At least 24 HIV-positive sex workers in Kenya have died after losing access to treatment and support services following disruptions to US-funded health programmes, according to frontline health workers and sex-worker organisations.
The deaths, confirmed by AFP, have raised concerns over the impact of reduced funding for services targeting key populations, including sex workers. Health workers and NGOs say the number of deaths could be higher, while new HIV infections among sex workers have also increased.
The disruption follows changes to US foreign assistance programmes announced in 2025, which affected organisations providing specialised HIV services. A July 2026 study by the Foundation for AIDS Research (amfAR) found that 73 per cent of PEPFAR-funded organisations providing services to key populations had stopped at least one such service.
The study covered 166 organisations across 46 countries. For years, Kenya has had clinics specifically serving sex workers, providing antiretroviral medicines, condoms and other HIV prevention and treatment services. Many of these facilities have since closed or reduced their operations, according to organisations working with the community.
Kenyan authorities estimate that about 285,000 women are engaged in sex work, with HIV prevalence among them standing at 27.5 per cent. Health experts have warned that reduced access to targeted services could contribute to further infections among sex workers and the wider population.
UNAIDS chief Winnie Byanyima said the disruption was putting previous progress in HIV prevention and treatment at risk. “This is the most serious disruption in the HIV response since the world came together to fight this disease,” she said.
Nearly 1.5 million people, equivalent to 3.2 per cent of Kenya’s population, are living with HIV.
One of those affected was Judy, a 36-year-old sex worker who was diagnosed with HIV in 2017, according to her friend Diana. Judy had been receiving support from the Bar Hostess Empowerment and Support Programme (BHESP), which provided her with medication, condoms and, at times, food at her home in Mathare, Nairobi.
Judy lived in severe financial hardship and sometimes earned as little as Sh50 or Sh100 from sex work or accepted food in exchange for services while supporting her four children. She could not afford transport to attend a BHESP clinic herself.
After BHESP lost funding following the dismantling of USAID programmes and its outreach workers were withdrawn, Judy was left without the support that had helped her access treatment. Sex workers interviewed for the report said many are reluctant to seek care at public hospitals because of stigma associated with sex work and HIV. Judy eventually stopped taking her medication, after which her health deteriorated.
“She had sores… Her skin was so rough,” said Diana.
BHESP said Judy was among three HIV-positive sex workers from Mathare who had died in recent months after stopping treatment. Diana said several others had died in similar circumstances in neighbouring informal settlements. Daisy Kwala, programmes director at BHESP, said the reduction in US-supported services had severely affected the organisation’s work. “The stop-work order from the US administration, for us, is a kill order,” said Kwala.
BHESP operated two centres supported by USAID. The first closed in September 2025, while the second is scheduled to close by the end of September 2026. Of the 14,500 sex workers who received services from the two centres, about 12,000 have since lost contact with BHESP, including 2,300 who were HIV-positive.
Douglas Bosire, head of the National Syndemic Diseases Control Council, said Kenya had made substantial progress in reducing HIV infections with support from international partners. New infections fell from about 110,000 in 2005 to 13,936 in 2025. “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,” he said.
The Sex Workers Outreach Programme (SWOP), which monitors about 45,000 sex workers in Nairobi, recorded a 48 per cent increase in new HIV infections during the first half of 2026 compared with the same period in 2024. Half of its clinics have closed following disruptions to USAID funding.
BHESP reported a 14-fold increase in infection rates at its remaining centre in Roysambu when the same quarter in 2026 was compared with 2024. The organisation said reduced monitoring has also resulted in patients arriving for treatment with more advanced illness 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.
SWOP clinical and research director Dr Joshua Kimani said the developments raised concerns about a possible return to the high levels of HIV infections recorded in the 1990s. “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.”
Bosire said the Government currently has resources to provide 200 million of the estimated 500 million condoms required annually for free distribution. A three-pack costs about Sh100, a price he said many sex workers cannot afford. The impact has also been reported outside Nairobi.
The Coast Sex Workers Alliance said 14 HIV-positive sex workers had died after losing access to treatment in the coastal region. Local sex worker organisations reported at least five additional deaths in western Kenya and two near the Ugandan border.
Dorothy Agalla of the Kisumu Sex Workers Alliance said all 25 USAID-funded clinics serving sex workers in western Kenya had closed. Fewer than 1,000 of the alliance’s 20,000 members are now receiving care at public health facilities.
The US administration has rejected responsibility for the reported deaths. Frank Garcia, its deputy assistant secretary for Africa, said the United States remained a major contributor to HIV research, funding and treatment. The developments come as Kenya and its international health partners face the challenge of maintaining HIV prevention and treatment services while adjusting to changes in external funding and programme delivery.
