called one big, beautiful bill

that put these clinics in his firing line. Whether there's going to be funds specifically earmarked for the most vulnerable populations, that is adolescents and also the key populations that we work with, is we don't know that either. So all we've sort of learned from our funders is that they are almost as much in the dark as we are. The first thing that happened was that the PEPFAR program was paused earlier this year and the clinics were ordered to stop their work overnight.

One day they could do their work, the next they couldn't. Then the clinics were told that they could continue shortly after that, except there was this uncertainty that hung over them. Then they learn that a good chunk of their funding that's basically keeping the program afloat could come to an end by October. But the fact of the matter is, some Americans are critical of their tax dollars being used to fund foreign aid programs. And some Republican senators in the U.S. have been weighing in. And there's a part of PEP for, that you look at it and you want to say, pass me the sick bucket.

$5.5 million to lesbian, gay, bisexual. Sexual, transgender queer. 4.4 in funding to recruit gender and inclusive development experts. 35 million to address vasectomy messaging. That's just a bunch of bullshit. In addition, the Sex Worker Outreach Program or Swap is under threat of defunding due to executive orders from Donald Trump, calling for the removal of certain diversity, equity, and inclusion terminology. Words and acronyms like diversity, LGBT, and transgender have been prohibited, Larry tells me.

They got an email telling them which words they can and can't use, moving forward. I think what the government is trying to do is trying to kill the queer community because people are going back, they are going to go back in the closet. So you think they're trying to kill the queer community? I think that's what they are doing indirect. We are worried, very much worried. Some stories don't knock. They kick the door in.

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The study was for a medication called pre-exposure prophylaxis, or prep. Basically, the way prep works is that if you're HIV negative, you take the pill every day, and you're virtually protected from the virus, whether you're wearing a condom or not. In HIV hotspots like this, it has a potential to be a game changer for people like Ibrahim, keeping him healthy while slowing the spread of HIV. So in our family, we lost a lot of people

because of my uncles, my father, my mother, because of HIV. So I knew HIV was real. My father was a mechanic stroke driver, so he usually was transporting goods from the coast to Uganda, something like that. He kind of had an HIV, and he brought it to my mother. He infected my mother. The life-saving HIV meds that we have today weren't around back then. These meds, along with condoms, have had a serious impact on transmission rates in the country.

In the mid-90s, about 10% of Kenyans were living with HIV. Now, 3.7% of the population are. That's as of 2023. Both of Ibrahim's parents died when he was 14 years old. He describes himself as an orphan. So when I heard about prep, I decided to at least take it because I knew maybe I might be next. And something, because the challenges that are first growing up, I didn't want my son to go through the same, same challenge of not having someone who can support him.

Yeah, Ibrahim is a father too. He was 17 years old when his son was born, which was three years after his parents' death. He was having sex with women more out of peer pressure. and he now has a son. He jokes that he and son are growing old together. When he prepared food, he makes sure prep was part of the menu. When he was serving, he's there. So once you finish your food, he tells me, Dad, you have to take this medication.

So he has been a very big supporter to me. And I had to tell him about my sexuality. And though it took me one and a half years to finish the story, because he was a bit young, so I was explaining a bit by bit. accepted me, and we are good. If you're unable to get PrEP through the clinic, will you be able to continue

getting PrEP? Prep will not be available, and it's my worry. I've been able to take PrEP for that long because it's available and it's free. I don't have to spend any money to get it. But maybe there's availability, if you won't be there, maybe there's a big problem. And believe me, if there's no prep, right now,

I could be HIV-positive. What also came out of this group was this methodology of working with community of working with outreach workers of the whole involvement of the key populations in the process Larry tells me the potential cuts are putting something else at risk

the health network they've created they employ queer people and sex workers as peer educators in a lot of cases these peer educators are former or even active clients Larry describes him as eager, bright, and creative people. They go out to various hotspots to offer education and try to bring people who are at risk

or those living with HIV into the clinics. And that model is being used in working with key populations around the world. I was invited to check out another one of their clinics and meet some of these peer educators. It's one that serves a large number of female sex workers. It's deep inside Magengo, which has a dense slum on the outskirts of Nairobi. Anthony Karimi agrees to take me. He manages the swap clinic.

So the importance of that clinic is that that is where our program started from. So we usually call it our mother clinic. It's a very cosmopolitan community and mostly Muslim-oriented in terms of religion. We travel from the core of the city on large paved roads to narrow dirt streets. They're full of life with some vendors outside shops made of corrugated sheet metal and tucktucks and motor cars weave between the cars and other vehicles. The streets swell with more life and more people the deeper we go, so much so it seems like it would be impossible for our van to pass.

