In a Nairobi cemetery, beneath an unmarked concrete block, lies the remains of Judy—an HIV-positive Kenyan sex worker who died just hours before she was scheduled to meet AFP last month. She is one of at least 24 HIV-positive sex workers in Kenya whose deaths have been confirmed by AFP, all of whom were in good health until US aid was slashed in early 2025, according to frontline health staff.

The actual death toll is likely much higher, and NGOs warn of an already massive surge in HIV infections among sex workers that could trigger a “catastrophic” rise in cases across the general population.

The US has historically been Kenya’s largest health donor, but the Trump administration has redirected support away from NGOs and enacted rules preventing them from promoting issues it opposes.

A July 2026 report by the Foundation for AIDS Research (amfAR) found that 73 percent of US-funded organisations were forced to end services for “key populations”—sex workers, LGBTQ communities, and drug users—despite these groups facing the highest infection risk.

Kenya once had numerous clinics specifically serving sex workers, offering antiretroviral drugs, condoms, and preventive treatments in peer-led environments free from judgment. Most have now shut down.

Kenyan authorities estimate there are 285,000 women engaged in sex work in the country, with an HIV prevalence rate of 27.5 percent. Experts fear infections will soar without targeted health support.

UNAIDS chief Winnie Byanyima told AFP that decades of progress are at risk. “This is the most serious disruption in the HIV response since the world came together to fight this disease,” she said.

Stigma

Nearly 1.5 million people—3.2 percent of Kenya’s population—live with HIV.

Judy, 36, was diagnosed in 2017, according to her friend Diana, also a sex worker. She managed her condition with help from the Bar Hostess Empowerment and Support Programme (BHESP), an NGO that delivered medication, condoms, and sometimes food to her in Nairobi’s Mathare slum.

Like most in her profession in Kenya, Judy lived in extreme poverty, sometimes selling sex for 50 or 100 Kenyan shillings (40 or 80 cents) or in exchange for food for her four children. She couldn’t afford transport to a BHESP clinic, so when the NGO lost funding amid USAID’s dismantling last year and its outreach teams were laid off, Judy was left without support.

Sex workers say they are terrified to seek care at public hospitals, knowing the intense stigma they’ll face in the conservative, majority-Christian nation. Discrimination against HIV-positive people is also widespread, and they fear neighbours will discover their diagnosis and ostracise them and their children.

‘Kill Order’

Judy stopped taking her medication despite the risks, and her immune system collapsed.

“She had sores… Her skin was so rough,” Diana said. AFP is only using first names to protect identities.

Judy is one of three HIV-positive sex workers from Mathare confirmed dead in recent months after stopping treatment, according to BHESP. Several others have died under similar circumstances in neighbouring slums, Diana said.

“The stop-work order from the US administration, for us, is a kill order,” said Daisy Kwala, programmes director for BHESP.

The NGO had two USAID-funded centres. It closed the first in September 2025, and the second will close by the end of this month. Of the 14,500 sex workers treated at these clinics, some 12,000 have completely dropped off BHESP’s radar, including 2,300 who were HIV-positive.

Kenya had been making significant progress on HIV/AIDS with international partners, said Douglas Bosire, head of the National Syndemic Diseases Control Council, noting a drop in new infections from around 110,000 in 2005 to 13,936 in 2025. But he warned “there is a risk of us reversing the gains if we do not quickly get this key population (sex workers)… to go to public facilities.”

The Sex Workers Outreach Programme (SWOP), a Nairobi NGO monitoring 45,000 people in the profession, recorded a 48 percent rise in new infections in the first half of 2026 compared to the same period in 2024. Half of SWOP’s clinics have closed due to USAID cuts.

BHESP recorded a 14-fold increase in infection rates at its surviving centre in the Roysambu suburb between one quarter in 2024 and the same period in 2026. Less regular monitoring means patients present with more advanced conditions and higher viral loads.

“They come for treatment late, and before they come, they will have transmitted more HIV to their customers in the community,” said BHESP nurse Sharon Lagat. “These customers… are our parents, our husbands, our friends, so definitely at the end of the day, the virus will reach to our homes.”

Dr Death

Doctor Joshua Kimani, SWOP’s renowned clinical and research director, fears “going back to where we were in 1990s” when infections were “out of control.”

A veteran of the fight against the virus, he recalls 1998 as his “worst year.” “I became ‘Dr Death’ because of telling people to go home, to die at home,” Kimani told AFP. “I don’t want to go back there.”

He said rising infections among sex workers will lead to rising numbers in the general population. “We cannot treat ourselves out of this epidemic. We need prevention,” he said.

Bosire said the government could only budget for 200 million of the 500 million condoms it needs to distribute freely each year. Sex workers can rarely afford a three-pack of condoms, priced at 100 shillings (80 cents).

“(But) they will still sell sex, they will still meet 6 to 10 people in a day, and that puts the entire community at risk,” said Kwala.

In the coastal region, there have been 14 deaths of HIV-positive sex workers who lost access to treatment, according to the Coast Sex Workers Alliance. At least five have died in Kenya’s west, according to the Kisumu Sex Workers Alliance, and two more near the Ugandan border, according to Survivors of Busia.

None of the 25 USAID-funded clinics for sex workers across western Kenya have survived, said Dorothy Agalla, director of the Kisumu NGO, with fewer than 1,000 of their 20,000 sex workers now receiving care at public facilities.

‘Gone’

Overcome with grief, Cecilia mourns her friend Beatrice. Both were sex workers. Beatrice, 43, stopped taking her antiretrovirals when visits from BHESP members in Mathare ceased, fearful of the stigma she and her children would face at a public clinic.

“She started deteriorating… then, poof, she was gone,” her friend said.

Beatrice died in her bed on August 24, 2025. Her sister Rosemary, 29, also a sex worker with HIV, died a year later.

Cecilia implores President Donald Trump to reverse the cuts and “bring us what we had.” “Please, we’d be very happy,” she whispered.

The Trump administration’s deputy assistant secretary for Africa, Frank Garcia, visited Nairobi on September 9, in part to promote a new health partnership based on “trade not aid.” He rejected any US responsibility for the deaths among sex workers.

“I completely push back on the narrative that… the most generous nation in the world with regard to AIDS research, AIDS funding, and AIDS distribution of life-saving methodologies, is in any way responsible for that,” he told AFP.