The vibrant greens of Mzuzu — known throughout Malawi as the “green city”—have faded into a bleak, grey reality for Chisomo Nkwanga. Four years ago, Chisomo received an HIV diagnosis that shattered his world. In the years that followed, he found a rhythm of survival through specialised care. Today, however, as he struggles to access the medication that keeps him alive, his personal battle has become a potent symbol of a community suddenly abandoned by the global health complex.
“I am a living dead,” Chisomo said, his voice trembling as he sat in the shadows of a small, cramped room. A young man who belongs to the community of men who have sex with men (MSM), his identity has become a barrier to his very survival. “I gave up.”
His despair is not isolated. Across Malawi—a nation where same-sex acts remain illegal and punishable by up to 14 years in prison—the recent withdrawal of targeted support for LGBTQ+ health programmes, primarily funded by the US Agency for International Development (Usaid) and Pepfar, has collapsed a fragile lifeline. This abrupt exit has forced one of the country’s most vulnerable populations back into the shadows of fear, stigma, and advancing disease.
For more than a decade, the health of Malawi’s LGBTQ+ communit y wa s sustained by a specialised ecosystem. Organisations such as the Centre for the Development of People (Cedep) operated drop- i n centres (DICs) that functioned as more than clinics; they were sanctuaries. In these spaces, staff were trained not only in clinical care but also in human rights and sensitivity. They offered HIV testing, antiretroviral therapy (ART) , and pre – ex posure prophylaxis (PrEP) without the stinging bite of judgment.
But this entire ecosystem was built on the precarious foundation of project-based funding. W hen the projects ended, the sanctuaries vanished.
Cedep executive director Gift Trapence describes a transition that was less of a handover and more of a cliff edge.
“The first big issue was that there was no proper transition to prepare service providers or the clients they were serving,” Trapence explained in a recent interview. “The funding cut came on such short notice that we couldn’t prepare or engage existing service providers. We didn’t even have time to train Ministry of Health staff on how to offer services to LGBTQ+ individuals.”
The scale of the disruption is stagger ing. According to Trapence, Cedep was reaching more than 10 000 individuals each year. When funding for the Protect project and similar initiatives ceased, the mechanism for tracking these individuals was effectively erased.
A system in panic
The withdrawal did not only affect patients; it sent shockwaves through the entire Malawian health sector. Trapence notes that the panic reached even the highest levels of government.
“Everyone was panicking— not only the key population sector or the LGBT sector, but everyone, including the government,” he said.
The panic is rooted in stark financial reality: 60 percent of Malawi’s HIV health budget comes directly from the US government. When a primary donor shif t s p r i o r i t i es or withdraws specialised “key populat i o n” fundi ng , t h e Ma l awi a n gov e r nme n t— lacking the resources to fill even a fraction of the gap—is left paralysed.
For Cedep, the financial fallout was immediate and brutal.
“We had to lay off staf f , which meant closing our drop-in cent res ,” Trapence said. “We shut down two centres and maintained two—one in Lilongwe and one in Blantyre— on skeleton staff. We did this because we knew that if we closed completely, we would be closing ever y thing for the LGBTI community. But six months later, we are still searching for resources. It hasn’t been easy.”
The shift from specialised, ring-fenced programmes to general state healthcare is failing by nearly every measurable metric. In Blantyre District, the closure of mobile clinics—which delivered life-saving medication directly to those too afraid to visit public hospi tal s—has triggered a medical crisis.
At the former Nyambadwe DIC, the default rate for oral PrEP has reached a staggering 80 percent. Of the 2 900 clients who were once consistent with treatment, only 20 percent remain engaged in care.
“This is a crisis waiting to happen,” warned Fyness, a former district coordinator. “When people stop taking PrEP, we increase the risk of new HIV infections. We are undoing a decade of progress in a matter of months.”
Trapence echoes this concern, noting that the loss extends beyond “pi l ls in hands” to the di sappearance of peer n a v i g a t o r s—commu n i t y members living with HIV who served as mentors and treatment supporters.
“These were people who ensured adherence to treatment,” he said. “They supported one another. Those st r uctures are gone. We lost everything, including the systems that increased service uptake.”
The Malawian government’s official response is “integration”: moving LGBTQ+ clients into mainstream public hospitals. But for a community criminalised by the state, integration feels less like inclusion and more like exposure.
Chisomo’s exper ience at a publ ic faci l i ty in Mzuzu illustrates the danger. When his peer educator disappeared following the funding cuts, his ART supply ran out. Desperate, he went to a public hospital.
“The healthcare worker shouted at me in front of others,” Chisomo recalled. “They said, ‘You gay—you are now starting to patronise our hospitals because the whites who suppor ted your ev i l behaviour have stopped?’”
The psychological toll of such encounters is profound. Ar tGlo executi ve di rector Rodger Phiri suggests stigma is now exacerbated by the removal of financial incentives for healthcare workers.
“In the past, health workers we r e t r a i n e d a n d g i v en a l lowances to provide KP-friendly care,” Phiri said. “Now, they see no benefit in assisting LGBTIQ people. The funding is cut—no training, no incentives. This exposes a core flaw: we created incentive-driven care instead of a sustainable, needs-driven model.”
Perhaps the most alarming cons e q u e n c e o f t h e a i d withdrawal is what activ ists describe as an “open season” on LGBTQ+ individuals. Trapence reports a direct correlation between funding cuts and a spike in physical and online violence.
“Th e fundi ng cu t i t sel f increased v iol ence against the LGBTI community,” he said. “We have seen a rise in discriminatory language and attacks, especially on digital platforms and social media.”
In Mangochi, the closure of the local DIC coincided with a surge in gender-based violence. Without a safe space to report abuse or access counselling, many victims simply vanish. One client descr ibed being mocked and laughed at by police officers when attempting to report an assault, targeted for his “feminine” mannerisms.
“The mes sage f rom the general community is clear,” said peer educator John Bongo. “They believe they can now act with impunity because the ‘protective’ organisations are no longer watching.”
Despite the data, donors and government officials continue to ask: How large is this population, really? Trapence responds with certainty.
“It’s a big community. We were reaching 10 000 individuals a year. Statistics show it represents between 3 and 5 percent of the total population.”
In a country of nearly 20 million people, that equates to hundreds of thousands of citizens being pushed out of the healthcare system.
Integration has failed in large part because of a training deficit bordering on the absurd. In Mzuzu, more than 200 clients were transferred to a public hospital where, out of 100 staff members, only five had received sensitivity training. As a result, fewer than 10 percent of those clients continue to seek care.
A flicker of resilience
Amid systemic collapse, what remains is the dedication of individuals who refuse to abandon their community. Yamikani Samala, a peer educator, now works as a volunteer. Without a salary or motorbike, he walks the streets of Mzuzu checking on former clients. Often, he collects their health passports and collects medication on their behalf so they do not have to endure abuse from healthcare workers.
“I do this because I care,” Samala said. “It’s not just about medication—it’s about showing them they are not alone. If I stop, some of these boys will die.”
But volunteers cannot carry this burden alone. As Gift Trapence continues his months-long search for new funding, the “living dead” like Chisomo remain in limbo.
“I just wish for a day when I can walk into a healthcare facility without fear,” Chisomo said. “Where I can be treated with dignity. Is that too much to ask from the world?”
