After the Trump administration’s dismantling of foreign aid, the impacts are felt in unexpected places — including Panama City, where vulnerable populations are left reeling. As a result of funding cuts, organizations working to provide HIV and health care services to those in need are struggling to stay afloat.
PANAMA CITY — After the Trump administration made cuts to the U.S. Agency for International Development (USAID) and PEPFAR — the U.S. President’s Emergency Plan For AIDS Relief — many relief organizations have been left with minimal resources to provide services to those in need, especially those affected by HIV or who are in need of sexual or reproductive health services.
In countries like Panama, health providers and aid workers say these cuts are hurting some of the country’s most vulnerable people.
As the last Spanish-speaking country in the Americas to decriminalize same-sex relations in 2008, Panama continues to grapple with widespread homophobia, stigma and discrimination against LGBTQ+ populations. Panama has not legalized same-sex marriage, which would afford greater rights to same-sex couples.
The country has relatively high HIV rates. In a 2023 report, the World Health Organization estimated that nearly 1% of Panama’s population between the ages of 15 and 49 years were living with HIV. That was almost twice as high as neighbors Colombia and Costa Rica. Panama’s most at-risk populations for HIV infection are men who have sex with men, transgender women, sex workers and Indigenous groups.
According to a 2024 report by the U.N. AIDS organization, “the numbers of AIDS-related deaths have decreased by 28% since 2010 overall, but increased among women in Costa Rica, El Salvador, Mexico, Panama, Paraguay and Peru.”
PEPFAR has been a literal lifeline for people in places like Panama. The program has saved millions of lives since it was founded over two decades ago. As the largest donor to global HIV efforts, the U.S.-funded program has been consistently relied on in the fight against HIV.
Yet, with President Donald Trump’s recent executive order pausing all U.S. foreign aid funding, many of PEPFAR’s projects have been stopped. As of March 25, the organization’s congressional reauthorization also expired, despite having enjoyed consistent bipartisan support and reauthorizations since 2008.
Ricardo Beteta Bond, the president of the first lesbian and gay organization founded in Panama — Asociación Hombres y Mujeres Nuevos de Panamá (AHMNP, or “New Men and Women of Panama Association”) — said the organization had to close their clinic due to a lack of funding from global organizations they relied upon, many of which depended heavily on USAID.
They were also set to run three projects this year funded by PEPFAR, focused on HIV prevention, migrant groups and support for those living with HIV and their families. Without the funding, they are no longer certain. Looking at the work his organization can do moving forward, Beteta Bond said “the scene looks bleak.”
Only 16 clinics in Panama offer antiretroviral treatment and, in Beteta Bond’s experience, these clinics are often understaffed and overcrowded with patients, meaning very few people can be seen each day. The frustrations of waiting long hours often discourages vulnerable populations from continuing to seek care at these clinics, Beteta Bond said.
According to the LGBTIQ rights organization Outright International, Panama has no laws against discrimination on sexual orientation or gender identity. Health providers say with so much stigma around these communities, many struggle to seek care.
At AHMNP, everyone who works there is a member of the LGBTQ+ population, meaning those who visit them can feel safe and know that this is their space, Beteta Bond said. “We have worked very, very hard to do that.”
Now, without funding, Beteta Bond doesn’t know where the people they’ve helped will be able to turn.
“This space is free for migrant groups,” Beteta Bond said, “Students come here, people who are unemployed, and poor people — Indigenous people, lesbians, sex workers come here.”
According to Natasha Dormoi Eluf — the country coordinator for the Panama branch of the global nonprofit AIDS Healthcare Foundation — the law strictly regulates who can perform HIV testing, as any blood-based medical procedure must be done by a certified lab technician.
However, without funding, the cost of providing one through organizations like AHMNP is simply not feasible.
This creates more barriers for vulnerable populations seeking care, as delays or referrals in HIV testing can discourage individuals — particularly those already hesitant to get tested — from continuing to seek help, further cutting into HIV prevention.
Unable to afford a technician, Beteta Bond had to throw away over 5,000 HIV prevention kits after they expired. Now, the only services he can provide are free contraceptives and lube received through donations.
This situation is particularly problematic as sexually transmitted diseases have been appearing in Panama more frequently than before, according to Dr. Nicolasa Terreros Barrios, rector at the Specialized University of the Americas (UDELAS). She said their increase is largely due to deficiencies in the country’s preventative health care services and public policies, as well as a lack of sexual education and comprehensive educational programs.
“Panama faces a serious problem, especially regarding these sexually transmitted diseases,” Barrios said. “The Panamanian state’s public policies aimed at addressing these kinds of situations have been largely neglected.”
The Ministry of Health of the Republic of Panama (MINSA) did not respond to a request for comment about what federal plans may be implemented to further address this issue amidst global cuts to foreign aid.
However, a March impact report from UN AIDS said the Ministry of Health had stepped in to re-establish distribution of preventive anti-infection drugs, also known as PrEP or pre-exposure prophylaxis, to key populations after delays because of PEPFAR funding uncertainty.
For high-risk populations, the cuts in funding and delay or stoppage of services raises major concerns, especially amid global funding cuts.
A representative of PLAPERTS, the Latin American Platform of People who Practice Sex Work, who asked not to be identified by name due to her profession, said many Panamanian clinics focused specifically on supporting the country’s most vulnerable populations have been closed due to these cuts.
She said there is significant uncertainty in how those people will continue to access HIV testing, particularly sex workers.
