Trump’s Foreign Aid Freeze Leaves South Africa’s Trans Community in Crisis

The cruel reality of international relations is that a former reality TV star can wield the power to sign a document with a smug flourish and, in doing so, cut millions of people off from lifesaving healthcare.

On January 20, 2025, global humanitarian aid was plunged into crisis when President Donald Trump, just days into his second term, issued an executive order freezing all US foreign aid pending a 90-day review.

Stop-work orders were immediately sent to all organisations dependent on funding from the President’s Emergency Plan for AIDS Relief (PEPFAR), throughs agencies like the Centers for Disease Control and Prevention (CDC) and the United States Agency for International Development (USAID).

In South Africa, where PEPFAR provided $332.6 million in aid in 2024, this sudden freeze had devastating consequences. With 8.5 million people living with HIV, the disruption created critical gaps in healthcare services. Clinics like Ivan Toms, a cornerstone in HIV/AIDS treatment and prevention for gay, bi and other men who have sex with men (MSM) in Cape Town, were forced to shut down, leaving millions without essential care.

However, an underreported effect of the disruption in aid is that many transgender individuals in South Africa are left scrambling to figure out short-term healthcare solutions as clinics providing HIV and gender-affirming healthcare, such as the WITS RHI Clinic, abruptly had to issue a statement that 28 January would be the last day people could pick up their medication from the clinic.

With aid funding frozen, those unable to stockpile their medications – particularly those from rural areas – faced an impossible choice: turn to South Africa’s woefully under-resourced and often hostile public healthcare system or seek out expensive private providers.

For many, there is no real choice at all. Rose, a trans woman who has relied on WITS RHI for nearly four years, explains: “I can’t go and get my script renewed now without shelling out money I don’t have for private GP visits or exorbitant pathology costs.” The public system offers little refuge, as it remains plagued by discrimination. “The public clinics don’t even treat you like a person,” Rose adds.

Jason, a trans man, echoes this sentiment. “Anyone on HRT (hormone replacement therapy) treatment plans will have no option but to use privately funded options,” he says, highlighting the dire situation faced by South Africa’s trans community.

Across online platforms, confusion and despair are mounting, as transgender individuals scramble to secure alternative care. The South African healthcare system has long failed to meet their needs, and this new crisis pushes them even further to the margins.

But the question remains: why these cuts? And why now?

Trump’s executive order suspending foreign aid is not an isolated act of fiscal conservatism—it is a direct extension of his broader anti-trans agenda. In the same week, another executive order reinforced his administration’s stance that there are only two sexes: male and female.

From its opening lines, the order reads as if it was lifted directly from Genspect’s playbook—an organisation closely tied to the US lobbying group Society of Evidence-Based Gender Medicine, known for opposing trans rights. Phrases like “men self-identifying as women” make it clear that this is yet another attempt to erase trans identities from public policy.

Buried further in the order is a mandate requiring the Secretaries of State and other government agencies to revise identification policies, ensuring that legal documents can only reflect a person’s assigned sex at birth.

This directive signals a complete reversal of existing protections for trans individuals who have legally updated their gender markers. A directive that Secretary of State Marco Rubio was happy to run with as he directed his staff to halt passport applications that contain a request for an X gender marker or a change of gender. Additionally, White House press secretary Karoline Leavitt told reporters that trans, nonbinary, and intersex people would “have to use their God-given sex, which was decided at birth.”

The suspension of aid, combined with these sweeping policy changes, makes one thing abundantly clear: this is not about fiscal responsibility. The programmes affected by the aid freeze make up less than 1% of the US budget. The financial impact is negligible; the ideological impact is the point. By targeting funding for programmes that support LGBTQ+ and gender-affirming healthcare, Trump is making it clear that so-called “gender ideology” has no place in his vision of American values.

There’s little doubt that should some US-funded programmes be allowed to resume their work after the 90-day review, those providing gender-affirming services to the transgender community will not be among them.

The United States has long wielded foreign aid as a tool of diplomacy, using it to advance strategic interests while simultaneously presenting itself as a defender of human rights. Yet, even as it projects this image abroad, Trump’s administration is actively dismantling protections for marginalised communities at home. The hypocrisy is stark: while the US claims to champion democracy and humanitarian efforts on the world stage, it is simultaneously rolling back human rights within its own borders.

The repercussions of these policies extend far beyond US borders. For trans individuals in South Africa and around the world, the loss of aid isn’t just a political manoeuvre — it’s a direct threat to their survival. While the financial impact is severe, the broader cultural consequences are equally alarming. When a global superpower like the US weaponises its influence to push anti-trans policies, it legitimises and fuels similar sentiments elsewhere.

In South Africa, anti-trans advocates have seized this moment to amplify their rhetoric. On Reddit’s r/downsouth subreddit, users reveled in the aid freeze, arguing that no funds should ever support trans healthcare and drawing false comparisons to mental health conditions.

Meanwhile, pro-Trump South Africans have taken to Instagram, posting reels celebrating the move with slogans like “Trump is making South Africa great again.”

Even within local trans-led initiatives, the backlash has been swift. Emo Night South Africa, an events collective that launched a mutual aid fund for trans healthcare, has been flooded with hostility. In the comment sections, anti-trans voices attempted to frame the aid freeze as an issue of personal responsibility—only to resort to outright transphobia when their arguments fell apart.

Trump’s policies do more than cut off funding—they amplify anti-trans rhetoric globally, further endangering already vulnerable communities. While there are no clear signs that these policies have directly influenced South Africa’s political landscape, the trans community continues to struggle with a failing healthcare system and persistent discrimination. A sluggish, inefficient bureaucracy further compounds these challenges, making even basic identity document changes an uphill battle.

For now, the future is uncertain.

 

Article by Cassandra Roxburgh, a non-binary writer who has written for News24, Mail and Guardian, Minority Africa, and Yes Magazine. When fae isn’t writing about queer issues, fae can be found jumping behind DJ decks as the founder of Emo Night South Africa, trail running, or scaling fake boulders in a climbing gym.

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This article was made possible with the support of the Other Foundation. The views expressed herein do not necessarily represent those of the Other Foundation. www.theotherfoundation.org.

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