美国政府2025年1月冻结USAID资金后，全球超过28万名援助工作者失业[1][2]，其中尼泊尔约35000名援助工作者受到影响[1]。在当地保守的社会环境和就业歧视下，约100名LGBTQ+援助工作者因无法找到工作而被迫从事性工作以维持生计[1][2]。
这些失业人员中许多曾在HIV防治领域工作。专业组织蓝钻石协会85%的资金来自USAID，失去了1200名PrEP用户和262名工作人员[1]。该组织的前员工中，35%-45%转向了性工作[1]。
接受采访的15名前援助工作者现已从事性工作，他们承认了其中的风险，但表示看不到其他出路[1]。一位名叫Rubi Lama的工作者曾通过援助工作月收入30000尼泊尔卢比（约200美元），如今通过性工作每晚仅能获得1600卢比（约10.50美元）[1]。
这些转向性工作的前援助工作者面临严重的人身安全威胁。接受采访者几乎无一幸免地遭遇过暴力，包括强奸事件[2]。援助工作者描述称自己"遭遇暴力""几乎每周被虐待""经历强奸"[1]。多数因雇主发现其变性身份而被拒录[2]，被迫进行无保护性行为[2]，警察骚扰和暴力也是常见现象[2]。
美国援助的削减还影响了整个尼泊尔的公共卫生。HIV检测在高感染率国家下降22%，部分地区的安全套资金被削减超90%[1]，HIV防治药物的可及性也随之下降[2]。
Following the U.S. State Department's freeze of USAID funds in January 2025, Nepal's aid sector has faced a severe employment crisis [1]. The funding halt resulted in the dismissal of approximately 35,000 aid workers in Nepal, part of a global reduction affecting over 281,000 positions, of which only 23,000 were American jobs [1].
The consequences have been particularly dire for LGBTQ+ aid workers. Approximately 100 members of this community have turned to sex work to survive [1][2]. Many of these individuals previously worked in HIV prevention initiatives. The Blue Diamond Society, a major AIDS service organization, depended on USAID for 85% of its funding and has lost 262 staff members, along with 1,200 clients enrolled in its PrEP program [1]. Between 35% and 45% of the organization's former employees have entered sex work [1].
Among those interviewed, the economic desperation is stark. One former worker, Rubi Lama, previously earned 30,000 Nepali rupees—approximately $200—per month as an aid worker, but now earns only 1,600 rupees, roughly $10.50, per night through sex work [1]. All 15 aid workers interviewed acknowledged the risks they now face but saw no alternative path forward [1].
The shift into sex work has exposed these vulnerable workers to severe dangers. Nearly all interviewed former aid workers have experienced violence, including gang rape [2]. Many face employer discrimination after their transgender identity is discovered [2]. Police harassment and brutality are commonplace [2], and workers report being coerced into unprotected sexual encounters [2].
The public health consequences extend beyond individual workers. HIV testing rates in high-prevalence countries have declined by 22%, while condom distribution funding has been cut by over 90% in some regions [1]. The reduction in U.S. aid has also decreased the availability of HIV prevention medications in Nepal [2].