Related story
While prostitution is legal in Panama, many sex workers remain unregistered, leading to frequent abuse from authorities, she said. Due to high registration costs, including costs of a mandatory photo ID card, and required testing at MINSA health centers on a frequent basis, it can be simply unfeasible for many to register.
A positive HIV result can also lead to “revocation of registration and deportation for non-Panamanian female sex workers with a work visa,” according to a study published in a BMJ medical journal.
As a sex worker herself, the PLAPERTS representative said she has witnessed extreme violence and discrimination in the industry — and as a trans woman, she faces these risks to an even greater extent.
Once these clinics, “spaces free of discrimination [and] free of stigma,” closed, she said few resources remain for the country’s unregistered sex workers to access testing for sexually transmitted infections or preventive medications like PrEP.
Asociación Viviendo Positivamente is an NGO in Panama that focuses on preventing HIV and supporting people who test positive. The organization helps people get tested and links those in need with support groups and the country’s health care system under MINSA.
Since it was founded two decades ago, the NGO has dedicated its work to empowering and helping those who feel they can’t speak up about what they’re going through due to stigma and discrimination, while removing these factors from the information they provide on HIV.
Dayra Garcia, the executive director of the organization, said their programs relied heavily on support from external cooperation agencies backed by the U.S. government. Now, the work of these agencies is paralyzed, and Asociación Viviendo Positivamente is confronted with how to continue operating.
She said one of their most recent projects, to be accomplished through USAID, had also been suspended. With so few resources and no governmental support, they’ve turned their efforts to local fundraising campaigns.
The whole country has felt the shift.
“Everything has come to a halt, not just for us as an organization, but also for the state, for the Ministry of Health, because many programs were connected to those cooperation agencies, and now everything has been left adrift,” Garcia said. “No one knows what’s going to happen — it’s going to be hard for the government itself to keep moving forward without international support.”
Eugenia Flores Millender — the co-founder and co-director of Florida State University’s Center of Population Sciences for Health Empowerment — said any humanitarian aid facilitated through NGOs can be impacted by Trump’s orders, as they’re all meant to receive some level of support from international policies.
Asociación Nuevos Horizontes is another NGO in Panama struggling to maintain its work under current conditions. Their organization advocates for the human rights of the country’s LGBTQ+ populations, with a focus on STI/HIV prevention through education, political advocacy and joint projects. The group also works frequently with migrant populations.
According to Juan Alonzo, the organization’s president, migrants with chronic illnesses like HIV often face the most barriers to medical care due to fears over their status and widespread stigma.
Related story
While Panama has advanced in providing migrants with antiretroviral treatment, Alonzo said, “what’s weakening the response now is the USAID funding cuts — the government wasn’t prepared to fill this gap and now lacks the resources to meet migrant health care demands.”
Alonzo said his organization received 60% of their funding from USAID.
With this gone, the group can no longer sustain many of their programs — particularly those supporting the country’s most vulnerable migrant populations, including individuals living with HIV, women and LGBTQ+ populations.
Now, the organization is completely self-funded and was working to stay afloat through May with things like food and yard sales, bingo, auctions and raffle events. While time will tell if they remain operational, Alonzo has not given up on seeking external funding while also continuing to seek new allies.
“As USAID funds dry up, we must act to ensure national resources address migrant needs. It’s an international obligation,” he said.
Zingwa, a migrant in Panama who asked that his full name not be shared due to concerns over his safety and immigration status, has been particularly impacted by Trump’s policies.
After fleeing his home country of Cameroon due to political persecution, he attempted to enter the U.S. but was quickly deported to Panama City. Along with many others, he was detained in a hotel before being transported to a camp in the Darién region and then back to a hotel in Panama City. During this process, Zingwa struggled to access his life-saving HIV medication.
After detainment in the U.S., he said his phone and other personal belongings were stripped away. His medication was also taken from him, he said, as he was unable to verify its name to immigration officials. Without his phone, he also couldn’t call his doctor to confirm the name.
On a path many migrants follow, Zingwa first arrived in Brazil from his home country and made his way up to the U.S. by crossing through the Darién Gap — a stretch of dangerous jungle that connects Colombia to Panama, the only overland route between South and North America. As Zingwa traversed rivers and streams in the jungle, the name of his medications was wiped away, he said.
Having taken them for four years, Zingwa quickly began to feel sick when he couldn’t access them, developing a cough and headache. When he arrived in the Darién camp, he was able to see a doctor and regain access to the medication, but its availability isn’t guaranteed. Without permanent citizenship or residency, he remains in an especially precarious situation.
“HIV care may be subsidized or free in the public sector – despite being free, there’s still a lot of stigma and there are ways that people are disincentivized, even as residents of [Panama], to seek out that care,” said Casey Xavier Hall — the assistant director at FSU’s Center of Population Sciences for Health Empowerment. On top of this, he added, migrants face especially difficult hurdles.
Zingwa never wanted to leave his home country but he said he had no other choice when the government tried to kill him. He felt that the U.S. was the only place he could be safe from their persecution, and that he would rather die there than be killed at his government’s hands. Since he fled, he has been unable to contact his family and wife back in Cameroon, and neither knows whether the other may still be alive.
His future and living situation remain uncertain, underscoring the major challenges of accessing health care amid unexpected and forced displacement, something many migrants experience. Zingwa’s turbulent journey seems far from over.
“I don’t know [what] I’m going to do if my drug is finished,” he said. “I may lose my life.”
Republish our articles for free, online or in print, under a Creative Commons license.
