On January 24, 2025, the administration of Donald Trump shut down the Washington office of USAID (the United States Agency for International Development) and froze all foreign aid funding. This move—part of the “America First” policy—resulted in the suspension of programs in health, education, economic development, and humanitarian aid that had been essential to millions of people worldwide.

A Global Blow to Vulnerable Communities

USAID was one of the largest donors supporting LGBTIQ+ communities and HIV programs in countries where domestic assistance is nearly nonexistent. In a world where trans people and those living with HIV are already marginalized, the loss of such support could prove devastating.

USAID had been a key partner in providing access to medication, testing, and community support. Without it, vulnerable groups now face even greater uncertainty.

According to the Associated Press, “Sub-Saharan Africa could be the hardest-hit region during this freeze in foreign aid. The U.S. provided more than $6.5 billion in humanitarian assistance to the region last year. HIV patients in Africa who arrived at clinics funded by a renowned American program—one that helped curb the global AIDS epidemic in the 1980s—found the doors closed.”

The Associated Press also reports that the effects are already being felt in Latin America. In Mexico, one of the busiest migrant shelters in the country’s south has lost its only doctor. A mental health program for LGBTIQ+ youth fleeing Venezuela was shut down. In Colombia, Costa Rica, Ecuador, and Guatemala, so-called “Safe Mobility Offices”—where migrants could apply for legal entry to the U.S.—have been closed.

Humanitarian organizations are still trying to assess the full scale of the damage: how many thousands of programs have been shut down and how many workers have been laid off or placed on unpaid leave due to the funding freeze.

Stephan Klingebiel, Director of the German Institute for Development and Sustainability, warns:
“About a quarter of U.S. development cooperation spending goes to the health sector. In Nepal, up to 600,000 children receive vitamin B through these programs. Reports are already coming in that all U.S.-funded projects there have stopped, forcing many local NGOs to immediately cease their work. This affects efforts to combat deadly diseases such as malaria, cholera, measles, and HIV—especially in Africa. It will also have consequences for emergency medical aid in the Global South, refugee assistance, and local economic support.”

What Does This Mean for Marginalized Groups in North Macedonia?

Like many countries in the region, North Macedonia relied on USAID support for both governmental and nongovernmental programs—strengthening institutions, supporting civil society, and advancing initiatives in healthcare, education, and economic development.

According to USAID’s official website, the agency assisted North Macedonia in building competent, transparent, and participatory governance systems to accelerate integration into NATO and the EU. In the long term, USAID aimed to help the country develop sustainable domestic funding mechanisms for its own progress.

With this decision, LGBTIQ+ organizations and HIV prevention programs now face severe financial challenges. Affected groups include youth-focused and community-based organizations such as TransformA, which has provided free psychological support, legal assistance, and advocacy for the trans community in North Macedonia. USAID played a crucial role in enabling many of these programs. Without it, organizations will need to seek alternative sources of funding—or risk scaling back or halting their work entirely.

Don’t Let the Marginalized Be Left to Die

This is a moment when governments must take responsibility. The loss of foreign aid cannot be used as an excuse to abandon those who are most vulnerable. LGBTIQ+ people and those living with HIV must not be left without support.

We call on the authorities in North Macedonia and across the region—as well as the international community—to find ways to compensate for the lost funding and protect the lives of their citizens. Marginalized communities must not become victims of the political games of global powers.

As activists warned in a Reuters report, “If governments do not take responsibility, this will be a death sentence for many people who depended on this aid.”

Now more than ever, solidarity and local action are essential. We cannot allow the lives of the most vulnerable to be left to chance.