But somehow we get through. People are pressed right up against the van's windows. So we're now getting into Mijengo, our mother clinic. I get out of the van and I'm taken through a brown metal clad building that has a stone base I'm introduced to one of the doctors he gives me a tour of the facility this is our first consultation room whereby I operate from it's not a massive place the tour doesn't take too long and we end up in a back room it's dim and there are three women sitting in a circle

I'm James. Yeah, yeah, yeah, yeah. This is a safe place for all of us. So you can have us. That's Joyce Adiam. She's tall with glasses and is in a black dress. Not only is she a peer educator, but she's a community researcher too. I am a female sex worker who is living with HIV,

and I've lived with HIV for over 24 years, and I'm able to achieve durable and detectable viral load. So someone living with HIV can suppress the virus, so much with meds that it can't be detected with standard tests. That's what she means by an undetectable viral load, and it's virtually impossible for them to pass the virus on to others. That includes mothers to their unborn babies. Joyce gets her life-saving medication for free here at this swap clinic.

One of the directors of the clinic has told me that they may have to reduce the number of clinics from 10 to 3 if the funding gets cut. I ask her what a reduction in service might mean. personally as a beneficiary of this stand-alone clinic will affect me because maybe the clinic is far away from here so maybe I will not even have the transport to go to that facility and then the population that is going to go to that facility is going to get high and then I will use a lot of time queuing in the line

to wait for a single service that maybe I could get from here and you see even here we can speak everything that we want to speak within here but if you go to a public hospital you cannot speak about what you want to speak. We talk about condom. We talk about sex. We talk about our children here. It is a safe space for us to interact freely,

without boundaries, without anybody stigmatizing us, without discrimination. And this is a healing safe space for all of us. That is what I can say. Susan Netiano, another peer educator who is sitting next to me, she tells me that the news of the potential funding cuts is getting around.

Now, for example, maybe we have clients who are HIV. positive. So they are afraid, maybe they are going to die because now, how are they going to get medicine? Because the medicine is free. Now they're saying that, okay, how are we

going to get medicine? How are we going to get condoms? How are going to? Yeah. There is a lot of panic out there. Just as we're wrapping up, Gladys Insta con guy, another peer educator breaks down in tears. She was diagnosed with HIV in 2001.

She starts talking about the stigma she's faced when seeking treatment at public clinics. They just like they mock you. They mock you, she says. Like you, a whole woman, how do you get a disease? They do stigmatize us too much. They stigmatize us too much, she said. Yeah.

As much as we are community champion, to be educators, as how to Chwaka, we try to demystify the mates and misconception around stigma and discrimination. but it is not something that can happen within a day. Yeah, we just gain courage and strength through these safe spaces that we have to speak about it. If it were not for this clinic, some of us could be dead by now. And then the community gets what appears to be a reprieve.

PEPFAR, the U.S. aid program that funds these clinics, appears to be saved by the U.S. Congress. I assume that that meant that the swap clinics were okay for now, but then there's news that the Trump administration is going to slash the program anyway by 52%. I call Larry. He tells me that they got a letter from their funders. And the letter that they sent basically said that because PEPFAR in the coming year is only going to be supporting treatment, and because 90% of our work is prevention. Their solution was that we transfer all of our clients who are on treatment to government clinics, and then basically we shut our clinics down. They basically cast this adrift. It's worse than what they were bracing for, but they figured out a temporary plan with some emergency funding they got from the University of Manitoba. Basically,

it's keeping three clinics open with a very skeleton staff. for three months and keeping the Magango Clinic, our original clinic, open for another year, again with the skeleton staff. They have proposals for alternative funding options out there, but Larry explains that with the petfarr cuts comes more NGOs bidding for the same grants. Unfortunately, also, we've had to send out more than 100 letters terminating contracts for staff as of September 30th when the PEPFAR grant ends. you know, we're hopeful that we will be able to hire some of those people back,

but obviously we will be able to hire everybody back. Joshua Kamani is on the call with Larry II. He's the head of the clinical services for the SWAT program. We don't want to go back to 2004, whereby people are dying like flies. He's been doing this work since 1993. I wouldn't like to be Dr. Death again. It has actually changed over the last years. That time we were just signing dead certificates.

We've not been doing that lately, and I wouldn't like to go back there. And he's determined not to. Despite the news, he has faith that things are going to work out with the grants. An unusual amount of faith. I'm not feeling the same faith from Larry. Their moods seem like polar opposites. I ask him about that, and he says that they faced major funding issues before, and they figured it out. In 2001, to dismiss myself, I still remained around, but I had to work for another group.

And then of a sudden, we started getting grants. And eventually I had to come back. So it happened again in 2004. There was less money, but then Pfeffer came about. For Joshua, it's all about hope. But he leaves me with this disclaimer. Hope is a good companion, but a very poor advisor. So maybe I'll stick on that for the time being and see exactly how things mattered.

You've been listening to Everything to Lose, that documentary produced by James Shirani with help from Julia Poggle at the CBC's Audio Documentary Unit. You've been listening to the current podcast. My name is Matt Galloway. Thanks for listening. I'll talk to you soon. For more CBC podcasts, go to cbc.ca slash podcasts.