Sex Work Or Starve: Aid Workers In Nepal Left Jobless By USAID Cuts Turn To Sex Work To Survive

She paces the side of the darkened highway in central Nepal, just enough light from the trucks roaring past to illuminate her painted face to the men rolling in on rickshaws and motorbikes. She knows that every stranger who pays for her body could end her life. But she also knows their money is the only thing preventing her death.

This spot, littered in condom wrappers and fringed by jungle, is familiar to her. Rubi Lama once came here not as a sex worker, but as an aid worker who helped sex workers.

For nine years, Lama — who is transgender — had devoted her life to conducting HIV outreach in Nepal’s marginalized communities, including the LGBTQ+ sex workers who wait by this highway each night. But after the United States slashed its foreign aid funding last year, Lama and more than 280,000 aid workers worldwide found themselves out of a job.

Much has been written about the devastating impacts the U.S. foreign aid cuts have had on the millions of people the funding once helped. Far less is known about the impacts on the helpers themselves.

In impoverished Nepal, where a conservative culture leaves openly transgender people with few legal job options, the impact on aid workers’ lives was particularly crushing. Starving and scared, Lama and around 100 other LGBTQ+ aid workers left jobless by the funding cuts have turned to sex work to survive, walking the streets alongside the very people they once fought so hard to help.

The public health implications are vast. With the U.S. funding cuts also eliminating access to HIV prevention medication in Nepal, health experts fear a spike in HIV prevalence among the surging ranks of sex workers, as well as members of the LGBTQ+ community.

On the side of the highway, the night is a cacophony of blaring horns and the shouts of drunken men. Lama, 28 years old, softspoken and shy, walks quietly among them, equal parts desperation and dread. Beyond her fear of HIV is her fear of violence, which she and nearly all her former colleagues who have taken to the streets have endured.

She’d give anything to go back to the nonprofit where she once cared for society’s most vulnerable. Now she is the one in need of care, but there is no one left to provide it.

It is 11 p.m. and she’s had two customers so far, who each paid her $3. Rent and food this month will cost her $80.

And so, her slight frame nearly swallowed by the shadows, she waits.

Lives on the line
Just a few minutes down the road, in Lama’s old office, stickers bearing the logo of the U.S. Agency for International Development still cling to laptops that lie unused on barren desks, and to the empty condom distribution containers collecting dust.

This is the headquarters for the formerly USAID-funded non-governmental organization called Friends Hetauda, which offered HIV testing, counseling and prevention services to central Nepal’s LGBTQ+ community. All of that ended in January 2025, when U.S. President Donald Trump froze funding for USAID, once the world’s leading donor of humanitarian assistance. Trump later dissolved the agency after calling it a waste of money, even though the U.S. spent just 1% of its budget on foreign aid.

In a statement to The Associated Press, the U.S. State Department said the Trump administration had reinvigorated its assistance programs to focus on efficiency, effectiveness and partnership. The department also said the U.S. spends more on health and humanitarian assistance than any other country.

“The rest of the world needs to contribute more and share the burden,” the department said.

Of the more than 281,000 jobs lost due to Trump’s dismantling of USAID, just 23,000 were American, says Sadie Healy, who runs a global health consulting firm and has been tracking the job losses worldwide. The rest were overseas — many of them belonging to impoverished locals living in conflict zones or economically depressed regions where other employment options are scarce.

In Nepal alone, an estimated 35,000 aid workers lost their jobs amid the USAID cuts, says NGO Federation of Nepal President Arjun Bhattarai. With the country already facing high unemployment, the fallout was devastating.

The Blue Diamond Society, an umbrella organization for NGOs like Lama’s former employer, received 85% of its funding from USAID and was staffed largely by people who were themselves gender and sexual minorities. They served as counselors, health assistants, data collectors and outreach workers. They ran 20 clinics across Nepal, dispensing antiretroviral medication to people with HIV along with PrEP, a medication taken by HIV-negative people to prevent infection. They offered free HIV tests along with condoms and lubricant, which reduce the risk of HIV transmission.

The funding cuts shut down the society’s services, leaving more than 1,200 clients without access to PrEP medication and 262 of the group’s 350 staffers without work.

Outside of NGOs, legal work for openly transgender people in Nepal is virtually nonexistent, executive director Manisha Dhakal says. Which is why between 35% and 45% of the society’s former staffers turned to sex work, she says.

The risks are immense, she says, for both her former employees and the public. Too fearful of discrimination to go to hospitals for antiretroviral drugs, many transgender people have stopped taking them — significantly increasing their risk of transmission. Lubricant and condoms are expensive, so some are having unprotected sex. And PrEP distribution has been halted to everyone but pregnant and lactating women.

“One decision from one powerful country — all these services are cut,” Dhakal says.

She sits at the society’s now-hushed headquarters, the bookshelf behind her lined with framed certificates from USAID, commending her organization for saving lives. Now, she says, those lives are on the line.

“The Trump administration’s executive order will cause people to die,” she says.

Her fears are echoed by Dr. Sarbesh Sharma, director of Nepal’s National Centre for AIDS and STD Control. Viruses like HIV, he warns, do not respect borders.

“Borders are for humans,” he says. “We have a lot of migrant workers, we have a lot of overseas students, we have an open border with India. So those make it not only a Nepal concern, it can become a global concern.”

As a result of the drop in global aid, HIV testing fell by 22% in countries with high infection rates, while funding for condoms was cut by more than 90% in some places, according to data released in June by the United Nations agency that fights HIV.

All 15 aid workers-turned-sex workers interviewed by the AP recognize the risks. One, who is HIV positive, says she lives in fear of transmitting the disease, yet still hits the streets nearly every night to stave off starvation.

Most of the workers spent months trying to find other jobs, frequently being rejected the moment the employers realized they were transgender. Many have been forced to have unprotected sex with clients. Nearly all have faced violence, including gang rape.

None see a way out.

Aashika Tamang, who spent 16 years working in HIV prevention, longs for the days where she liaised with volunteers and social workers. Now, she says, she is abused at least once a week and largely liaises with addicts.

There’s a surreal whiplash when she bumps into fellow sex workers who once came to her for help.

“I used to meet them during the day,” she says. “Now I meet them during the night.”
-AP