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12，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12。
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 12. 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.
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